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Seol CH, Sung MD, Chang S, Yoon BR, Roh YH, Park JE, Chung KS. Development of a Simple Scoring System for Predicting Discharge Safety from the Medical ICU to Low-Acuity Wards: The Role of the Sequential Organ Failure Assessment Score, Albumin, and Red Blood Cell Distribution Width. J Pers Med 2024; 14:643. [PMID: 38929864 PMCID: PMC11204447 DOI: 10.3390/jpm14060643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/30/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
Despite advancements in artificial intelligence-based decision-making, transitioning patients from intensive care units (ICUs) to low-acuity wards is challenging, especially in resource-limited settings. This study aimed to develop a simple scoring system to predict ICU discharge safety. We retrospectively analyzed patients admitted to a tertiary hospital's medical ICU (MICU) between July 2016 and December 2021. This period was divided into two phases for model development and validation. We identified risk factors associated with unexpected death within 14 days of MICU discharge and developed a predictive scoring system that incorporated these factors. We verified the system's performance using validation data. In the development cohort, 522 patients were discharged from the MICU, and 42 (8.04%) died unexpectedly. In multivariate analysis, the Sequential Organ Failure Assessment (SOFA) score (odds ratio [OR] 1.26, 95% confidence interval [CI] 1.13-1.41), red blood cell distribution width (RDW) (OR 1.20, 95% CI 1.07-1.36), and albumin (OR 0.37, 95% CI 0.16-0.84) were predictors of unexpected death. Each variable was assigned a weighted point in the scoring system, and the area under the curve (AUC) was 0.788 (95% CI 0.714-0.855). The scoring system was performed using an AUC of 0.738 (95% CI 0.653-0.822) in the validation cohort of 343 patients with 9.62% of unexpected deaths. When a cut-off of 0.032 was applied, a sensitivity and a specificity of 81.8% and 55.2%, respectively, were achieved. This simple bedside predictive score for ICU discharge uses the SOFA score, albumin level, and RDW to aid in timely decision-making and optimize critical care facility allocation in resource-limited settings.
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Affiliation(s)
- Chang Hwan Seol
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin 16995, Republic of Korea;
| | - Min Dong Sung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (M.D.S.); (S.C.)
| | - Shihwan Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (M.D.S.); (S.C.)
| | - Bo Ra Yoon
- Department of Internal Medicine, New Korea Hospital, Gimpo 10086, Republic of Korea;
| | - Yun Ho Roh
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Ji Eun Park
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Kyung Soo Chung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (M.D.S.); (S.C.)
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Park JH, Cho SS, Jung J, Choi SS. Feasibility of using red cell distribution width for prediction of postoperative mortality in severe burn patients: an association with acute kidney injury after surgery. Anesth Pain Med (Seoul) 2023; 18:357-366. [PMID: 37919920 PMCID: PMC10635847 DOI: 10.17085/apm.23046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Severe burns cause pathophysiological processes that result in mortality. A laboratory biomarker, red cell distribution width (RDW), is known as a predictor of mortality in critically-ill patients. We examined the association between RDW and postoperative mortality in severe burn patients. METHODS We retrospectively analyzed medical data of 731 severely burned patients who underwent surgery under general anesthesia. We evaluated whether preoperative RDW value can predict 3-month mortality after burn surgery using receiver operating characteristic (ROC) curve analysis, logistic regression, and Cox proportional-hazards regression analysis. Mortality was also analyzed according to preoperative RDW values and incidence of postoperative acute kidney injury (AKI). RESULTS The 3-month mortality rate after burn surgery was 27.1% (198/731). The area under the ROC curve of preoperative RDW to predict mortality after burn surgery was 0.701 (95% confidence interval [CI], 0.667-0.734; P < 0.001) with a cut-off point of 12.9. The adjusted hazard ratio in patients with RDW > 12.9 was 1.238 (95% CI, 1.138-1.347; P < 0.001). Subgroup analysis showed that the survival rate was 88.8% for the non-AKI group with RDW ≤ 12.9 and 17.6% for the AKI group with RDW > 12.9. Preoperative RDW was considered an independent risk factor for mortality (odds ratio, 1.679; 95% CI, 1.378- 2.046; P < 0.001). CONCLUSIONS Preoperative RDW may predict 3-month postoperative mortality in patients with severe burns, while preoperative RDW > 12.9 and postoperative AKI may further increase mortality after burn surgery.
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Affiliation(s)
- Ji Hyun Park
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, Korea
| | - Seong-Sik Cho
- Department of Occupational and Environmental Medicine, College of Medicine, Dong-A University, Busan, Korea
| | - Jongeun Jung
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, Korea
| | - Seong-Soo Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Lai H, Wu G, Zhong Y, Chen G, Zhang W, Shi S, Xia Z. Red blood cell distribution width improves the prediction of 28-day mortality for patients with sepsis-induced acute kidney injury: A retrospective analysis from MIMIC-IV database using propensity score matching. JOURNAL OF INTENSIVE MEDICINE 2023; 3:275-282. [PMID: 37533812 PMCID: PMC10391576 DOI: 10.1016/j.jointm.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/02/2022] [Accepted: 02/07/2023] [Indexed: 08/04/2023]
Abstract
Background The predictive value of red blood cell distribution width (RDW) for mortality in patients with sepsis-induced acute kidney injury (SI-AKI) remains unclear. The present study aimed to investigate the potential association between RDW at admission and outcomes in patients with SI-AKI. Methods The Medical Information Mart for Intensive Care (MIMIC)-IV (version 2.0) database, released in June of 2022, provides medical data of SI-AKI patients to conduct our related research. Based on propensity score matching (PSM) method, the main risk factors associated with mortality in SI-AKI were evaluated using Cox proportional hazards regression analysis to construct a predictive nomogram. The concordance index (C-index) and decision curve analysis were used to validate the predictive ability and clinical utility of this model. Patients with SI-AKI were classified into the high- and low-RDW groups according to the best cut-off value obtained by calculating the maximum value of the Youden index. Results A total of 7574 patients with SI-AKI were identified according to the filter criteria. Compared with the low-RDW group, the high-RDW group had higher 28-day (9.49% vs. 31.40%, respectively, P <0.001) and 7-day (3.96% vs. 13.93%, respectively, P <0.001) mortality rates. Patients in the high-RDW group were more prone to AKI progression than those in the low-RDW group (20.80% vs. 13.60%, respectively, P <0.001). Based on matched patients, we developed a nomogram model that included age, white blood cells, RDW, combined hypertension and presence of a malignant tumor, treatment with vasopressor, dialysis, and invasive ventilation, sequential organ failure assessment, and AKI stages. The C-index for predicting the probability of 28-day survival was 0.799. Decision curve analysis revealed that the model with RDW offered greater net benefit than that without RDW. Conclusion The present findings demonstrated the importance of RDW, which improved the predictive ability of the nomogram model for the probability of survival in patients with SI-AKI.
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Affiliation(s)
- Honghao Lai
- Department of Burns, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong, China
- Department of Burns, Changhai Hospital, Naval Medical University, Shanghai 200433, China
- Research Institute, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510060, China
| | - Guosheng Wu
- Department of Burns, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Yu Zhong
- Department of Burns, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Guangping Chen
- Department of Burns, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong, China
| | - Wei Zhang
- Department of Burns, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Shengjun Shi
- Department of Burns, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong, China
| | - Zhaofan Xia
- Department of Burns, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong, China
- Department of Burns, Changhai Hospital, Naval Medical University, Shanghai 200433, China
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Zou K, Huang S, Ren W, Xu H, Zhang W, Shi X, Shi L, Zhong X, Peng Y, Lü M, Tang X. Development and Validation of a Dynamic Nomogram for Predicting in-Hospital Mortality in Patients with Acute Pancreatitis: A Retrospective Cohort Study in the Intensive Care Unit. Int J Gen Med 2023; 16:2541-2553. [PMID: 37351008 PMCID: PMC10284301 DOI: 10.2147/ijgm.s409812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/04/2023] [Indexed: 06/24/2023] Open
Abstract
Purpose The aim of this study is to develop and validate a predictive model for the prediction of in-hospital mortality in patients with acute pancreatitis (AP) based on the intensive care database. Patients and Methods We analyzed the data of patients with AP in the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database and Electronic Intensive Care Unit Collaborative Research Database (eICU-CRD). Then, patients from MIMIC-IV were divided into a development group and a validation group according to the ratio of 8:2, and eICU-CRD was assigned as an external validation group. Univariate logistic regression and least absolute shrinkage and selection operator regression were used for screening the best predictors, and multivariate logistic regression was used to establish a dynamic nomogram. We evaluated the discrimination, calibration, and clinical efficacy of the nomogram, and compared the performance of the nomogram with Acute Physiology and Chronic Health Evaluation II (APACHE-II) score and Bedside Index of Severity in AP (BISAP) score. Results A total of 1030 and 514 patients with AP in MIMIC-IV database and eICU-CRD were included in the study. After stepwise analysis, 8 out of a total of 37 variables were selected to construct the nomogram. The dynamic nomogram can be obtained by visiting https://model.sci-inn.com/KangZou/. The area under receiver operating characteristic curve (AUC) of the nomogram was 0.859, 0.871, and 0.847 in the development, internal, and external validation set respectively. The nomogram had a similar performance with APACHE-II (AUC = 0.841, p = 0.537) but performed better than BISAP (AUC = 0.690, p = 0.001) score in the validation group. Moreover, the calibration curve presented a satisfactory predictive accuracy, and the decision curve analysis suggested great clinical application value of the nomogram. Conclusion Based on the results of internal and external validation, the nomogram showed favorable discrimination, calibration, and clinical practicability in predicting the in-hospital mortality of patients with AP.
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Affiliation(s)
- Kang Zou
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, People’s Republic of China
| | - Shu Huang
- Department of Gastroenterology, Lianshui County People’ Hospital, Huaian, People’s Republic of China
- Department of Gastroenterology, Lianshui People’ Hospital of Kangda College Affiliated to Nanjing Medical University, Huaian, People’s Republic of China
| | - Wensen Ren
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, People’s Republic of China
| | - Huan Xu
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, People’s Republic of China
| | - Wei Zhang
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, People’s Republic of China
| | - Xiaomin Shi
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, People’s Republic of China
| | - Lei Shi
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, People’s Republic of China
| | - Xiaolin Zhong
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, People’s Republic of China
| | - Yan Peng
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, People’s Republic of China
| | - Muhan Lü
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, People’s Republic of China
| | - Xiaowei Tang
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, People’s Republic of China
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Yang Y, Wang Q, Gao L, Liu S, Zhao J, Liu G, Zhang S. Promising applications of red cell distribution width in diagnosis and prognosis of diseases with or without disordered iron metabolism. Cell Biol Int 2023. [PMID: 37092585 DOI: 10.1002/cbin.12029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/02/2023] [Accepted: 04/12/2023] [Indexed: 04/25/2023]
Abstract
Many indicators, including red cell distribution width (RDW) and iron metabolism, are sensitive to a variety of risk factors, and are associated with the pathological alterations and disease onset. RDW reflects the degree of heterogeneous volumes of peripheral red blood cells (RBCs). It has been well-known that increased RDW indicates iron deficiency anemia, hemolytic anemia, ineffective erythropoiesis, and shorten lifespan of RBCs. Increased RDW is also prevalent in various non-anemic pathological conditions and diseases. We here review the factors affecting RDW, particularly disordered iron metabolism, chronic inflammation, and oxidative stress, and recapitulate the interplays among these factors. Furthermore, we review the application of increased RDW together with disordered iron homeostasis and the deregulations of hepcidin expression and ferritin levels in the diagnoses and prognosis of anemic and nonanemic diseases. RDW is inexpensive and readily available and may be valuable in adding to the diagnosis and monitoring of many pathological conditions. RDW combined with other indicators, for example, hepcidin and ferritin levels, should be utilized more frequently in clinical practice.
