Red Cell Distribution Width Is Associated with All-Cause and Cardiovascular Mortality in Patients with Diabetes

Correlation of Albumin, Red Cell Distribution Width and Other Biochemical and Hematological Parameters with Glycated Hemoglobin in Diabetic, Prediabetic and Non-Diabetic Patients

Diabetes mellitus is a chronic metabolic disease that affects more than 10.5% of the world's adult population. Biochemical and hematological parameters, such as albumin (ALB) and red cell distribution width (RDW), have been shown to be altered in diabetic patients. This study aimed to correlate hematological and biochemical parameters with glycated hemoglobin (HbA1c). A total of 777 adults (372 women and 405 men, aged 19-85 years) were divided into three groups: 218 participants with HbA1c < 5.7% (group A: non-diabetic), 226 with HbA1c ≥ 5.7% and <6.5% (group B: prediabetic) and 333 with HbA1c ≥ 6.5% (group C: diabetic). Biochemical and hematological parameters were compared among the three groups. An analysis of variance was performed to determine the correlations of the parameters among the groups. The ALB and sodium (Na) levels were significantly lower in group C than in groups A (ALB: 3.8 g/dL vs. 4.1 g/dL, p < 0.0001, Na: 138.4 mmol/L vs. 139.3 mmol/L, p < 0.001) and B (ALB: 3.8 g/dL vs. 4.0 g/dL, p < 0.0001, Na: 138.4 mmol/L vs. 139.6 mmol/L, p < 0.0001), whereas the RDW-standard deviation (RDW-SD) and urea were increased in group C as compared to group A (RDW: 45.8 vs. 43.9 fL, p < 0.0001, urea: 55.6 mg/dL vs. 38.5 mg/dL, p < 0.0001). The mean platelet volume (MPV) was increased in group C as compared to group A (9.3 fL vs. 9.1 fL, p < 0.05, respectively). Τhe increase in RDW-SD in group A as compared to B and C demonstrates the impact of hyperglycemia on red blood cells. Albumin and RDW might improve risk assessment for the development of diabetes. These results highlight the potential role of these parameters as an indication for prediabetes that would alert for measurement of HbA1c.

The Prognostic Significance of Red Cell Distribution Width in Cardiac Surgery: A Systematic Review and Meta-Analysis

RED CELL DISTRIBUTION WIDTH (RDW) is a routinely available biomarker of likely erythropoietic dysfunction, which may be associated with adverse outcomes after cardiac surgery. This systematic review and meta-analysis aimed to clarify the prognostic value of RDW in patients undergoing cardiac surgery. The authors searched MEDLINE, Embase, and the Cochrane Library from inception to May 10, 2022 for studies investigating the association between elevated RDW (as defined by the authors of included studies) and adverse outcomes after cardiac surgery. Herein, the authors extracted maximally adjusted hazard ratios (HRs) and odds ratios (ORs) with associated CIs, and pooled them using random-effects inverse- variance modeling. The authors explored interstudy heterogeneity using metaregression. The authors included 26 studies involving 48,092 patients who had undergone cardiac surgery. Elevated preoperative RDW was associated with long-term mortality (pooled HR 1.63, 95% CI 1.05-2.52), short-term mortality (pooled OR 2.16, 95% CI 1.21-3.87), acute kidney injury (AKI; pooled OR 1.30, 95% CI 1.19-1.41) and postoperative atrial fibrillation (POAF; pooled OR 1.44, 95% CI 1.05-1.96). Some studies suggested a significant association between preoperative RDW elevation and neurologic complications; however, their number was insufficient for meta-analysis. The postoperative RDW levels were less consistently reported and could not be meta-analyzed. In conclusion, the authors found that elevated preoperative RDW was associated with increased short- and long-term mortality, POAF, and AKI after cardiac surgery. Further research is needed to investigate its role in the risk stratification of patients undergoing cardiac surgery.

Relation of Red Cell Distribution Width to Glucose Metabolism and Adverse Long-Term Prognosis in Patients with Acute Coronary Syndrome

INTRODUCTION

Red cell distribution width (RDW) reflects the heterogeneity of red blood cell size. However, few studies examined whether RDW is related to glucose metabolism indices, such as fasting blood glucose (FBG) and hemoglobin A1c (HbA1c), diabetic mellitus (DM) state or long-term outcomes of acute coronary syndrome (ACS) patients.