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Affiliation(s)
- Yashuang Yang
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, Shandong, China
| | - Quanshu Wang
- Biomedical Sciences College & Shandong Medicinal Biotechnology Centre, Shandong First Medical University, Jinan, Shandong, China
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Ling Gao
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, Shandong, China
| | - Sijin Liu
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Jiajun Zhao
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, Shandong, China
| | - Guoliang Liu
- Department of Pulmonary and Critical Care Medicine, Centre for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Shuping Zhang
- Biomedical Sciences College & Shandong Medicinal Biotechnology Centre, Shandong First Medical University, Jinan, Shandong, China
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
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Scalco R, Aleman M, Nogueira CEW, Freitas NB, Curcio BR. Red cell distribution width values and red cell distribution width-to-platelet ratio in Thoroughbred foals in the first 24 hours of life. J Vet Emerg Crit Care (San Antonio) 2023; 33:217-222. [PMID: 36537889 DOI: 10.1111/vec.13274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 02/19/2022] [Accepted: 02/24/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To report red cell distribution width (RDW) values, to calculate RDW-to-platelet ratio (RPR), and to investigate a possible correlation of RDW and RPR index values in neonatal foals classified as healthy or at risk based on clinical information from a population of foals up to 24 hours of life. DESIGN Retrospective study conducted from records and CBCs of foals born between June and November from 2018 to 2020 foaling seasons. SETTING Breeding farm. ANIMALS Three hundred and nine neonatal full-term Thoroughbred foals. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Foals were evaluated by a veterinarian within 15 minutes after birth, and a blood sample was collected within 24 hours of life. Based on clinical information, 88 of 309 foals (28.4%) were considered at risk of perinatal disease, and 201 were healthy. Mean gestational age for the foals was 346.3 ± 9.7 days. RDW values did not differ between groups. Gestational length demonstrated to have a negative correlation with RDW (r = -0.156, P = 0.005) and mean corpuscular volume (r = -0.135, P = 0.01), indicating a link of these variables to foal maturity. RPR index was higher for at-risk (0.073 ± 0.018) than for healthy foals (0.068 ± 0.014, P = 0.01). CONCLUSION RPR might be a promising early indicator of disease for the field triage of neonatal foals.
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Affiliation(s)
- Rebeca Scalco
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
- Departamento de Clínicas Veterinária, Faculdade de Medicina Veterinária, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Monica Aleman
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Carlos E W Nogueira
- Departamento de Clínicas Veterinária, Faculdade de Medicina Veterinária, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Natalia B Freitas
- Departamento de Clínicas Veterinária, Faculdade de Medicina Veterinária, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Bruna R Curcio
- Departamento de Clínicas Veterinária, Faculdade de Medicina Veterinária, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
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Yu D, Chen P, Zhang X, Wang H, Dhuromsingh M, Wu J, Qin B, Guo S, Zhang B, Li C, Zeng H. Association of lymphopenia and RDW elevation with risk of mortality in acute aortic dissection. PLoS One 2023; 18:e0283008. [PMID: 36920980 PMCID: PMC10016706 DOI: 10.1371/journal.pone.0283008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 02/28/2023] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVE The study aimed to investigate whether lymphopenia and red blood cell distribution width (RDW) elevation are associated with an increased risk of mortality in acute aortic dissection (AAD). METHODS This multicenter retrospective cohort study enrolled patients diagnosed with AAD by aortic computed tomographic angiography (CTA) from 2010 to 2021 in five teaching hospitals in central-western China. Cox proportional hazards regression and Kaplan-Meier curves were used in univariable and multivariable models. Clinical outcomes were defined as all-cause in-hospital mortality, while associations were evaluated between lymphopenia, accompanied by an elevated RDW, and risk of mortality. RESULTS Of 1903 participants, the median age was 53 (interquartile range [IQR], 46-62) years, and females accounted for 21.9%. Adjusted increased risk of mortality was linearly related to the decreasing lymphocyte percentage (P-non-linearity = 0.942) and increasing RDW (P-non-linearity = 0.612), and per standard deviation (SD) of increment lymphocyte percentage and RDW was associated with the 26% (0.74, 0.64-0.84) decrement and 5% (1.05, 0.95-1.15) increment in hazard ratios (HRs) and 95% confidence intervals (CIs) of mortality, respectively. Importantly, lymphopenia and elevation of RDW exhibited a significant interaction with increasing the risk of AAD mortality (P-value for interaction = 0.037). CONCLUSIONS Lymphopenia accompanied by the elevation of RDW, which may reflect the immune dysregulation of AAD patients, is associated with an increased risk of mortality. Assessment of immunological biomarkers derived from routine tests may provide novel perspectives for identifying the risk of mortality.
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Affiliation(s)
- Dan Yu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Engineering Research Center of Vascular Interventional Therapy, Wuhan, China
- Department of Cardiac Intensive Care Unit, People’s Hospital of Zhengzhou University (Henan Provincial People’s Hospital), Zhengzhou, China
| | - Peng Chen
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xueyan Zhang
- Department of Critical Care Medicine, Henan Key Laboratory for Critical Care Medicine, People’s Hospital of Zhengzhou University (Henan Provincial People’s Hospital), Zhengzhou, China
| | - Hongjie Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Engineering Research Center of Vascular Interventional Therapy, Wuhan, China
| | - Menaka Dhuromsingh
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Engineering Research Center of Vascular Interventional Therapy, Wuhan, China
| | - Jinxiu Wu
- Department of Critical Care Medicine, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Bingyu Qin
- Department of Critical Care Medicine, Henan Key Laboratory for Critical Care Medicine, People’s Hospital of Zhengzhou University (Henan Provincial People’s Hospital), Zhengzhou, China
- * E-mail: (BQ); (SG); (BZ); (CL); (HZ)
| | - Suping Guo
- Department of Cardiac Intensive Care Unit, People’s Hospital of Zhengzhou University (Henan Provincial People’s Hospital), Zhengzhou, China
- Department of Cardiac Intensive Care Unit, Central China Fuwai Hospital of Zhengzhou University (Fuwai Central China Cardiovascular Hospital), Zhengzhou, China
- * E-mail: (BQ); (SG); (BZ); (CL); (HZ)
| | - Baoquan Zhang
- Department of Critical Care Medicine, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
- * E-mail: (BQ); (SG); (BZ); (CL); (HZ)
| | - Chunwen Li
- Department of Emergency Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- * E-mail: (BQ); (SG); (BZ); (CL); (HZ)
| | - Hesong Zeng
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Engineering Research Center of Vascular Interventional Therapy, Wuhan, China
- * E-mail: (BQ); (SG); (BZ); (CL); (HZ)
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Zhao L, Zhang Y, Lin P, Li W, Huang X, Li H, Xia M, Chen X, Zhu X, Tang X. Postoperative red blood cell distribution width predicts functional outcome in aneurysmal subarachnoid hemorrhage after surgical clipping: A single-center retrospective study. Front Neurol 2022; 13:1036433. [PMID: 36619907 PMCID: PMC9817139 DOI: 10.3389/fneur.2022.1036433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Red blood cell (RBC) parameters are associated with outcomes following aneurysmal subarachnoid hemorrhage (aSAH), but their predictive value remains uncertain. This study aimed to detect the association between RBC parameters and functional outcome in aSAH patients undergoing surgical clipping. Methods This retrospective observational study included aSAH patients who underwent surgical clipping at Affiliated Hospital of North Sichuan Medical College between August 2016 and September 2019. The functional outcome following aSAH was assessed by modified Rankin Scale (mRS), and mRS 3-6 was defined as poor functional outcome. Results Out of 187 aSAH patients included (62% female, 51-66 years old), 73 patients had poor functional outcome. Multivariate logistic regression of admission parameters showed that World Federation of Neurosurgical Societies (WFNS) grade (odds ratio [95% CI]: 1.322 [1.023-1.707], p = 0.033) and white blood cell (WBC) (odds ratio [95% CI]: 1.136 [1.044-1.236], p = 0.003) were independently associated with poor functional outcome. In postoperative parameters, RBC distribution width (RDW) (odds ratio [95% CI]: 1.411 [1.095-1.818], p = 0.008), mean platelet volume (MPV, odds ratio [95% CI]: 1.253 [1.012-1.552], p = 0.039) and admission WFNS grade (odds ratio [95% CI]: 1.439 [1.119-1.850], p = 0.005) were independently associated with poor functional outcome. The predictive model including WFNS grade, admission WBC, and postoperative RDW and MPV had significantly higher predictive power compared to WFNS grade alone (0.787 [0.722-0.852] vs. 0.707 [0.630-0.784], p = 0.024). The combination of WFNS grade and WBC on admission showed the highest positive predictive value (75.5%) and postoperative RDW and MPV combined with admission WFNS grade and WBC showed the highest negative predictive value (83.7%). Conclusion Postoperative RDW is independently associated with poor functional outcome in aSAH patients undergoing surgical clipping. A combined model containing postoperative RDW may help predict good outcome in patients with aSAH after timely aneurysm clipping.
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Affiliation(s)
- Long Zhao
- Department of Neurosurgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China,School of Clinical Medicine, North Sichuan Medical College, Nanchong, China,Neurosurgical Research Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yi Zhang
- School of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Ping Lin
- School of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Weida Li
- School of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Xingyuan Huang
- School of Psychiatry, North Sichuan Medical College, Nanchong, China
| | - Hangyang Li
- School of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Mingkai Xia
- School of Medical Imaging, North Sichuan Medical College, Nanchong, China
| | - Xinlong Chen
- School of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Xi Zhu
- Outpatient Department, Affiliated Hospital of North Sichuan Medical College, Nanchong, China,*Correspondence: Xi Zhu ✉
| | - Xiaoping Tang
- Department of Neurosurgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China,Neurosurgical Research Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China,Xiaoping Tang ✉
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Cao W, Ren H, Song B, Liao Z, Li H. Red cell distribution width and Glasgow coma scale score as predictors of in-hospital mortality in maintenance hemodialysis patients diagnosed with spontaneous intracerebral hemorrhage. Medicine (Baltimore) 2022; 101:e31094. [PMID: 36281123 PMCID: PMC9592290 DOI: 10.1097/md.0000000000031094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Glasgow Coma Scale (GCS) score is being widely used as a useful predictor to investigate patients with head injury. High red cell distribution width (RDW) values have been independently associated with mortality and poor neurological outcome. However, there are few data available for Spontaneous Intracerebral Hemorrhage (SIH) in maintenance hemodialysis (MHD) patients. This study aimed to evaluate the prognostic value of the combined measurement of RDW and GCS score in MHD patients with SIH. We retrospectively studied 46 MHD patients who was admitted to our hospital for nontraumatic SIH from October 2014 to May 2020. Data including demographic information, cause of renal failure, comorbidities at ESRD, clinical and laboratory parameters at admission were collected from medical records. Univariate and multivariate Logistic regression analysis were performed to identify independent risk factors of the in-hospital Mortality in Hemodialysis Patients with SIH. The receiver operating characteristic curve (ROC) and areas under the curve (AUCs) were determined. The sensitivity and specificity of independent risk factors were calculated for a range of different cutoff points. A total of 46 patients were enrolled in the study. The in-hospital mortality rate was 69.57%. We divided subjects into 2 groups based on the clinical outcomes. Compared with survivors (n = 14), non-survivors (n = 32) had longer hemodialysis vintage (P = .017), lower GCS score (P < .001), higher hemoglobin (Hb) (P = .032) and RDW (P = .009). In multivariate logistic regression analysis, GCS score (OR 0.719, 95% CI 0.546-0.946; P = .018) and RDW (OR 4.549, 95% CI 1.243-0.946; P = .018) were independent risk factors of in-hospital mortality in MHD patients with SIH. The area under the ROC curve (AUC) for GCS score was 0.849 (95% CI 0.729-0.970) while that for RDW was 0.743 (95% CI 0.596-0.891). The AUC for the combined prediction was 0.916 (95% CI 0.828-1.000), with a sensitivity of 90.63% and a specificity of 88.46%. In conclusion, high RDW and low GCS score were useful and independent poor prognostic markers for in-hospital mortality of MHD patients with SIH.
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Affiliation(s)
- Wen Cao
- Department of Nephrology, People’s Hospital of Deyang City, Deyang, Sichuan, China
| | - Haoyuan Ren
- Department of Gastrointestinal Surgery, People’s Hospital of Deyang City, Deyang, Sichuan, China
- *Correspondence: Haoyuan Ren, Department of Gastrointestinal Surgery, People’s Hospital of Deyang City, Deyang 618000, Sichuan, China (e-mail: )
| | - Bin Song
- Department of Nephrology, People’s Hospital of Deyang City, Deyang, Sichuan, China
| | - Zuchun Liao
- Department of Nephrology, People’s Hospital of Deyang City, Deyang, Sichuan, China
| | - Haiyan Li
- Department of Nephrology, People’s Hospital of Deyang City, Deyang, Sichuan, China
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Wu H, Liao B, Cao T, Ji T, Huang J, Ma K. Diagnostic value of RDW for the prediction of mortality in adult sepsis patients: A systematic review and meta-analysis. Front Immunol 2022; 13:997853. [PMID: 36325342 PMCID: PMC9618606 DOI: 10.3389/fimmu.2022.997853] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/23/2022] [Indexed: 12/04/2022] Open
Abstract
Background Red blood cell distribution width (RDW) is a common biomarker of bacterial infections, and it can be easily obtained from a routine blood test. We investigate the diagnostic value of RDW for the prediction of mortality in adult sepsis patients through a review and meta-analysis. We registered this review in PROSPERO (Registration Number: CRD42022357712), and the details of the registration are included in Appendix 1. Methods We searched PubMed, Cochrane Library, Springer, and Embase between Jan. 1, 2000, and May 30, 2022, for primary studies about this research. We collected articles that investigated RDW for varying degrees of sepsis patients—those who suffered from sepsis, severe sepsis, or sepsis shock. Studies of healthy people and sepsis of children and neonates were excluded from our research. The definition of study characteristics and data extraction were finished by two independent researchers and discrepancies resolved by consensus. The combined sensitivities and specificities were calculated by meta-analysis using STATA14.0. The sensitivity of the included studies was analyzed by excluding studies that had potential heterogeneity. A summary operating characteristic curve was made to evaluate the diagnostic value for the prediction of mortality in adult sepsis patients. The Fagan test was used to explore likelihood ratios and posttest probabilities. Finally, we investigated the source of heterogeneity using meta-regression. Results Twenty-four studies, including 40,763 cases altogether, were included in this analysis. Bivariate analysis indicated a combined sensitivity of 0.81 (95% CI 0.73–0.86) and specificity of 0.65 (95% CI 0.54–0.75). The area under the summary receiver operating characteristic curve was 0.81 (95% CI 0.77–0.84). Substantial heterogeneity resided in the studies (I2 =96.68, 95% CI 95.95–97.4). Meta-regression showed that the reference description, prospective design, and blinded interpretation of the included studies could be responsible for the heterogeneity. Conclusions RWD is an available and valuable biomarker for prediction of mortality in adult sepsis patients. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022357712.