METHODS AND RESULTS

A total of 448 consecutive patients with ACS were enrolled in this study. All patients were followed up for major cardiovascular adverse events (MACEs), and the mean follow-up was 952 days. Linear regression analysis showed that RDW inversely correlated with FBG but not HbA1c or DM. Kaplan-Meier survival curve analysis demonstrated that higher RDW levels were significantly positively associated with MACEs in the whole study population and the ACS patients with high FBG but not the low FBG group. Cox multivariate regression analysis revealed the independent function of RDW on MACEs in all ACS patients and ACS patients with high FBG. The receiver operating characteristic (ROC) curve demonstrated the optimal cutoff value of RDW for MACEs.

CONCLUSION

We first reported that higher RDW was associated with decreased FBG but not HbA1c or DM and an increased risk of MACEs in patients with ACS. This relationship was also found in ACS patients with higher FBG levels but not in ACS patients with lower FBG.

Associations of Nutritional, Environmental, and Metabolic Biomarkers with Diabetes-Related Mortality in U.S. Adults: The Third National Health and Nutrition Examination Surveys between 1988-1994 and 2016

Background: Nutritional, environmental, and metabolic status may play a role in affecting the progression and prognosis of type 2 diabetes. However, results in identifying prognostic biomarkers among diabetic patients have been inconsistent and inconclusive. We aimed to evaluate the associations of nutritional, environmental, and metabolic status with disease progression and prognosis among diabetic patients. Methods: In a nationally representative sample in the NHANES III (The Third National Health and Nutrition Examination Survey, 1988−1994), we analyzed available data on 44 biomarkers among 2113 diabetic patients aged 20 to 90 years (mean age: 58.2 years) with mortality data followed up through 2016. A panel of 44 biomarkers from blood and urine specimens available from NHANES III were included in this study and the main outcomes as well as the measures are mortalities from all-causes. We performed weighted logistic regression analyses after controlling potential confounders. To assess incremental prognostic values of promising biomarkers beyond traditional risk factors, we compared c-statistics of the adjusted models with and without biomarkers, separately. Results: In total, 1387 (65.2%) deaths were documented between 1988 and 2016. We observed an increased risk of all-cause mortality associated with higher levels of serum C-reactive protein (p for trend = 0.0004), thyroid stimulating hormone (p for trend = 0.04), lactate dehydrogenase (p for trend = 0.02), gamma glutamyl transferase (p for trend = 0.02), and plasma fibrinogen (p for trend = 0.03), and urine albumin (p for trend < 0.0001). In contrast, higher levels of serum sodium (p for trend = 0.005), alpha carotene (p for trend = 0.006), and albumin (p for trend = 0.005) were associated with a decreased risk of all-cause mortality. In addition, these significant associations were not modified by age, sex, or race. Inclusion of thyroid stimulating hormone (p = 0.03), fibrinogen (p = 0.01), and urine albumin (p < 0.0001), separately, modestly improved the discriminatory ability for predicting all-cause mortality among diabetic patients. Conclusions: Our nationwide study findings provide strong evidence that some nutritional, environmental, and metabolic biomarkers were significant predictors of all-cause mortality among diabetic patients and may have potential clinical value for improving stratification of mortality risk.

Incorporation of Laboratory Test Biomarkers Into Dual Antiplatelet Therapy Score Improves Prediction of Ischemic and Bleeding Events in Post-percutaneous Coronary Intervention Patients

This study aimed to examine the performance of the dual antiplatelet therapy (DAPT) score in two retrospective cohorts of post-percutaneous coronary intervention (PCI) patients and to explore whether incorporating additional biomarkers could further improve the predictive power of the DAPT score. In a retrospective derivation cohort of 4,798 PCI patients, the validity of DAPT score for stratifying ischemic/bleeding risks was explored. Then, the association between the baseline status of 54 laboratory test biomarkers and ischemic/bleeding events was revealed while adjusting for the DAPT score. Combinations of individual laboratory test biomarkers that were significantly associated with ischemic/bleeding events were explored to identify the ones that improved discrimination of ischemic and bleeding events when incorporated into DAPT score. Finally, the impact of the combination of biomarkers with DAPT score was validated in an independent retrospective validation cohort of 1,916 PCI patients. Patients with a high DAPT score (DAPT score ≥ 2) had significantly higher risk of ischemic events and significantly lower risk of bleeding than patients with a low DAPT score (DAPT score < 2). Moreover, the addition of aspartate aminotransferase (AST) and red cell distribution width CV (RDW-CV) into the DAPT score further improved discrimination of ischemia and bleeding. Furthermore, the incremental predictive value of AST + RDW-CV maintained with measurements was updated at post-baseline time points. DAPT score successfully stratified the risks of ischemia/bleeding post PCI in the current cohorts. Incorporation of AST + RDW-CV into the DAPT score further improved prediction for both ischemic and bleeding events.