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Affiliation(s)
| | | | | | | | | | - Keqiang Ma
- *Correspondence: Hongsheng Wu, ; Keqiang Ma,
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Moreno-Torres V, Royuela A, Múñez-Rubio E, Gutierrez-Rojas Á, Mills-Sánchez P, Ortega A, Tejado-Bravo S, García-Sanz J, Muñoz-Serrano A, Calderón-Parra J, Fernández-Cruz A, Ramos-Martínez A. Red blood cell distribution width as prognostic factor in sepsis: A new use for a classical parameter. J Crit Care 2022; 71:154069. [PMID: 35667275 DOI: 10.1016/j.jcrc.2022.154069] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 05/06/2022] [Accepted: 05/14/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE To evaluate Red blood cell distribution width (RDW) as a sepsis prognostic biomarker. METHODS 203 septic patients admitted to the ICU. Analysis of RDW dynamics, hospital mortality discrimination ability and the added value when incorporated to the SOFA, LODS, SAPS-II and APACHE-II scores using the AUC-ROC. RESULTS Non-survivors presented higher RDW values during the first week after ICU admission (p = 0.048). Only SOFA and RDW were independently associated with mortality when adjusted by Charlson, immunosuppression, nosocomial infection, NEWS2, SAPS-II, septic shock and haemoglobin (p < 0.05). After adjustment, AUC-ROC was 0.827, 0.822, 0.824, 0.834 and 0.812 for each model including admission, 24, 48 and 72-h and 7-days RDW, respectively. When added to the scores, 24-h RDW and admission RDW improved their discrimination ability (SOFA AUC-ROC = 0.772 vs 0.812 SOFA + admission RDW, p = 0.041; LODS AUC-ROC = 0.687 vs 0.710, p = 0.002; SAPS-II AUC-ROC = 0.734 vs 0.785, p = 0.021; APACHE-II AUC-ROC = 0.672 vs 0.755, p = 0.003). Admission RDW with SOFA presented the better discrimination ability for mortality. CONCLUSION RDW is an independent prognostic marker of death in septic patients admitted in the ICU that improves SOFA, LODS, APACHE-II and SAPS-II discrimination ability. This parameter could be incorporated to the prognostic scores as a marker of systemic dysfunction and dysregulated inflammatory response.
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Affiliation(s)
- Víctor Moreno-Torres
- Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda. C/Joaquín Rodrigo 2, Majadahonda, Madrid, Spain.
| | - Ana Royuela
- Clinical Biostatistics Unit, Health Research Institute Puerta de Hierro-Segovia de Arana, CIBERESP, Madrid, Spain. C/Joaquín Rodrigo 2, Majadahonda, Madrid, Spain
| | - Elena Múñez-Rubio
- Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda. C/Joaquín Rodrigo 2, Majadahonda, Madrid, Spain
| | - Ángela Gutierrez-Rojas
- Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda. C/Joaquín Rodrigo 2, Majadahonda, Madrid, Spain
| | - Patricia Mills-Sánchez
- Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda. C/Joaquín Rodrigo 2, Majadahonda, Madrid, Spain
| | - Alfonso Ortega
- Intensive Care Unit Department, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda. C/Joaquín Rodrigo 2, Majadahonda, Madrid, Spain
| | - Sandra Tejado-Bravo
- Intensive Care Unit Department, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda. C/Joaquín Rodrigo 2, Majadahonda, Madrid, Spain
| | - Javier García-Sanz
- Intensive Care Unit Department, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda. C/Joaquín Rodrigo 2, Majadahonda, Madrid, Spain
| | - Alejandro Muñoz-Serrano
- Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda. C/Joaquín Rodrigo 2, Majadahonda, Madrid, Spain
| | - Jorge Calderón-Parra
- Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda. C/Joaquín Rodrigo 2, Majadahonda, Madrid, Spain
| | - Ana Fernández-Cruz
- Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda. C/Joaquín Rodrigo 2, Majadahonda, Madrid, Spain
| | - Antonio Ramos-Martínez
- Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda. C/Joaquín Rodrigo 2, Majadahonda, Madrid, Spain
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Oh SH, Do HJ, Park JS, Cho JY, Park CH. Can red cell distribution width in very low birth weight infants predict bronchopulmonary dysplasia? Medicine (Baltimore) 2022; 101:e28640. [PMID: 35060550 PMCID: PMC8772710 DOI: 10.1097/md.0000000000028640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/30/2021] [Indexed: 01/05/2023] Open
Abstract
Red cell distribution width (RDW) is a useful marker for assessing the severity and prognosis of various diseases in adults. However, whether it is applicable to children, especially in newborns, has not been determined.This study aimed to investigate the RDW values of preterm infants and evaluate whether RDW values in the early days of life can predict bronchopulmonary dysplasia (BPD) development.One hundred and eight infants born at <30 weeks of gestation with a birth weight of <1500 g participated in this retrospective study. RDW values measured at birth, 7 days (D7), and 28 days (D28) after birth were reviewed. The changes in RDW values in the first month of life were analyzed, and we evaluated the relationship between RDW and BPD.The mean RDW values at birth, D7, D28 and the change from birth to D7 were 16.2 ± 0.1%, 17.5 ± 0.2%, 17.6 ± 0.2% and 1.3 ± 1.8%, respectively. RDW at birth was lower in the infants born at <28 weeks' gestational age than in those born at ≥28 weeks' gestational age (15.7 ± 0.3 vs 16.4 ± 0.2, P = .024). RDW values of both groups increased during the first week after birth and did not differ significantly at D7. The levels remained similar at 1 month of age. RDW at birth, D7, and D28 and the changes in RDW from birth to D7 were not correlated with the development of BPD independent of its severity.The usefulness of RDW as a predictor of BPD development remains questionable and requires further study.
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Affiliation(s)
- Seong Hee Oh
- Department of Pediatrics, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, South Korea
| | - Hyun-Jeong Do
- Department of Pediatrics, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, South Korea
| | - Ji Sook Park
- Department of Pediatrics, College of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, South Korea
- Institute of Health Sciences, Gyeongsang National University, Jinju, South Korea
| | - Jae Young Cho
- Department of Pediatrics, College of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, South Korea
- Institute of Health Sciences, Gyeongsang National University, Jinju, South Korea
| | - Chan-Hoo Park
- Institute of Health Sciences, Gyeongsang National University, Jinju, South Korea
- Department of Pediatrics, College of Medicine, Gyeongsang National University, Gyeongsang National University Changwon Hospital, Changwon, South Korea
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Abdelaleem NA, Makhlouf HA, Nagiub EM, Bayoumi HA. Prognostic biomarkers in predicting mortality in respiratory patients with ventilator-associated pneumonia. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2021. [PMCID: PMC7971396 DOI: 10.1186/s43168-021-00062-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Ventilator-associated pneumonia (VAP) is the most common nosocomial infection. Red cell distribution width (RDW) and neutrophil-lymphocyte ratio (NLR) are prognostic factors to mortality in different diseases. The aim of this study is to evaluate prognostic efficiency RDW, NLR, and the Sequential Organ Failure Assessment (SOFA) score for mortality prediction in respiratory patients with VAP. Results One hundred thirty-six patients mechanically ventilated and developed VAP were included. Clinical characteristics and SOFA score on the day of admission and at diagnosis of VAP, RDW, and NLR were assessed and correlated to mortality. The average age of patients was 58.80 ± 10.53. These variables had a good diagnostic performance for mortality prediction AUC 0.811 for SOFA at diagnosis of VAP, 0.777 for RDW, 0.728 for NLR, and 0.840 for combined of NLR and RDW. The combination of the three parameters demonstrated excellent diagnostic performance (AUC 0.889). A positive correlation was found between SOFA at diagnosis of VAP and RDW (r = 0.446, P < 0.000) and with NLR (r = 0.220, P < 0.010). Conclusions NLR and RDW are non-specific inflammatory markers that could be calculated quickly and easily via routine hemogram examination. These markers have comparable prognostic accuracy to severity scores. Consequently, RDW and NLR are simple, yet promising markers for ICU physicians in monitoring the clinical course, assessment of organ dysfunction, and predicting mortality in mechanically ventilated patients. Therefore, this study recommends the use of blood biomarkers with the one of the simplest ICU score (SOFA score) in the rapid diagnosis of critical patients as a daily works in ICU.
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Red cell distribution width as a predictor of outcome in hospitalized cirrhotic patients. Eur J Gastroenterol Hepatol 2021; 33:e978-e985. [PMID: 35048659 DOI: 10.1097/meg.0000000000002337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND A systemic inflammatory response syndrome (SIRS) is linked to red cell distribution width (RCDW), which produces pro-inflammatory signals that act directly on hematopoietic stem cells in the bone marrow. This stimulation may cause alterations in the membrane of red blood cells (RBCs), as assessed by RCDW, which have been linked to increased morbidity and death in a number of systemic disorders. AIM This study aims to evaluate RCDW as a predictor of outcome in hospitalized cirrhotic patients. METHODS This prospective cross-sectional study was conducted on 1000 patients. The outcome was assessed by days of hospitalization; mortality in hospitalized patients or during short-term follow-up (3 months) and rehospitalization during follow-up of 6 months. RESULTS Male represented 69.6%. Mean age was 57.67 ± 13.07 years old. Baseline co-morbidities were recorded as the presence of diabetes mellitus (200 patients) and hypertension (400 patients). Hepatitis C virus was the commonest etiology of the diseased liver (90%). Child-Pugh classes A, B and C of studied patients represented (21.2%, 38.8% and 40%). The survived patients during follow-up represented 63.3%. Area under the curve for RCDW was 0.923 (95% CI, 0.904-0.943), 0.910 for C-reactive protein (95% CI, 0.890-0.930), 0.904 for Hb (95% CI, 0.883-0.925) and 0.903 for platelets (95% CI, 0.882-0.924). RCDW cutoff point at 21.35 for predicting survival had sensitivity 93%, specificity 91%, accuracy 92%, positive predictive value 85 and negative predictive value 96. Regression analysis revealed a significant positive association between both RCDW and white blood cells with mortality. CONCLUSION RCDW could provide useful information for predicting the length of hospitalization and survival in hospitalized cirrhotic patients.
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The Value of a Complete Blood Count (CBC) for Sepsis Diagnosis and Prognosis. Diagnostics (Basel) 2021; 11:diagnostics11101881. [PMID: 34679578 PMCID: PMC8534992 DOI: 10.3390/diagnostics11101881] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/08/2021] [Accepted: 10/10/2021] [Indexed: 12/28/2022] Open
Abstract
Sepsis represents an important global health burden due to its high mortality and morbidity. The rapid detection of sepsis is crucial in order to prevent adverse outcomes and reduce mortality. However, the diagnosis of sepsis is still challenging and many efforts have been made to identify reliable biomarkers. Unfortunately, many investigated biomarkers have several limitations that do not support their introduction in clinical practice, such as moderate diagnostic and prognostic accuracy, long turn-around time, and high-costs. Complete blood count represents instead a precious test that provides a wealth of information on individual health status. It can guide clinicians to early-identify patients at high risk of developing sepsis and to predict adverse outcomes. It has several advantages, being cheap, easy-to-perform, and available in all wards, from the emergency department to the intensive care unit. Noteworthy, it represents a first-level test and an alteration of its parameters must always be considered within the clinical context, and the eventual suspect of sepsis must be confirmed by more specific investigations. In this review, we describe the usefulness of basic and new complete blood count parameters as diagnostic and prognostic biomarkers of sepsis.