Red Blood Cell Distribution Width Predicts Myocardial Infarction and Mortality After Vascular Surgery-A Prospective Cohort Study

BACKGROUND

This study aims to investigate the association between preoperative Red blood cell Distribution Width (RDW) and postoperative outcomes, including myocardial infarction (MI), and mortality.

METHODS

A prospective cohort including all patients submitted to elective vascular arterial surgery at a university hospital. The primary and secondary outcomes were 30-day mortality and 30-day MI, respectively.

RESULTS

Atrial fibrillation, chronic kidney disease (CKD), and dependent functional status were more prevalent in deceased patients. After multivariable analysis, age (adjusted OR 1.08, 95% Confidence Interval [1.01-1.15], p = 0.027) and RDW-standard deviation (RDW-SD) (1.08 [1.01-1.16], p = 0.032) remained independent predictors of mortality. Patients with MI had higher rates of diabetes, CKD, dependent functional status, ASA physical status IV, and insulin medication. After multivariable analysis, dependent functional status (4.8 [1.6-15.0], p = 0.007), insulin medication (4.4 [1.5-12.6], p = 0.007) and RDW-SD (1.10 [1.02-1.19], p = 0.020) were independent predictors of MI.

CONCLUSION

RDW-SD independently predicted postoperative MI and mortality, and may provide valuable information for prevention and early management of adverse outcomes.

Improving postpartum hemorrhage risk prediction using longitudinal electronic medical records

OBJECTIVE

Postpartum hemorrhage (PPH) remains a leading cause of preventable maternal mortality in the United States. We sought to develop a novel risk assessment tool and compare its accuracy to tools used in current practice.

MATERIALS AND METHODS

We used a PPH digital phenotype that we developed and validated previously to identify 6639 PPH deliveries from our delivery cohort (N = 70 948). Using a vast array of known and potential risk factors extracted from electronic medical records available prior to delivery, we trained a gradient boosting model in a subset of our cohort. In a held-out test sample, we compared performance of our model with 3 clinical risk-assessment tools and 1 previously published model.

RESULTS

Our 24-feature model achieved an area under the receiver-operating characteristic curve (AUROC) of 0.71 (95% confidence interval [CI], 0.69-0.72), higher than all other tools (research-based AUROC, 0.67 [95% CI, 0.66-0.69]; clinical AUROCs, 0.55 [95% CI, 0.54-0.56] to 0.61 [95% CI, 0.59-0.62]). Five features were novel, including red blood cell indices and infection markers measured upon admission. Additionally, we identified inflection points for vital signs and labs where risk rose substantially. Most notably, patients with median intrapartum systolic blood pressure above 132 mm Hg had an 11% (95% CI, 8%-13%) median increase in relative risk for PPH.

CONCLUSIONS

We developed a novel approach for predicting PPH and identified clinical feature thresholds that can guide intrapartum monitoring for PPH risk. These results suggest that our model is an excellent candidate for prospective evaluation and could ultimately reduce PPH morbidity and mortality through early detection and prevention.

Association between Red Blood Cell Distribution Width and Diabetic Retinopathy: A 5-Year Retrospective Case-Control Study

Purpose

Red blood cell distribution width (RDW) has been regarded as an emerging biomarker of the general population and cardiovascular disease. In this study, we aimed to evaluate the association between RDW and diabetic retinopathy (DR).

Methods

This case-control study included 167 patients with DR, 131 patients with diabetes mellitus (DM), and 170 age- and sex-matched healthy controls from April 2014 to May 2019. Demographic data, laboratory parameters, and ocular examinations were collected.

Results

RDW values of the DR group were significantly higher than those of the healthy control (p < 0.001) and DM group (p=0.002). A similar trend was observed when RDW was compared among the 3 groups with respect to age and gender. Logistic regression analysis has shown the OR of RDW was 3.791 (2.33–6.168; p < 0.001) against the control group and was 1.348 (0.997–1.823; p=0.047) against the DM group.