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Qu J, Zhou T, Xue M, Sun H, Shen Y, Chen Y, Tang L, Qian L, You J, Yang R, Liu Y. Correlation Analysis of Hemoglobin-to-Red Blood Cell Distribution Width Ratio and Frailty in Elderly Patients With Coronary Heart Disease. Front Cardiovasc Med 2021; 8:728800. [PMID: 34513961 PMCID: PMC8429811 DOI: 10.3389/fcvm.2021.728800] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/04/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Coronary heart disease (CHD) is a common chronic disease in the elderly. Frailty can accelerate the development of CHD and lead to adverse health outcomes. Risk prediction and decision-making for frailty are crucial. The peripheral hemoglobin-to-red blood cell distribution width ratio (HRR) is a novel biomarker of inflammation. Our purpose was to explore the correlation between HRR and frailty in elderly patients with CHD. Methods: This cross-sectional study evaluated 245 Chinese hospitalized patients with CHD. Blood parameters measured upon admission were obtained via the hospital electronic information medical record system. The Fried Frailty Phenotype Scale was used to evaluate the frailty status of the participants. The Receiver operating characteristic curve was used to determine the optimal cut-off values of HRR. We used univariate analysis to examine the potential factors affecting frailty. Kendall's tau-b grade correlation was used to analyze the correlation between HRR and frailty. The ordered logistic regression model was used to analyze the relationship between HRR and frailty. Results: A total of 233 elderly patients with CHD were included in our study. Among the patients, 33.48% (78) were in a state of frailty. The optimal cut-off values of HRR was 9.76. The area under the curve (AUC) for HRR in the frailty patients was 0.652, exceed Hb (AUC = 0.618) and RDW (AUC = 0.650). Kendall's tau-b grade correlation analysis showed that HRR (K = −0.296, P < 0.001) was negatively correlated with frailty. The ordered logistic regression analysis determined that lower HRR was associated with frailty (P < 0.05) after adjusted for age, body mass index, number of drugs, comorbidity index, heart failure, red blood cells, albumin, total cholesterol, triglyceride, high density lipoprotein cholesterol, and low density lipoprotein cholesterol. Conclusion: Lower HRR is an independent risk factor for frailty in elderly hospitalized patients with CHD. HRR was a more powerful prognostic indicator for frailty than either Hb or RDW alone. Clinicians should focus on timely identification of the risk of frailty in order to improve patient quality of life and to reduce the risk of complications.
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Affiliation(s)
- Jiling Qu
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Ting Zhou
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Mengxin Xue
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Huiping Sun
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Yijing Shen
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Yuhui Chen
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Lei Tang
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Lin Qian
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Jiachun You
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Ruohan Yang
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Yongbing Liu
- School of Nursing, Yangzhou University, Yangzhou, China
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Cai N, Chen ZQ, Tao M, Fan WT, Liao W. Mean platelet volume and red blood cell distribution width is associated with prognosis in premature neonates with sepsis. Open Med (Wars) 2021; 16:1175-1181. [PMID: 34514164 PMCID: PMC8389506 DOI: 10.1515/med-2021-0323] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/18/2021] [Accepted: 06/30/2021] [Indexed: 12/22/2022] Open
Abstract
Objective To evaluate the prognostic value of the mean platelet volume (MPV) and red blood cell distribution width (RDW) in sepsis among premature neonates. Methods This was a retrospective cohort study conducted in the neonatal intensive care unit between May 2015 and May 2020. Premature neonates with late-onset sepsis were enrolled. The demographic data, blood cell count analysis, C-reactive protein, and blood culture were compared between survivors and non-survivors. Results A total of 73 premature neonates with sepsis in the survivor group and 10 cases in the non-survivor group. Significant differences were observed between the survivor and non-survivor groups with regard to birth weight, MPV, and RDW (P < 0.05). The results of binomial stepwise logistic regression suggested that MPV (OR = 3.226, P = 0.017 < 0.05) and RDW (OR = 2.058, P = 0.019 < 0.05) were independent predictor for prognosis in preterm with sepsis. A receiver operating characteristic analysis showed that the areas under the curves were 0.738 for MPV alone, 0.768 for RDW alone, and 0.854 for MPV combined with RDW. Conclusion MPV and RDW were independent predictors of prognosis and the combination of the two helps in predicting the prognosis of preterm with late-onset sepsis in the early stage.
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Affiliation(s)
- Na Cai
- Department of Pediatrics, The First Hospital Affiliated to Army Medical University, Chongqing 400038, China
| | - Zhi Qiang Chen
- Department of Pediatrics, The First Hospital Affiliated to Army Medical University, Chongqing 400038, China
| | - Min Tao
- Department of Pediatrics, The First Hospital Affiliated to Army Medical University, Chongqing 400038, China
| | - Wen Ting Fan
- Department of Pediatrics, The First Hospital Affiliated to Army Medical University, Chongqing 400038, China
| | - Wei Liao
- Department of Pediatrics, The First Hospital Affiliated to Army Medical University, Chongqing 400038, China
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Brown M, Nassoiy S, Plackett T, Luchette F, Posluszny J. Red blood cell distribution width and outcome in trauma patients. J Osteopath Med 2021; 121:221-228. [PMID: 33567079 PMCID: PMC8086633 DOI: 10.1515/jom-2020-0089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Context Red blood cell distribution width (RDW) has been used to predict mortality during infection and inflammatory diseases. It also been purported to be predictive of mortality following traumatic injury. Objective To identify the role of RDW in predicting mortality in trauma patients. We also sought to identify the role of RDW in predicting the development of sepsis in trauma patients. Methods A retrospective observational study was performed of the medical records for all adult trauma patients admitted to Loyola University Medical Center from 2007 to 2014. Patients admitted for fewer than four days were excluded. Admission, peak, and change from admission to peak (Δ) RDW were recorded to determine the relationship with in-hospital mortality. Patient age, development of sepsis during the hospitalization, admission to the intensive care unit (ICU), and discharge disposition were also examined. Results A total of 9,845 patients were admitted to the trauma service between 2007 and 2014, and a total of 2,512 (25.5%) patients fit the inclusion criteria and had both admission and peak values available. One-hundred twenty (4.6%) died while in the hospital. RDW values for all patients were (mean [standard deviation, SD]): admission 14.09 (1.88), peak 15.09 (2.34), and Δ RDW 1.00 (1.44). Admission, peak, and Δ RDW were not significant predictors of mortality (all p>0.50; hazard ratio [HR], 1.01-1.03). However, trauma patients who eventually developed sepsis had significantly higher RDW values (admission RDW: 14.27 (2.02) sepsis vs. 13.98 (1.73) no sepsis, p<0.001; peak RDW: 15.95 (2.55) vs. 14.51 (1.97), p<0.001; Δ RDW: 1.68 (1.77) vs. 0.53 (0.91), p<0.001). Conclusion Admission, peak, and Δ RDW were not associated with in-hospital mortality in adult trauma patients with a length of stay (LOS) ≥four days. However, the development of sepsis in trauma patients is closely linked to increased RDW values and in-hospital mortality.
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Affiliation(s)
- McKenzie Brown
- Department of Surgery and Public Health Sciences , Loyola University Medical Center , Maywood , IL , USA
| | - Sean Nassoiy
- Department of Surgery and Public Health Sciences , Loyola University Medical Center , Maywood , IL , USA
| | - Timothy Plackett
- Department of Surgery and Public Health Sciences , Loyola University Medical Center , Maywood , IL , USA.,759th Forward Surgical Team , BLDG A-6631 Gorham Street , 28310-0001 Fort Bragg , NC , USA
| | - Fred Luchette
- Department of Surgery and Public Health Sciences , Loyola University Medical Center , Maywood , IL , USA.,Department of Surgery , Edward Hines Jr. Veterans Administration Hospital , Hines , IL , USA
| | - Joseph Posluszny
- Department of Surgery and Public Health Sciences , Loyola University Medical Center , Maywood , IL , USA
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Elevated Red Cell Distribution Width as a Useful Marker in Neonatal Sepsis. J Pediatr Hematol Oncol 2021; 43:180-185. [PMID: 33512870 DOI: 10.1097/mph.0000000000002070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/14/2020] [Indexed: 01/18/2023]
Abstract
Neonatal sepsis is an important cause of neonatal morbidity and mortality in the neonatal intensive care unit. Red blood cell distribution width (RDW) is an important and independent prognostic factor in several diseases. The objective of this study was to evaluate the diagnostic value of RDW in neonatal sepsis. An observational, retrospective cohort study was conducted on newborns admitted to the neonatal intensive care unit in a Tertiary Care University Hospital between 2016 and 2019. Patients were classified into sepsis and control groups. Demographic characteristics and laboratory findings including RDW were analyzed. RDW was significantly higher in the sepsis group than in the control group (P=0.001). RDW had an area under the receiver operating characteristic curve of 0.799 for the diagnosis of sepsis. The sensitivity and specificity of an RDW value of 17.4% were found to be 60% and 88.3%, respectively (P=0.001). Multivariable logistic regression analysis showed a positive association of RDW with sepsis (odds ratio: 2.71; 95% confidence interval: 2.19-3.36; P=0.001). RDW value was significantly higher in neonatal sepsis and could be used as a useful alternative to other assessment tools as a readily available biomarker.
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Lorente L, Martín MM, Ruiz C, Abreu-González P, Pérez-Cejas A, González-Rivero AF, Ramos-Gómez L, Argueso M, Solé-Violán J, Cáceres JJ, Jiménez A, García-Marín V. Red blood cell distribution width as mortality biomarker in patients with traumatic brain injury. Acta Neurol Belg 2021; 121:715-720. [PMID: 32572840 DOI: 10.1007/s13760-020-01409-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/10/2020] [Indexed: 01/10/2023]
Abstract
One study found higher red blood cell distribution width (RDW) on the admission of traumatic brain injury (TBI) in non-surviving patients; however, a regression analysis was not carried out to establish an association between RDW and TBI mortality. Thus, the objectives of this study were to determine whether there is an association between RDW and TBI mortality, and to describe the temporal profile of RDW during the first week. Isolated (< 10 points in non-cranial aspects of Injury Severity Score) and severe (< 9 points in Glasgow Coma Scale) TBI patients were included. RDW at days 1, 4, and 8 of TBI were determined. The end-point study was 30-day mortality. Ninety-seven surviving patients compared to the 38 non-surviving patients had higher RDW at days 1 (p < 0.001), 4 (p < 0.001), and 8 (p < 0.001). The area under the curve (95% CI) for prediction of mortality by RDW at days 1, 4, and 8 was 0.81 (0.73-0.87; p < 0.001), 0.92 (0.85-0.96; p < 0.001) and 0.94 (0.88-0.98; p < 0.001). Regression analysis showed an association between RDW and mortality (odds ratio = 1.778; 95% CI 1.312-2.409; p < 0.001). The association found between RDW on admission and mortality is the main new finding of our study. Regarding the temporal profile of RDW, the fact that RDW during the first week of TBI may help in estimating prognosis is another interesting finding of our study.
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21
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Li Q, Chen X, Han B. Red blood cell distribution width is associated with frailty in older inpatients in China: Sex differences in a cross-sectional study. Exp Gerontol 2021; 150:111392. [PMID: 33965555 DOI: 10.1016/j.exger.2021.111392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 12/20/2022]
Abstract
AIMS Although some studies have investigated an association between inflammatory marker and frailty, little is known about the relationship of red blood cell volume distribution width (RDW) and frailty. This study aimed to determine whether there were sex-specific associations of RDW and frailty among older hospitalized patients. METHODS A cross-sectional study was conducted in a comprehensive tertiary hospital in mainland China between February 2015 and November 2017. Hospitalized patients aged 60 years and above were included. Frailty was defined according to Fried's frailty phenotype. Data on patients' demographics, clinical characteristics, and inflammatory markers were collected. The association was evaluated by using the linear and logistic regression modeling. RESULTS The frailty prevalence was 26.65% (89/334) in men and 28.07% (80/285) in women. After adjusting for all covariates, patients in the 4th RDW quartile exhibited an increased risk of frailty compared with those of the 1st RDW quartile [men: odds ratio (OR) = 2.26; 95%CI = 1.01, 5.07; women: OR = 6.29; 95%CI = 2.11, 18.71]. P for trend were < 0.05 for all models. CONCLUSIONS An increased RDW among older inpatients was more strongly associated with a corresponding increased risk of frailty in women than in men. Our findings suggest that there were sex differences in the association between elevated RDW levels and frailty among older inpatients. These results may provide support for the intervention decision-making.
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Affiliation(s)
- Qiuping Li
- Department of Nursing, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xi Chen
- Department of Nursing, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Binru Han
- Department of Nursing, Xuanwu Hospital, Capital Medical University, Beijing, China.
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22
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Li Y, She Y, Fu L, Zhou R, Xiang W, Luo L. Association Between Red Cell Distribution Width and Hospital Mortality in Patients with Sepsis. J Int Med Res 2021; 49:3000605211004221. [PMID: 33823636 PMCID: PMC8033474 DOI: 10.1177/03000605211004221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective Sepsis is the leading cause of death in patients admitted to adult intensive
care units (ICUs). We aimed to determine the predictive value of red blood
cell distribution width (RDW) in patients with sepsis in a large cohort. Methods This retrospective observational study used data from the eICU Collaborative
Research Database. The prognostic value of RDW was investigated using the
receiver operating characteristic (ROC) curve, multiple logistic regression
model, integrated discriminatory index (IDI), and net reclassification index
(NRI). Results In total, 9743 patients were included. The area under the ROC curve of the
RDW for predicting hospital mortality was 0.631 (95% confidence interval
[CI]: 0.616–0.645). Based on the multiple logistic regression model, an RDW
of ≥14.5% was correlated with hospital mortality, regardless of Sequential
Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health
Evaluation IV (APACHE IV) scores (odds ratio [OR]: 1.838, 95% CI:
1.598–2.119). Using SOFA and APACHE IV scores as reference, the IDI and
continuous NRI of RDW for hospital mortality was about 0.3 and 0.014,
respectively. Conclusions The RDW may be useful in predicting hospital mortality in patients with
sepsis, offering extra prognostic value beyond SOFA and APACHE IV
scores.
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Affiliation(s)
- Yide Li
- Department of Critical Care Medicine, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Yingfang She
- Neurology Medicine Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Le Fu
- Department of Critical Care Medicine, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Ruitong Zhou
- Department of Critical Care Medicine, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Wendi Xiang
- Department of Operating Room, Xiangya Hospital of Central South University, Changsha, China
| | - Liang Luo
- Department of Critical Care Medicine, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
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23
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Fan YW, Liu D, Chen JM, Li WJ, Gao CJ. Fluctuation in red cell distribution width predicts disseminated intravascular coagulation morbidity and mortality in sepsis: a retrospective single-center study. Minerva Anestesiol 2021; 87:52-64. [PMID: 33538418 DOI: 10.23736/s0375-9393.20.14420-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Red cell distribution width (RDW) values increase in many diseases and conditions, including sepsis. However, the relationship between RDW fluctuation and prognosis in patients with sepsis or the likely morbidity associated with sepsis-induced disseminated intravascular coagulation (DIC) has not been previously investigated. This study examined the association between dynamic changes to RDW and DIC occurrence in sepsis, as well as the prognostic significance of changes to RDW during hospital stay in patients with sepsis. METHODS We collected baseline emergency department admissions' data. All RDW values recorded during hospitalization of patients with sepsis were combined to calculate RDW standard deviation (RDW-SD) and the increase rate of RDW; we also collected data on coagulation indicators. The endpoints were 28-day mortality and sepsis-related DIC morbidity. RESULTS Of 232 patients included in our analysis, 66 were diagnosed with DIC (28.4%), and 86 (37.1%) died within 28 days. The RDW-SD and the increase rate of RDW were independent risk factors for 28-day mortality and sepsis-associated DIC morbidity, respectively. The DIC occurrence and mortality rate increased continually with an increasing rate of RDW of at least 6%. CONCLUSIONS The RDW-SD and RDW increase rate shown in the study as the indicators of RDW fluctuation can help predict sepsis-related DIC morbidity and prognosis in patients with sepsis.
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Affiliation(s)
- Yi W Fan
- Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dan Liu
- Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia M Chen
- Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen J Li
- Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cheng J Gao
- Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China -
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24
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Lorente L, Martín MM, Argueso M, Solé-Violán J, Perez A, Marcos Y Ramos JA, Ramos-Gómez L, López S, Franco A, González-Rivero AF, Martín M, Gonzalez V, Alcoba-Flórez J, Rodriguez MÁ, Riaño-Ruiz M, Guillermo O Campo J, González L, Cantera T, Ortiz-López R, Ojeda N, Rodríguez-Pérez A, Domínguez C, Jiménez A. Association between red blood cell distribution width and mortality of COVID-19 patients. Anaesth Crit Care Pain Med 2021; 40:100777. [PMID: 33171297 PMCID: PMC7648194 DOI: 10.1016/j.accpm.2020.10.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/23/2020] [Accepted: 10/02/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE We have previously reported an association between high red blood cell distribution width (RDW) and mortality in septic and brain infarction patients. However, no association between RDW and mortality in coronavirus disease 2019 (COVID-19) patients has been reported so far; thus, the objective of this study was to determine if that association exists. METHODS Prospective and observational study carried out in 8 Intensive Care Units from 6 hospitals of Canary Islands (Spain) including COVID-19 patients. We recorded RDW at ICU admission and 30-day survival. RESULTS We found that patients who did not survive (n=25) compared to surviving patients (n=118) were older (p=0.004), showed higher RDW (p=0.001), urea (p<0.001), APACHE-II (p<0.001) and SOFA (p<0.001), and lower platelet count (p=0.007) and pH (p=0.008). Multiple binomial logistic regression analysis showed that RDW was associated with 30-day mortality after controlling for: SOFA and age (OR=1.659; 95% CI=1.130-2.434; p=0.01); APACHE-II and platelet count (OR=2.062; 95% CI=1.359-3.129; p=0.001); and pH and urea (OR=1.797; 95% CI=1.250-2.582; p=0.002). The area under the curve (AUC) of RDW for mortality prediction was of 71% (95% CI=63-78%; p<0.001). We did not find significant differences in the predictive capacity between RDW and SOFA (p=0.66) or between RDW and APACHE-II (p=0.12). CONCLUSIONS Our study provides new information regarding the ability to predict mortality in patients with COVID-19. There is an association between high RDW and mortality. RDW has a good performance to predict 30-day mortality, similar to other severity scores (such as APACHE II and SOFA) but easier and faster to obtain.
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Affiliation(s)
- Leonardo Lorente
- Intensive Care Unit, Hospital Universitario de Canarias, Ofra, s/n. La Laguna, 38320 Santa Cruz de Tenerife, Spain.
| | - María M Martín
- Intensive Care Unit, Hospital Universitario Nuestra Señora de Candelaria, Crta del Rosario s/n, Santa Cruz de Tenerife 38010, Spain
| | - Mónica Argueso
- Intensive Care Unit, Complejo Hospitalario Universitario Insular, Plaza Dr. Pasteur s/n, Las Palmas de Gran Canaria 35016, Spain
| | - Jordi Solé-Violán
- Intensive Care Unit, Hospital Universitario Dr. Negrín, Barranco de la Ballena s/n, Las Palmas de Gran Canaria 35010, Spain
| | - Alina Perez
- Internal Intensive Care Unit, Hospital Universitario de Canarias, Ofra, s/n, La Laguna, 38320 Santa Cruz de Tenerife, Spain
| | - José Alberto Marcos Y Ramos
- Intensive Care Unit, Hospital Doctor José Molina Orosa, Ctra. Arrecife-Tinajo, km 1.300, Arrecife, Lanzarote 35550, Spain
| | - Luis Ramos-Gómez
- Intensive Care Unit, Hospital General La Palma, Buenavista de Arriba s/n, Breña Alta, La Palma 38713, Spain
| | - Sergio López
- Department of Anaesthesiology, Hospital Universitario Dr. Negrín, Barranco de la Ballena s/n, Las Palmas de Gran Canaria 35010, Spain
| | - Andrés Franco
- Immunology Unit of Laboratory Department, Hospital Universitario de Canarias, Ofra, s/n. La Laguna, 38320 Santa Cruz de Tenerife, Spain
| | - Agustín F González-Rivero
- Laboratory Department, Hospital Universitario de Canarias, Ofra, s/n. La Laguna, 38320 Santa Cruz de Tenerife, Spain
| | - María Martín
- Intensive Care Unit, Hospital Universitario de Canarias, Ofra, s/n. La Laguna, 38320 Santa Cruz de Tenerife, Spain
| | - Verónica Gonzalez
- Intensive Care Unit, Hospital Universitario de Canarias, Ofra, s/n. La Laguna, 38320 Santa Cruz de Tenerife, Spain
| | - Julia Alcoba-Flórez
- Microbiology Unit of Laboratory Department, Hospital Universitario Nuestra Señora de Candelaria, Crta del Rosario s/n, Santa Cruz de Tenerife 38010, Spain
| | - Miguel Ángel Rodriguez
- Intensive Care Unit, Hospital Universitario Nuestra Señora de Candelaria, Crta del Rosario s/n, Santa Cruz de Tenerife 38010, Spain
| | - Marta Riaño-Ruiz
- Department of Biochemistry, Complejo Hospitalario Universitario Insular, Plaza Dr. Pasteur s/n, Las Palmas de Gran Canaria 35016, Spain
| | - Juan Guillermo O Campo
- Intensive Care Unit, Complejo Hospitalario Universitario Insular, Plaza Dr. Pasteur s/n, Las Palmas de Gran Canaria 35016, Spain
| | - Lourdes González
- Internal Intensive Care Unit, Hospital Universitario de Canarias, Ofra, s/n, La Laguna, 38320 Santa Cruz de Tenerife, Spain
| | - Tamara Cantera
- Intensive Care Unit, Hospital Doctor José Molina Orosa, Ctra. Arrecife-Tinajo, km 1.300, Arrecife, Lanzarote 35550, Spain
| | - Raquel Ortiz-López
- Intensive Care Unit, Hospital General La Palma, Buenavista de Arriba s/n, Breña Alta, La Palma 38713, Spain
| | - Nazario Ojeda
- Department of Anaesthesiology, Hospital Universitario Dr. Negrín, Barranco de la Ballena s/n, Las Palmas de Gran Canaria 35010, Spain
| | - Aurelio Rodríguez-Pérez
- Department of Anaesthesiology, Hospital Universitario Dr. Negrín, Barranco de la Ballena s/n, Las Palmas de Gran Canaria 35010, Spain
| | - Casimira Domínguez
- Laboratory Department, Hospital Universitario Dr. Negrín, Barranco de la Ballena s/n, Las Palmas de Gran Canaria 35010, Spain
| | - Alejandro Jiménez
- Research Unit, Hospital Universitario de Canarias, Ofra, s/n, La Laguna, 38320 Santa Cruz de Tenerife, Spain
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25
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Gupta MK, Yadav G, Singh Y, Bhalekar A. Correlation of the changing trends of red cell distribution width and serum lactate as a prognostic factor in sepsis and septic shock. J Anaesthesiol Clin Pharmacol 2021; 36:531-534. [PMID: 33840936 PMCID: PMC8022044 DOI: 10.4103/joacp.joacp_105_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 10/20/2019] [Accepted: 03/06/2020] [Indexed: 01/20/2023] Open
Abstract
Background and Aims: Various biomarkers are used for predicting outcome from sepsis and septic shock but single value doesn't give clear-cut picture. Changing trends of serum lactate and red cell distribution width (RDW) gives more accurate information of patient outcome. So, aim of this prospective observational study was to identify the correlation, for initial and changing trend of blood lactate level and RDW, with 28-day mortality in sepsis and septic shock. Material and Methods: Patient who fulfills the criteria of sepsis and septic shock, according to the consensus conference published in 2016, were included in this study. All patients were resuscitated and managed according to institutional protocol for sepsis and septic shock. Serum lactate and RDW was obtained from arterial blood gas and complete blood count, respectively. Serum lactate and RDW were recorded at 0 h, 6 h, 24 h, day 2, day 3, day 7, week 2, and week 3. Mean between two groups were compared with student t-test. Pearson and Spearman correlation coefficient was used for establishing correlation between two continuous data. P value < 0.05 indicates significant difference between two groups. Results: There is positive correlation between serum lactate and RDW at all-time point in non-survival group while negative correlation was found in survival group except on day1 and 2. Conclusion: Changing trends of serum lactate and RDW can be used as a prognostic marker in patient of sepsis and septic shock.