Conclusion

RDW values were significantly elevated in DR patients, and an elevated RDW was associated with an increased incidence of DR in patients with DM.

Red cell distribution width in patients with diabetes and myocardial infarction: An analysis from the EXAMINE trial

AIM

To determine the clinical correlates of increased red blood cell distribution width (RDW), its potential mechanistic association with multiple circulating biomarkers, and its prognostic value in patients with type 2 diabetes (T2D) who had a recent acute coronary syndrome.

METHODS

We used time-updated Cox models applied to patients enrolled in the Examination of Cardiovascular Outcomes with Alogliptin versus Standard of Care (EXAMINE) trial.

RESULTS

A total of 5380 patients were included, the median age was 61 years and 32% were women. Patients with higher RDW were older, more frequently women, with a longer diabetes duration and increased co-morbidities. An RDW of more than 16.1% (both baseline and time-updated) was independently associated with the study primary composite outcome of non-fatal myocardial infarction, non-fatal stroke or cardiovascular death (time-updated adjusted HR = 1.36, 95% CI = 1.16-1.61, p < .001), all-cause death (time-updated adjusted HR = 2.01, 95% CI = 1.60-2.53, p < .001), as well as mortality from non-cardiovascular causes (time-updated adjusted HR = 2.67, 95% CI = 1.72-4.15, p < .001). RDW had a weak-to-moderate correlation with haemoglobin and circulating markers that reflected inflammation, apoptosis, fibrosis and congestion. Alogliptin did not alter RDW values.

CONCLUSIONS

RDW is a marker of disease severity associated with a multitude of poor outcomes, including both cardiovascular and non-cardiovascular death. RDW correlated modestly with inflammatory, pro-apoptotic, pro-fibrotic and congestion markers, and its levels were not affected by alogliptin during the course of the trial.

Red Blood Cell Distribution Width (RDW) Correlates to the Anatomical Location of Colorectal Cancer. Implications for Clinical Use

PURPOSE

The pathological, clinical, and therapeutic features of colorectal cancer (CRC) depend on its anatomical localization. We investigated possible associations between the red blood cell distribution width (RDW) and CRC localization.

METHODS

Two-hundred eighty-eight consecutive patients with CRC were retrospectively studied. Demographic, clinical, pathological and laboratory data were retrieved from clinical records and reports.

RESULTS

Median RDW values were significantly higher in patients with right-sided CRC when compared to those with CRC in other localizations (16.2, IQR: 14.5-20.0 vs 13.8, IQR: 13.0-16.1, p < 0.0001). Anisocytosis was statistically associated to haemoglobin (Hb), mean haemoglobin concentration (MHC), and mean corpuscular volume (MCV) values in all the patient groups examined. A cut-off value of 14.3% was associated with right-sided localization with sensitivity and specificity of 76.3% and 64.2%, respectively (AUC 0.71).

CONCLUSION

Median RDW values were significantly higher in right-sided CRC when compared to other tumour locations, and may represent an additional marker for differential diagnosis.

High red blood cell distribution width is associated with a risk of short-term mortality in hospitalized surgical, but not clinical patients

BACKGROUND & AIMS

The distribution width of red blood cells (RDW) is a known factor risk for mortality. However, the association between high RDW and short-term mortality in surgical patients is poorly understood. The aim of this study was to evaluate the association of high RDW with all-cause in-hospital mortality, in surgical and non-surgical patients.

METHODS

A retrospective study was performed with patients aged 18 years or older, hospitalized in Clinical Medical and Surgery wards, using adjustments based on a conceptual model. Cox regression was used to determine the independent predictors of in-hospital mortality. The RDW cutoff value was 13.6%.

RESULTS

Of the 2923 patients, 46.1% were over 60 years old, 58.7% were male and 4.7% died. The area under the ROC curve was 0.677 (CI 95%: 0.619-0.712). RDW was associated with an adjusted risk for all-cause in-hospital mortality in surgical (HR 1.17 - CI 95%: 1.03-1.32), but not in clinical patients. For every 1% increase in RDW, the risk of all-cause hospital death in surgical patients increased by 17%. RDW ≥13.6% was associated with an adjusted risk of all cause in-hospital mortality in surgical (HR 2.65 - 95%CI: 1.22-5.73), but not in clinical patients.