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Affiliation(s)
- Mukesh K Gupta
- Department of Anaesthesiology, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Ghanshyam Yadav
- Department of Anaesthesiology, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Yashpal Singh
- Department of Anaesthesiology, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Arvind Bhalekar
- Department of Anaesthesiology, IMS, BHU, Varanasi, Uttar Pradesh, India
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Rezaeifar P, Nouri-Vaskeh M, Nazemiyeh M, Dorraji A, Sharifi A. Clinical Utility of Red Cell Distribution Width in Patients with Pleural Effusion. TANAFFOS 2020; 19:364-370. [PMID: 33959174 PMCID: PMC8088153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The red cell distribution width (RDW) value has been recently recognized as a valuable biomarker in clinical practice. The RDW value has not been evaluated so far in patients with pleural effusion. Thus, this study aimed to investigate whether RDW could distinguish between exudative and transudative pleural effusions. MATERIALS AND METHODS We measured protein and lactate dehydrogenase levels on both pleural fluids and serum samples from 223 cases and classified them as transudates or exudates based on the classic Light's criteria. We collected blood cell count elements such as RDW from the medical records. We also investigated the correlation between RDW and the nature of pleural effusion. RESULTS In 55.2% of the patients, pleural fluid was exudative. Although we found no significant association between RDW and the nature of the pleural fluid, we detected a significantly higher amount of RDW (14.9 ≤) in patients with exudative pleural effusion compared to transudate (66.7% vs. 33.3%; P= 0.01). In this category, neoplastic conditions were mostly observed in the patients (76.3%), followed by pulmonary thromboembolism (21.1%) and systemic lupus erythematous (2.6%). CONCLUSION The findings could not reveal any noticeable correlation between RDW and the Light criteria. However, it appears that elevated RDW levels give insights into the valuable nature of RDW in different conditions such as neoplastic diseases.
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Affiliation(s)
- Parisa Rezaeifar
- Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoud Nouri-Vaskeh
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoud Nazemiyeh
- Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Dorraji
- Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Akbar Sharifi
- Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran,,Correspondence to: Sharifi A Address: Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Email address:
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27
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Hornick A, Tashtish N, Osnard M, Shah B, Bradigan A, Albar Z, Tomalka J, Dalton J, Sharma A, Sekaly RP, Hejal R, Simon DI, Zidar DA, Al-Kindi SG. Anisocytosis is Associated With Short-Term Mortality in COVID-19 and May Reflect Proinflammatory Signature in Uninfected Ambulatory Adults. Pathog Immun 2020; 5:312-326. [PMID: 33089037 PMCID: PMC7556412 DOI: 10.20411/pai.v5i1.391] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/14/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Red cell distribution width (RDW), a measure of anisocytosis, is observed in chronic inflammation and is a prognostic marker in critically ill patients without COVID-19, but data in COVID-19 are limited. METHODS Between March 12 and April 19, 2020, 282 individuals with confirmed COVID-19 and RDW available within 7 days prior to COVID-19 confirmation were evaluated. Individuals were grouped by quartiles of RDW. Association between quartiles of RDW and mortality was assessed using the Kaplan-Meier method and statistical significance was assessed using the log-rank test. The association between RDW and all-cause mortality was further assessed using a Cox proportional hazards model. Plasma cytokine levels in uninfected ambulatory adults without cardiovascular disease (n=38) were measured and bivariate Spearman correlations and principle components analysis were used to identify relationships between cytokine concentrations with RDW. RESULTS After adjusting for age, sex, race, cardiovascular disease, and hemoglobin, there was an association between RDW and mortality (Quartile 4 vs Quartile 1: HR 4.04 [1.08-15.07]), with each 1% increment in RDW associated with a 39% increased rate of mortality (HR 1.39 [1.21-1.59]). Remote RDW was also associated with mortality after COVID-19 infection. Among uninfected ambulatory adults without cardiovascular disease, RDW was associated with elevated pro-inflammatory cytokines (TNF-α, IL8, IL6, IL1b), but not regulatory cytokines (TGFb). CONCLUSIONS Anisocytosis predicts short-term mortality in COVID-19 patients, often predates viral exposure, and may be related to a pro-inflammatory phenotype. Additional study of whether the RDW can assist in the early identification of pending cytokine storm is warranted.
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Affiliation(s)
- Andrew Hornick
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center
| | - Nour Tashtish
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center
| | - Michael Osnard
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center
| | - Binita Shah
- New York VA Harbor Healthcare System and New York University School of Medicine, New York, NY
| | - Allison Bradigan
- Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH
| | | | | | - Jarrod Dalton
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | | | | | - Rana Hejal
- Case Western Reserve University, Cleveland, OH.,Department of Pulmonary and Critical Care, University Hospitals, Cleveland, OH
| | - Daniel I Simon
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center.,Case Western Reserve University, Cleveland, OH
| | - David A Zidar
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center.,Case Western Reserve University, Cleveland, OH.,Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | - Sadeer G Al-Kindi
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center.,Case Western Reserve University, Cleveland, OH
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28
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Gunduz M, Ciftci I, Yasti AC, Guven A. Red cell distribution width and neutrophil-to-lymphocyte ratio as a predictive factor in treatment of pediatric patients with burns. INTERNATIONAL JOURNAL OF BURNS AND TRAUMA 2020; 10:101-106. [PMID: 32934863 PMCID: PMC7486559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/22/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Red cell distribution width (RDW) is associated with mortality in certain diseases. Neutrophil-to-lymphocyte ratio [NLR] is being used as a decisive parameter in inflammatory diseases. The association between morbidity and RDW-NLR in children with burns is unclear. We aimed to evaluate effectivity of these markers in children with burn. METHODS Retrospectively the treatment records of 39 children with second-degree superfisial, second-degree deep, and third-degree burns were evaluated. First group included patients those treated with grafts and second group included those treated with topical agents. Total body surface area [TBSA], age, RDW, NLR, sex, and albumin values were evaluated. The association of RDW and NLR with both groups were analysed. RESULTS Patients in group 2 had mild increase in RDW and NLR values but it was not more statistically significant than in group 1. A positive relationship between NLR and length of hospital stay, TBSA and length of hospital stay, and RDW and lymphocyte values was found. A negative correlation between albumin values and length of hospital stay was found. CONCLUSION NLR is associated with morbidity in patients with burns; although RDW has not any relationship with morbidity in pediatric scald burns.
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Affiliation(s)
- Metin Gunduz
- Department of Pediatric Surgery, Selcuk University Medical FacultyTurkey
| | - Ilhan Ciftci
- Department of Pediatric Surgery, Selcuk University Medical FacultyTurkey
| | - Ahmet Cinar Yasti
- Department of General Surgery, Hitit University Medical FacultyTurkey
| | - Ahmet Guven
- Department of Pediatric Surgery, Istanbul Silivri Medical Park HospitalTurkey
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29
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Lorente L, Martín MM, González-Rivero AF, Pérez-Cejas A, Sabatel R, Ramos L, Argueso M, Cáceres JJ, Solé-Violán J, Jiménez A, García-Marín V. Red blood cell distribution width and mortality of spontaneous intracerebral hemorrhage patients. Clin Neurol Neurosurg 2020; 195:106066. [PMID: 32652396 DOI: 10.1016/j.clineuro.2020.106066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Two studies have found an association between hematoma expansion and red blood cell distribution width (RDW) in the diagnosis of spontaneous intracerebral hemorrhage (SIH); however, its association with SIH mortality has been not reported. Thus, the objectives of this study were to determine whether RDW in patients with SIH could be associated with mortality and could be used as mortality biomarker. PATIENTS AND METHODS Observational and prospective study of patients with severe supratentorial SIH (Glasgow Coma Scale < 9) from Intensive Care Units of 6 Spanish hospitals. RDW was recorded at days 1, 4 and 8 of SIH. Thirty-day mortality was considered the end-point study. RESULTS Non-surviving patients (n = 54) compared to surviving patients (n = 63) had higher RDW (p ≤ 0.001) at days 1, 4 and 8 of SIH. The area under curve (95 % confidence interval) to predict 30-day mortality by RDW at days 1, 4, and 8 of SIH was 0.87 (0.79-0.92; p < 0.001), 0.74 (0.64-0.83; p < 0.001) and 0.79 (0.68-0.87; p < 0.001) respectively. In the regression analysis an association between RDW and 30-day mortality was found controlling for early evacuation of SIH, midline shift, ICH score and glycemia (Odds ratio = 1.159; 95 % CI = 1.046-1.284; p = 0.005). CONCLUSIONS The higher RDW during the first week of SIH in non-surviving than in surviving patients, and the potential role of RDW at any time during the first week as mortality biomarker are the main novelties of our study.
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Affiliation(s)
- Leonardo Lorente
- Intensive Care Unit. Hospital Universitario de Canarias. Ofra, s/n. La Laguna, 38320 Santa Cruz de Tenerife, Spain.
| | - María M Martín
- Intensive Care Unit. Hospital Universitario Nuestra Señora de Candelaria, Crta del Rosario s/n, Santa Cruz de Tenerife, 38010, Spain.
| | - Agustín F González-Rivero
- Laboratory Department. Hospital Universitario de Canarias. Ofra, s/n. La Laguna, 38320, Santa Cruz de Tenerife, Spain.
| | - Antonia Pérez-Cejas
- Laboratory Department. Hospital Universitario de Canarias. Ofra, s/n. La Laguna, 38320, Tenerife, Spain.
| | - Rafael Sabatel
- Department of Radiology. Hospital Universitario de Canarias. Ofra, s/n. La Laguna, 38320, Santa Cruz de Tenerife, Spain.
| | - Luis Ramos
- Intensive Care Unit. Hospital General La Palma, Buenavista de Arriba s/n, Breña Alta, La Palma, 38713, Spain.
| | - Mónica Argueso
- Intensive Care Unit. Hospital Clínico Universitario de Valencia. Avda. Blasco Ibáñez nº17-19, Valencia, 46004, Spain.
| | - Juan J Cáceres
- Intensive Care Unit. Hospital Insular, Plaza Dr. Pasteur s/n, Las Palmas de Gran Canaria, 35016, Spain.
| | - Jordi Solé-Violán
- Intensive Care Unit. Hospital Universitario Dr. Negrín, Barranco de la Ballena s/n, Las Palmas de Gran Canaria, 35010, Spain.
| | - Alejandro Jiménez
- Research Unit. Hospital Universitario de Canarias. Ofra, s/n. La Laguna, 38320, Santa Cruz de Tenerife, Spain.
| | - Victor García-Marín
- Department of Neurosurgery, Hospital Universitario de Canarias. Ofra, s/n. La Laguna, 38320, Santa Cruz de Tenerife, Spain.
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El Said AM, Fayed AM, El-Reweny EM. Comparative study between complete blood picture indices and presepsin as early prognostic markers in septic shock patients. EGYPTIAN JOURNAL OF ANAESTHESIA 2020. [DOI: 10.1080/11101849.2020.1789403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Ahmed M. El Said
- Department of Critical Care Medicine, Alexandria Armed Forces Hospital, Alexandria, Egypt
| | - Akram M. Fayed
- Department of Critical Care Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ehab M. El-Reweny
- Department of Critical Care Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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31
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Zhang L, Yu CH, Guo KP, Huang CZ, Mo LY. Prognostic role of red blood cell distribution width in patients with sepsis: a systematic review and meta-analysis. BMC Immunol 2020; 21:40. [PMID: 32631218 PMCID: PMC7339553 DOI: 10.1186/s12865-020-00369-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 06/29/2020] [Indexed: 02/08/2023] Open
Abstract
Background Outcome prediction for patients with sepsis may be conductive to early aggressive interventions. Numerous biomarkers and multiple scoring systems have been utilized in predicting outcomes, however, these tools were either expensive or inconvenient. We performed a meta-analysis to evaluate the prognostic role of red blood cell distribution width (RDW) in patients with sepsis. Methods The online databases of Embase, Web of science, Pubmed, Corchrane library, Chinese Wanfang database, CNKI database were systematically searched from the inception dates to June, 24th, 2020, using the keywords red cell distribution width and sepsis. The odds ratio (OR) or Hazards ratio (HR) with corresponding 95% confidence intervals (95%CI) were pooled to evaluate the association between baseline RDW and sepsis. A random-effects model was used to pool the data, and statistical heterogeneity between studies was evaluated using the I2 statistic. Sensitivity and subgroup analyses were performed to detect the publication bias and origin of heterogeneity. Results Eleven studies with 17,961 patients with sepsis were included in the meta-analysis. The pooled analyses indicated that increased baseline RDW was associated with mortality (HR = 1.14, 95%CI 1.09–1.20, Z = 5.78, P < 0.001) with significant heterogeneity (I2 = 80%, Pheterogeneity < 0.001). Similar results were found in the subgroup analysis stratified by site of infection, comorbidity, Newcastle-Ottawa Scale (NOS) score, study design, patients’ country. The predefined subgroup analysis showed that NOS score may be the origin of heterogeneity. Conclusions For patients with sepsis, baseline RDW may be a useful predictor of mortality, patients with increased RDW are more likely to have higher mortality.