CONCLUSIONS

High RDW was associated with a risk of in-hospital mortality independent of age, sex, hemoglobin level, multimorbidity, nutritional status and immunological condition. We therefore recommend the use of RDW as a possible marker of mortality risk in clinical practice in surgical patients.

Association of the mean platelet volume and red cell distribution width with dipper and non-dipper blood pressure in prehypertensive non-smokers

OBJECTIVE

Absence of nocturnal blood pressure (BP) dipping is associated with poor health outcomes, including increased mortality. Non-dipper BP seems to be a predictor of cardiovascular damage in hypertensive patients. The aim of this study was to investigate the association of the mean platelet volume (MPV) and red cell distribution width (RDW) with nocturnal dipping/non dipping status in newly diagnosed and untreated prehypertensive non-smokers, using ambulatory BP monitoring.

RESULTS

Twenty-eight patients (15 males) in the dipper group and 24 patients (11 males) in the non-dipper group were evaluated in this study. The age of patients was 41.64 ± 15.01 and 37.96 ± 15.08 years in the dipper and non-dipper groups, respectively. The rate of nocturnal systolic BP drop in the dipper and non-dipper groups was 13.79 ± 3.35% (10.20-22.10) and 5.96 ± 2.87% (1.10-9.30) (P < 0.001), respectively. Also, the mean rate of nocturnal diastolic BP drop in the dipper and non-dipper groups was 17.02 ± 5.09% (10.30-26.90) and 6.19 ± 2.75% (1.20-9.70) (P < 0.001), respectively. RDW and MPV were significantly higher in non-dipper patients than dipper patients (P = 0.001 and P = 0.012, respectively). Bivariate analysis revealed that MPV was inversely correlated with the nocturnal systolic BP drop (P = 0.005, r = - 0.385). Furthermore, RDW was inversely correlated with systolic BP drop (P = 0.019, r = - 0.324).

Baseline Red Blood Cell Distribution Width as a Predictor of Stroke Occurrence and Outcome: A Comprehensive Meta-Analysis of 31 Studies

Background: Red blood cell distribution width (RDW) may be a potential biomarker of inflammation in patients with stroke. Elevated RDW is associated with higher incidence of stroke, unfavorable functional outcome, and increased mortality, although results are inconsistent in the reported literature. This study aims to evaluate the predictive power of RDW regarding stroke occurrence and outcome. Methods: A thorough literature search was conducted utilizing the PubMed Central (PMC) and EMBASE databases to identify studies up to May 2019. Data from these studies were pooled, and combined odds ratios/risk ratios (ORs/RRs) were estimated for the risk of stroke, functional outcome, and mortality. A subgroup analysis was also performed to explore heterogeneity in terms of population status, demographic factors (age, gender distribution, and country), and vascular risk factors (hypertension, diabetes mellitus, and current smoking). Results: A total of 31 studies with 3,487,896 patients were included in the analysis. Elevated RDW was found to be a risk factor in ischemic stroke (OR/RR 1.528; 95% confidence interval [CI] = 1.372-1.703), whereas combined OR in subarachnoid hemorrhage (SAH) was not statistically significant (OR/RR 1.835; 95% CI = 0.888-3.792). Elevated RDW posed increased risk in populations with conventionally higher risk of stroke, such as atrial fibrillation (AF) (OR/RR 1.292; 95% CI = 1.107-1.508) and diabetes mellitus (OR/RR 2.101; 95% CI = 1.488-2.968), and in community cohorts (OR/RR 1.245; 95% CI = 1.216-1.275). In addition, higher RDW was associated with unfavorable functional outcome, either at discharge (OR/RR 1.220; 95% CI = 1.070-1.39) or at 90 days (OR/RR 1.277; 95% CI = 1.155-1.413). Higher mortality was found in patients with increased RDW (OR/RR 1.278; 95% CI = 1.221-1.337), independent of demographic factors (age, gender distribution, and country). Conclusions: Baseline RDW should be integrated into clinical practice as a predictor of ischemic stroke occurrence and outcome. Future studies should also explore the dynamic change of RDW in post-stroke patients to evaluate the clinical significance of RDW and its impact on the inflammatory state of ischemic stroke.