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Affiliation(s)
- Lin Zhang
- Department of clinical laboratory, Hunan children's hospital, Changsha, China.
| | - Cui-Hua Yu
- Department of GCP certified sites, The third hospital of Changsha City, Changsha, Hunan Province, China
| | - Kuan-Peng Guo
- Department of clinical laboratory, Hunan children's hospital, Changsha, China
| | - Cai-Zhi Huang
- Department of clinical laboratory, Hunan children's hospital, Changsha, China
| | - Li-Ya Mo
- Department of clinical laboratory, Hunan children's hospital, Changsha, China
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32
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Angulo M, Moreno L, Aramendi I, Dos Santos G, Cabrera J, Burghi G. Complete Blood Count and Derived Indices: Evolution Pattern and Prognostic Value in Adult Burned Patients. J Burn Care Res 2020; 41:1260-1266. [PMID: 32511725 DOI: 10.1093/jbcr/iraa091] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Certain parameters of complete blood count (CBC) such as red cell distribution width (RDW) and mean platelet volume, as well as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and RDW-to-platelet ratio (RPR) have been associated with inflammatory status and outcome in diverse medical conditions. The aim of this study was to describe the evolution pattern of these parameters in adult burned patients. Adult burned patients admitted to the National Burn Center in Uruguay between May 2017 and February 2018 (discovery cohort) and between March 2018 and August 2019 (validation cohort) were included. Patients' characteristics and outcomes were recorded, as well as CBC parameters on days 1, 3, 5, and 7 after thermal injury. Eighty-eight patients were included in the discovery cohort. Total body surface area burned was 14 [7-23]% and mortality was 15%. Nonsurvivors presented higher RDW and mean platelet volume (P < .01). NLR decreased after admission in all patients (P < .01), but was higher in nonsurvivors (P < .01). Deceased patients also presented higher RPR on days 3, 5, and 7 (P < .001). On the contrary, PLR was reduced in nonsurvivors (P < .05). There was a significant correlation between NLR on admission and burn extension and severity. Kaplan-Meier analysis revealed that NLR, PLR, and RPR could identify patients with increased mortality. These findings were confirmed in the validation cohort (n = 95). Basic CBC parameters and derived indices could be useful as biomarkers to determine prognosis in adults with thermal injuries.
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Affiliation(s)
- Martín Angulo
- National Burn Center, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.,Department of Critical Care Medicine, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.,Department of Pathophysiology, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Laura Moreno
- National Burn Center, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.,Department of Critical Care Medicine, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Ignacio Aramendi
- National Burn Center, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.,Department of Critical Care Medicine, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Gimena Dos Santos
- Department of Hematology, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Julio Cabrera
- National Burn Center, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.,Department of Critical Care Medicine, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Gastón Burghi
- National Burn Center, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.,Department of Critical Care Medicine, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
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Early Mortality of Brain Infarction Patients and Red Blood Cell Distribution Width. Brain Sci 2020; 10:brainsci10040196. [PMID: 32224967 PMCID: PMC7226572 DOI: 10.3390/brainsci10040196] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/14/2020] [Accepted: 03/24/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Meta-analysis has found that high baseline red blood cell distribution width (RDW) is associated with increased long-term mortality (mortality at one year or more) in ischemic stroke. The objectives of this study were to determine whether there is an association between RDW and 30-day mortality, and to explore whether RDW during the first week of ischemic stroke could be a 30-day mortality biomarker. METHODS We included patients with malignant middle cerebral artery infarction (MMCAI). RDW at days 1, 4, and 8 of MMCAI were determined. The end-point study was 30-day mortality. RESULTS We found that survivor (n = 37) in respect to non-survivor patients (n = 37) had lower RDW at days 1 (p < 0.001), 4 (p < 0.001), and 8 (p = 0.02). The area under curve (95% CI) for prediction of 30-day mortality by RDW at days 1, 4, and 8 of MMCAI were 0.80 (0.69-0.89; p < 0.001), 0.79 (0.66-0.89; p < 0.001), and 0.73 (0.58-0.84; p = 0.02). Regression analysis showed an association between RDW (odds ratio = 1.695; 95% CI = 1.230-2.335; p < 0.001) and 30-day mortality. CONCLUSIONS The association between RDW and early mortality, and the potential role of RDW during the first week of MMCAI as a prognostic biomarker of early mortality were the main novelties of our study.
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Hu ZD, Lippi G, Montagnana M. Diagnostic and prognostic value of red blood cell distribution width in sepsis: A narrative review. Clin Biochem 2020; 77:1-6. [DOI: 10.1016/j.clinbiochem.2020.01.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/21/2019] [Accepted: 01/06/2020] [Indexed: 02/06/2023]
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35
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Hou P, Xue HP, Mao XE, Li YN, Wu LF, Liu YB. Inflammation markers are associated with frailty in elderly patients with coronary heart disease. Aging (Albany NY) 2019; 10:2636-2645. [PMID: 30325739 PMCID: PMC6224228 DOI: 10.18632/aging.101575] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 09/24/2018] [Indexed: 12/24/2022]
Abstract
The neutrophil-to-lymphocyte ratio (NLR) and red blood cell distribution width (RDW) are important indicators of adverse outcomes and have predictive value for many diseases; however, the relationships between frailty, and the NLR and RDW in patients with coronary heart disease (CHD) have not been determined. In this cross-sectional study, we investigated the association between frailty, and the NLR and RDW in elderly CHD patients ≥ 60 years of age. Frailty was defined according to frailty phenotype. Of 345 patients enrolled in the study, 22.6%, 58.3%, and 19.1% were characterized as robust, pre-frail, and frail, respectively. A significant positive correlation was observed between frailty and the NLR (r = 0.169) and RDW (r = 0.196). After adjusting for confounders, linear regression analyses showed that participants in the 4th quartile of the NLR or RDW were more likely to have a higher frailty phenotype score. Based on multivariable logistic regression, patients in the 4th quartile of the NLR and RDW, the fully-adjusted odds ratios for incident frailty were 2.894 (p = 0.011) and 2.494 (p = 0.040), respectively. Our findings indicate that frailty is associated with the NLR and RDW in elderly patients with CHD.
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Affiliation(s)
- Ping Hou
- School of Nursing, Yangzhou University, Yangzhou 225000, China
| | - Hui-Ping Xue
- School of Nursing, Yangzhou University, Yangzhou 225000, China
| | - Xin-E Mao
- School of Nursing, Yangzhou University, Yangzhou 225000, China
| | - Yong-Nan Li
- School of Nursing, Yangzhou University, Yangzhou 225000, China
| | - Lin-Feng Wu
- School of Nursing, Yangzhou University, Yangzhou 225000, China
| | - Yong-Bing Liu
- School of Nursing, Yangzhou University, Yangzhou 225000, China
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36
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Uffen JW, Oomen P, de Regt M, Oosterheert JJ, Kaasjager K. The prognostic value of red blood cell distribution width in patients with suspected infection in the emergency department. BMC Emerg Med 2019; 19:76. [PMID: 31795936 PMCID: PMC6889630 DOI: 10.1186/s12873-019-0293-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 11/19/2019] [Indexed: 12/21/2022] Open
Abstract
Background Sepsis is a potential life threatening dysregulated immune response to an infection, which can result in multi-organ failure and death. Unfortunately, good prognostic markers are lacking in patients with suspected infection to identify those at risk. Red blood cell distribution width (RDW) is a common and inexpensive hematologic laboratory measurement associated with adverse prognosis in multiple diseases. The aim of this study was to determine the prognostic value of RDW for mortality and early clinical deterioration in patients with a suspected infection in the emergency department. Methods In this single center prospective observational cohort study, consecutive patients with suspected infection presenting for internal medicine in the emergency department between September 2016 and March 2018 were included. For prognostic validation of bedside sepsis scores and RDW receiver operating characteristics were generated. Association between RDW and mortality and ICU admission was analyzed univariate and in a multivariate logistic regression model. Results 1046 patients were included. In multivariate analyses, RDW was significantly associated with 30-day mortality (OR 1.15, 95% CI: 1.04–1.28) and early clinical deterioration (OR 1.09, 95% CI: 1.00–1.18). For 30-day mortality RDW had an AUROC of 0.66 (95% CI 0.59–0.72). Optimal cut-off value for RDW 2 was 12.95%. For early clinical deterioration RDW had an AUROC of 0.59 (95% CI 0.54–0.63) with an optimal cut-off value of 14.48%. Conclusions RDW was found to be a significant independent prognostic factor of 30-day mortality and early clinical deterioration in patients with suspected infection.. Therefore it can be a used as an extra marker besides bedside sepsis scores in identifying patients at risk for worse outcome in patients with suspected infection.
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Affiliation(s)
- Jan Willem Uffen
- Department of Internal Medicine, division Acute Medicine, University Medical Centre Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands.
| | - Patrick Oomen
- Department of Internal Medicine, division Acute Medicine, University Medical Centre Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Marieke de Regt
- Department of Internal Medicine, division Infectious Disease, University Medical Centre Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Jan Jelrik Oosterheert
- Department of Internal Medicine, division Infectious Disease, University Medical Centre Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Karin Kaasjager
- Department of Internal Medicine, division Acute Medicine, University Medical Centre Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
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Zidar DA, Al-Kindi SG, Liu Y, Krieger NI, Perzynski AT, Osnard M, Nmai C, Anthony DD, Lederman MM, Freeman ML, Bonomo RA, Simon DI, Dalton JE. Association of Lymphopenia With Risk of Mortality Among Adults in the US General Population. JAMA Netw Open 2019; 2:e1916526. [PMID: 31790569 PMCID: PMC6902755 DOI: 10.1001/jamanetworkopen.2019.16526] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 10/08/2019] [Indexed: 12/28/2022] Open
Abstract
Importance Immune dysregulation can increase the risk of infection, malignant neoplasms, and cardiovascular disease, but improved methods are needed to identify and quantify immunologic hazard in the general population. Objective To determine whether lymphopenia is associated with reduced survival in outpatients. Design, Setting, and Participants This retrospective cohort study of the National Health and Nutrition Examination Survey (NHANES) included participants enrolled from January 1, 1999, to December 31, 2010, a large outpatient sample representative of the US adult population. Associations were evaluated between lymphopenia and other immunohematologic (IH) markers, clinical features, and survival during 12 years of follow-up, completed on December 31, 2011. Spearman correlations, Cox proportional hazards regression models, and Kaplan-Meier curves were used in univariable and multivariable models, allowing for nonlinear associations with bivariate cubic polynomials. Data were analyzed from September 1, 2018, through July 24, 2019. Exposures Absolute lymphocyte counts (ALC), red blood cell distribution width (RDW), and C-reactive protein (CRP) level. Main Outcomes and Measures All-cause survival. Results Among the 31 178 participants, the median (interquartile range) age at baseline was 45 (30-63) years, 16 093 (51.6%) were women, 16 260 (52.2%) were nonwhite, and overall 12-year rate of survival was 82.8%. Relative lymphopenia (≤1500/μL) and severe lymphopenia (≤1000/μL) were observed in 20.1% and 3.0%, respectively, of this general population and were associated with increased risk of mortality (age- and sex-adjusted hazard ratios [HRs], 1.3 [95% CI, 1.2-1.4] and 1.8 [95% CI, 1.6-2.1], respectively) due to cardiovascular and noncardiovascular causes. Lymphopenia was also associated with worse survival in multivariable models, including traditional clinical risk factors, and this risk intensified when accompanied by bone marrow dysregulation (elevated RDW) and/or inflammation (elevated CRP level). Ten-year mortality ranged from 3.8% to 62.1% based on lymphopenia status, tertile of CRP level, and tertile of RDW. A high-risk IH profile was nearly twice as common as type 2 diabetes (19.3% and 10.0% of participants, respectively) and associated with a 3-fold risk of mortality (HR, 3.2; 95% CI, 2.6-4.0). Individuals aged 70 to 79 years with low IH risk had a better 10-year survival (74.1%) than those who were a decade younger with a high-risk IH profile (68.9%). Conclusions and Relevance These findings suggest that lymphopenia is associated with reduced survival independently of and additive to traditional risk factors, especially when accompanied by altered erythropoiesis and/or heightened inflammation. Immune risk may be analyzed as a multidimensional entity derived from routine tests, facilitating precision medicine and population health interventions.
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Affiliation(s)
- David A. Zidar
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Department of Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Sadeer G. Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Yongmei Liu
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Nikolas I. Krieger
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Adam T. Perzynski
- Center for Healthcare Research and Policy, Case Western Reserve University at MetroHealth, Cleveland, Ohio
| | - Michael Osnard
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Christopher Nmai
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Donald D. Anthony
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
- Division of Rheumatology, MetroHealth Medical Center, Cleveland, Ohio
| | | | | | - Robert A. Bonomo
- Department of Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
| | - Daniel I. Simon
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Jarrod E. Dalton
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
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Zhang FX, Li ZL, Zhang ZD, Ma XC. Prognostic value of red blood cell distribution width for severe acute pancreatitis. World J Gastroenterol 2019; 25:4739-4748. [PMID: 31528098 PMCID: PMC6718036 DOI: 10.3748/wjg.v25.i32.4739] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/02/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Severe acute pancreatitis (SAP) is a common condition in the intensive care unit (ICU) and has a high mortality. Early evaluation of the severity and prognosis is very important for SAP therapy. Recently, red blood cell distribution (RDW) was associated with mortality of sepsis patients and could be used as a predictor of prognosis. Similarly, RDW may be associated with the prognosis of SAP patients and be used as a prognostic indicator for SAP patients.