Correlation of Hemoglobin A1c with Red Cell Width Distribution and Other Parameters of Red Blood Cells in Type II Diabetes Mellitus

Objective

To determine the correlation of glycated hemoglobin (HbA1c) with red cell width (RDW) and other analytic parameters of red blood cells (RBCs) in type II diabetic patients.

Design

Cross-sectional analytical study.

Place and duration of the study

Al-Tibri Medical College and Hospital Karachi; from July 2017 to January 2018.

Patients and methods

This cross-sectional study was conducted on diagnosed type II diabetic patients visiting the outpatient department of medicine at Al-Tibri Medical College Hospital from July 2017 to January 2018. Diabetes mellitus was diagnosed according to American Diabetes Association (ADA) guidelines. After taking consent and conducting a clinical assessment (include history and physical examination), laboratory tests, such as fasting blood glucose, random blood glucose, complete blood count (CBC), and HbA1c, were collected on proforma.

Results

A total of 119 patients were eligible for the study with a mean age of 48.63±12.462 (range 24-76) years; among those, males were 74 (62.2%) and females were 45 (37.8%). The mean duration of diabetes mellitus (DM) was 6.735±3.759 (range 1-20) years. The mean hemoglobin of patients was 11.59±1.315 gm/dl. The mean corpuscular volume (MCV) was 76.65±11.121 fl and the mean RDW was found to be 18.287±4.352, with the highest value of 30.20. The mean MCH was 30.223±23.873 pg, with the highest value of 38.4 pg. The mean cell hemoglobin concentration (MCHC) was 28.214±4.7498 mg/dl.

The HbA1c of the study population was found to be moderately uncontrolled and the mean HbA1c was 8.278±5.015%, with the highest value of 16.2%. The mean fasting blood sugar was 158±39.50 mg/dl while the mean random blood sugar was 236±57.390 mg/dl.

The correlation of HbA1c with RDW turned out to be significant statistically (p-0.035) while other RBCs and/or hematological parameters, such as MCV, hemoglobin, and platelets, revealed no significant correlation.

Conclusion

The study highlighted that RDW has a significant correlation with HbA1c and is an inexpensive and freely available test so it may be used as a marker of glycemic status.

Combination of red blood cell distribution width and body mass index (COR-BMI) predicts in-hospital mortality in patients with different diagnoses?

Background

The combination of red blood cell distribution width and body mass index (COR-BMI) is indicated as a new prognostic index of survival in patients with laryngeal cancer. However, the ability of this prediction in other types of cancer or whether its use can be expanded to non-oncological patients is unknown. The aim of this study was to investigate the prediction of prognosis of in-hospital mortality of the COR-BMI in oncological and non-oncological patients.

Methods

A retrospective study was performed with all hospitalized patients between 2014 and 2016, totaling 2930 patients, 262 oncological and 2668 non-oncological. The COR-BMI was divided into three classes: 0, RDW ≤ 13.1% and BMI ≥ 25 kg/m²; 1, RDW ≤ 13.1% and BMI < 18.5 or ≥ 18.5 but < 25 kg/m² and RDW > 13.1% and BMI ≥ 18.5 but < 25 or BMI ≥ 25 kg/m²; and 2, RDW > 13.1% and BMI < 18.5 kg/m². In order to analyze the relationship between COR-BMI and in-hospital mortality in the studied population, the Cox Proportional Hazards Model was used in a multivariate analysis based on a conceptual model.

Results

The COR-BMI was an independent predictor of in-hospital mortality in non-oncological patients (1 versus 0: HR = 3.34; CI = 1.60–6.96, p = 0.001; 2 versus 0: HR = 3.38; CI = 1.22–9.39, p = 0.019). The survival rate of these patients was lower among those with the highest scores on the COR-BMI. This prediction was not found in oncological patients.

Conclusion

The present study suggests that the COR-BMI may have its practical use expanded to non-oncological patients as an independent predictor of in-hospital mortality.

Correlation Between Red Cell Distribution Width and Peripheral Vascular Disease Severity and Complexity

A traditional hematological marker, red cell distribution width (RDW), is accepted as a novel marker of atherosclerotic vascular diseases. Clinical importance of the RDW as a prognostic biomarker in peripheral vascular disease (PVD) has been reported in a few studies. Herein, we aimed to show the correlation between RDW and PVD severity and its complexity in terms of angiographic evaluation. A total of 118 patients who underwent peripheral lower extremity angiography were subsequently evaluated retrospectively. Upon admission, RDW level was measured with automated complete blood count. Severity and complexity of the PVD was evaluated according to Trans-Atlantic Inter-Society Consensus (TASC II) classification. A TASC II A-B lesion was defined as simple PVD, and a TASC II C-D lesion was defined as prevalent and complex PVD. Then, both groups were compared statistically according to clinical, laboratory, and demographic features, including RDW levels. In 49.6% of the patients, TASC II C-D lesions were observed. Advanced age, male gender, and body mass index (BMI) were associated with TASC II groups. Red cell distribution width levels were correlated with presence of PVD, as well as TASC II grades (p:0.02). The fourth quartile (75th percentile) of the RDW levels was 14.1, and patients with RDW levels ≥14.1 had a more significant correlation with the presence and severity of PVD (p:0.001). In the multivariate regression analysis, elevated RDW was found to be an independent predictor of the presence of PVD and also TASC II C-D lesions (OR:2.26, with a 95% confidence interval (CI) 0.051-0.774; p:0.02). Elevated RDW levels was associated with TASC II C-D lesions, which indicated more prevalent and complex PVD.

Evaluation of complete blood count parameters in cardiovascular diseases: An early indicator of prognosis?

BACKGROUND

Studies have been conducted to evaluate the correlation between complete blood count (CBC) indices and cardiovascular diseases (CVDs). Considering the dispersion of these studies as well as reports on prognostic value of CBC parameters in CVDs, we have summarized these findings as a review article for the first time.

METHODS

Relevant English language literature was searched and retrieved from Google Scholar search engine and PubMed database (1996-2018). We used "Complete blood count", "Cardiovascular disease", "Red cell distribution width", and "Mean platelet volume" as keywords.

RESULTS

Numerous studies indicated that red cell distribution width (RDW) is an independent prognostic biomarker in relation to CVD diseases. MPV is another considerable prognostic biomarker for CVDs. Elevations of inflammatory markers such as neutrophil to lymphocyte ratio (NLR) in CVD patients (especially in myocardial infarction and heart failure) can be considered as a factor of poor prognosis.

CONCLUSIONS

RDW can be used as a valuable independent biomarker to investigate the prognosis of patients with heart failure (HF), atherosclerosis, myocardial infarction (MI), and other CVDs. Rapid and stable increase in MPV makes it a reliable prognostic/diagnostic parameter in CVDs such as MI and unstable angina. Among different inflammatory markers the evaluation of total white blood cell count, NLR, monocyte to high-density lipoprotein ratio (MHR) and platelet to lymphocyte ratio (PLR) may have a high value in predicting the prognosis of different CVDs including MI, HF and atherosclerosis in patients.

l-arginine minimizes immunosuppression and prothrombin time and enhances the genotoxicity of 5-fluorouracil in rats

OBJECTIVE

The aim of this study was to evaluate the effect of low doses of l-arginine supplementation on hemogram, integrity of DNA and spleen, inflammatory infiltrate in the jejunum, and in the coagulogram of rats submitted to 5-fluorouracil (5-FU) chemotherapy.

METHODS

Thirty-two Wistar rats were fed commercial feed and water ad libitum and grouped into four (eight rats per group): The control group was given a 0.9% physiologic solution to simulate the application of 5-FU in the other groups; the G_5-FU group was given a dose of 5-FU; the G_Arg50 and G_Arg100 groups were given a dose of 5-FU and supplemented with 50 and 100 mg l-arginine/d added in the drinking water ad libitum.

RESULTS

The rats in the G_Arg50 group did not lose weight after chemotherapy. G_Arg50 rats presented polycythemia owing to dehydration caused by diarrhea generated by 5-FU. G_Arg100 rats had increased total leukocyte count, eosinophils, lymphocytes, and index in the total index of DNA damage, yet showed a reduction in prothrombin time and in the spleen depletion index. Rats in the G_5-FU, G_Arg50, and G_Arg100 groups had similar moderate inflammatory infiltrate in the jejunum.

CONCLUSION

Supplementation with 100 mg/d of l-arginine minimized immunosuppression, spleen depletion, and prothrombin time and contributed to the breakdown of 5-FU-generated DNA in Wistar rats. Supplementation with 50 mg/d of l-arginine decreased the weight loss generated by 5-FU in Wistar rats. Supplements with 50 or 100 mg of l-arginine did not interfere with 5-FU-generated jejunal inflammatory infiltrate.