AIM To investigate the prognostic value of RDW for SAP patients.
METHODS We retrospectively enrolled SAP patients admitted to the ICU of the First Affiliated Hospital of China Medical University from June 2015 to June 2017. According to the prognosis at 90 d, SAP patients were divided into a survival group and a non-survival group. RDW was extracted from a routine blood test. Demographic parameters and RDW were recorded and compared between the two groups. The receiver operator characteristic (ROC) curve was constructed and Cox regression analysis was performed to investigate the prognostic value of RDW for SAP patients.
RESULTS In this retrospective cohort study, 42 SAP patients were enrolled, of whom 22 survived (survival group) and 20 died (non-survival group). The baseline parameters were comparable between the two groups. The coefficient of variation of RDW (RDW-CV), standard deviation of RDW (RDW-SD), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and Sequential Organ Failure Assessment (SOFA) score were significantly higher in the non-survival group than in the survival group (P < 0.05). The RDW-CV and RDW-SD were significantly correlated with the APACHE II score and SOFA score, respectively. The areas under the ROC curves (AUCs) of RDW-CV and RDW-SD were all greater than those of the APACHE II score and SOFA score, among which, the AUC of RDW-SD was the greatest. The results demonstrated that RDW had better prognostic value for predicting the mortality of SAP patients. When the RDW-SD was greater than 45.5, the sensitivity for predicting prognosis was 77.8% and the specificity was 70.8%. Both RDW-CV and RDW-SD could be used as independent risk factors to predict the mortality of SAP patients in multivariate logistic regression analysis and univariate Cox proportional hazards regression analysis, similar to the APACHE II and SOFA scores.
CONCLUSION The RDW is greater in the non-surviving SAP patients than in the surviving patients. RDW is significantly correlated with the APACHE II and SOFA scores. RDW has better prognostic value for SAP patients than the APACHE II and SOFA scores and could easily be used by clinicians for the treatment of SAP patients.
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Affiliation(s)
- Fang-Xiao Zhang
- Department of Critical Care Medicine, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Zhi-Liang Li
- Department of Critical Care Medicine, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Zhi-Dan Zhang
- Department of Critical Care Medicine, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Xiao-Chun Ma
- Department of Critical Care Medicine, First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
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Park HJ, Song J, Park YB, Lee SK, Lee SW. Red blood cell distribution width is useful in discriminating adult onset Still's disease and sepsis within 24 hours after hospitalization. Korean J Intern Med 2018; 33:1234-1240. [PMID: 28838228 PMCID: PMC6234388 DOI: 10.3904/kjim.2016.068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 11/11/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND/AIMS Red blood cell distribution width (RDW) is a value representing the heterogeneity in the size of red blood cell, and it is usually used in distinguishing types of anaemia. Recently, it was reported that it could reflect the burden of inflammation in diverse diseases and their prognosis. Hence, in this study, we investigated whether RDW may contribute to discriminating adult onset Still's disease (AOSD) from sepsis in serious febrile patients within 24 hours after hospitalization. METHODS We reviewed the medical records and enrolled 21 AOSD patients, 27 sepsis patients and 30 matched healthy controls. We collected at least two laboratory results of variables including RDW within 24 hours after hospitalization, and we calculated their mean values. RESULTS Sepsis patients showed the significantly increased median white blood cell count, compared to AOSD patients (14,390.0/mm3 vs. 12,390.0/mm3 , p = 0.010). The median RDW in sepsis patients was higher than that in AOSD patients (15.0% vs. 13.3%, p = 0.001), and furthermore, the median RDW in both patient-groups was significantly higher than that in healthy controls. In contrast, the median ferritin level in sepsis patients was lower than that in AOSD patients (544.0 mg/dL vs. 3,756.6 mg/dL, p = 0.001). In multivariate analysis, RDW ≥ 14.8% (odds ratio, 17.549) and ferritin < 2,251.0 mg/dL (odds ratio, 32.414) independently suggested sepsis more than AOSD in patients initially presenting with fever requiring hospitalization. CONCLUSION RDW might be a rapid and helpful marker for a differential diagnosis between AOSD from sepsis at an early phase.
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Affiliation(s)
- Hee-Jin Park
- Division of Rheumatology, Department of Internal Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Jungsik Song
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Beom Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Soo-Kon Lee
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Won Lee
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Correspondence to Sang-Won Lee, M.D. Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: +82-2-2228-1984 Fax: +82-2-363-6884 E-mail:
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Red blood cell distribution width predicts long-term outcomes in sepsis patients admitted to the intensive care unit. Clin Chim Acta 2018; 487:112-116. [PMID: 30218659 DOI: 10.1016/j.cca.2018.09.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/01/2018] [Accepted: 09/11/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although some underpowered studies have proven that increased red blood cell distribution width (RDW) may be associated with short-term prognosis of sepsis, the long-term prognostic value of RDW remains largely unknown. METHODS This retrospective observational study was based on the Medical Information Mart for Intensive Care III (MIMIC III), a large critical care database. Baseline RDW and conventional disease severity scores were extracted along with data on 4-year mortality, of adult patients with severe sepsis upon first admission to the intensive care unit (ICU). The prognostic value of RDW was analyzed with Kapan-Meier cure, Cox model, receiver operating characteristic (ROC) curve analysis, net reclassification index (NRI) and integrated discriminatory index (IDI). RESULTS A total of 4264 subjects were included. The area under ROC curve of RDW for predicting 4-year mortality was 0.64 (95% CI: 0.63-0.66). In multivariable Cox model, increased RDW was independently associated with all-cause mortality, irrespective of anemia. With conventional severity scores as reference, RDW had continuous NRI comprised between 0.18 and 0.20, and IDI comprised between 0.30 and 0.40. CONCLUSION RDW values significantly predicts long-term all-cause mortality in critically ill patients with severe sepsis beyond conventional severity scores.
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Tonietto TA, Boniatti MM, Lisboa TC, Viana MV, Dos Santos MC, Lincho CS, Pellegrini JAS, Vidart J, Neyeloff JL, Faulhaber GAM. Elevated red blood cell distribution width at ICU discharge is associated with readmission to the intensive care unit. Clin Biochem 2018; 55:15-20. [PMID: 29550510 DOI: 10.1016/j.clinbiochem.2018.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/27/2018] [Accepted: 03/13/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Red blood cell distribution width (RDW) is a predictor of mortality in critically ill patients. Our objective was to investigate the association between the RDW at ICU discharge and the risk of ICU readmission or unexpected death in the ward. METHODS A secondary analysis of prospectively collected data study was conducted including patients discharged alive from the ICU to the ward. The target variable was the RDW collected at ICU discharge. Elevated RDW was defined as an RDW > 16%. Outcomes of interest included readmission to the ICU, unexpected death in the ward and in-hospital death. Variables with a p-value <0.1 in the univariate analysis or with biological plausibility for the occurrence of the outcome were included in the Cox proportional hazards model for adjustment. RESULTS We included 813 patients. A total of 138 readmissions to the ICU and 44 unexpected deaths in the ward occurred. Elevated RDW at ICU discharge was independently associated with readmission to the ICU or unexpected death in the ward after multivariable adjustment (HR: 1.901; 95% CI 1.357-2.662). Other variables associated with this outcome included age, tracheostomy and mean corpuscular volume (MCV) at ICU discharge. Similar results were obtained after the exclusion of unexpected deaths in the ward (HR 1.940; CI 1.312-2.871) and for in-hospital deaths (HR 1.716; 95% CI 1.141-2.580). CONCLUSIONS Elevated RDW at ICU discharge is independently associated with ICU readmission and in-hospital death.
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Affiliation(s)
- Tiago Antonio Tonietto
- Department of Critical Care Medicine, Hospital Nossa Senhora da Conceição, 596 Francisco Trein Ave, Porto Alegre 91350-200, RS, Brazil; Department of Critical Care Medicine, Hospital de Clínicas de Porto Alegre, 2350 Ramiro Barcelos Street, Porto Alegre 90035-903, RS, Brazil.
| | - Marcio Manozzo Boniatti
- Department of Critical Care Medicine, Hospital de Clínicas de Porto Alegre, 2350 Ramiro Barcelos Street, Porto Alegre 90035-903, RS, Brazil.
| | - Thiago Costa Lisboa
- Department of Critical Care Medicine, Hospital de Clínicas de Porto Alegre, 2350 Ramiro Barcelos Street, Porto Alegre 90035-903, RS, Brazil.
| | - Marina Verçoza Viana
- Department of Critical Care Medicine, Hospital Nossa Senhora da Conceição, 596 Francisco Trein Ave, Porto Alegre 91350-200, RS, Brazil; Department of Critical Care Medicine, Hospital de Clínicas de Porto Alegre, 2350 Ramiro Barcelos Street, Porto Alegre 90035-903, RS, Brazil.
| | - Moreno Calcagnotto Dos Santos
- Department of Critical Care Medicine, Hospital de Clínicas de Porto Alegre, 2350 Ramiro Barcelos Street, Porto Alegre 90035-903, RS, Brazil.
| | - Carla Silva Lincho
- Department of Critical Care Medicine, Hospital Nossa Senhora da Conceição, 596 Francisco Trein Ave, Porto Alegre 91350-200, RS, Brazil.
| | - José Augusto Santos Pellegrini
- Department of Critical Care Medicine, Hospital de Clínicas de Porto Alegre, 2350 Ramiro Barcelos Street, Porto Alegre 90035-903, RS, Brazil.
| | - Josi Vidart
- Department of Critical Care Medicine, Hospital de Clínicas de Porto Alegre, 2350 Ramiro Barcelos Street, Porto Alegre 90035-903, RS, Brazil.
| | - Jeruza Lavanholi Neyeloff
- Hospital de Clínicas de Porto Alegre, 2350 Ramiro Barcelos Street, Porto Alegre 90035-903, RS, Brazil.
| | - Gustavo Adolpho Moreira Faulhaber
- Department of Internal Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, 721 Jeronimo de Ornelas Ave, Porto Alegre 90040-341, RS, Brazil.
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Kim HJ, Yoo J, Jung SM, Song JJ, Park YB, Lee SW. Red Blood Cell Distribution Width Can Predict Vasculitis Activity and Poor Prognosis in Granulomatosis with Polyangiitis. Yonsei Med J 2018; 59:294-302. [PMID: 29436199 PMCID: PMC5823833 DOI: 10.3349/ymj.2018.59.2.294] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/04/2017] [Accepted: 12/05/2017] [Indexed: 11/27/2022] Open
Abstract
PURPOSE We investigated whether red blood cell distribution width (RDW) predicts vasculitis activity based on Birmingham vasculitis activity score (BVAS) or BVAS for granulomatosis with polyangiitis (GPA) at diagnosis and poor prognosis during follow-up in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). MATERIALS AND METHODS We reviewed the medical records of 150 patients with AAV. We defined severe GPA as BVAS for GPA ≥7 (the highest quartile). Correlation and standardised correlation coefficients were analysed by linear regression tests. The differences between groups were evaluated by Mann-Whitney test. Relative risk (RR) was assessed by chi square test and Cox hazards model. RESULTS RDW was correlated only with the vasculitis activity of GPA among patients with AAV. An increase in RDW was associated with the absence of ear nose throat (ENT) manifestation, but not proteinase 3-ANCA. Significant differences were noted in cumulative refractory free survival according to RDW ≥15.4% (p=0.007) and the absence of ENT manifestation (p=0.036). Multivariate Cox hazards analysis identified RDW ≥15.4% as the only significant predictor of refractory disease in GPA (RR 17.573). CONCLUSION RDW predicts vasculitis activity in GPA, and RDW ≥15.4% at diagnosis may increase the risk of severe GPA at diagnosis and predict refractory diseases during follow-up.
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Affiliation(s)
- Ho Jae Kim
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Juyoung Yoo
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Min Jung
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jason Jungsik Song
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Beom Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Won Lee
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Korea.
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Ju XF, Wang F, Wang L, Wu X, Jiang TT, You DL, Yang BH, Xia JJ, Hu SY. Dynamic Change of Red Cell Distribution Width Levels in Prediction of Hospital Mortality in Chinese Elderly Patients with Septic Shock. Chin Med J (Engl) 2018; 130:1189-1195. [PMID: 28485319 PMCID: PMC5443025 DOI: 10.4103/0366-6999.205858] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background: The normal range of red cell distribution width (RDW) level is <15%. Several studies have indicated that a high RDW level was associated with mortality in critically ill patients, and the patients with a high RDW level need increased focus in clinical practice. In view of the difficulty in defining the specific value of high RDW level, the key is to focus on the patient with the level beyond the normal upper limit. This study aimed to determine whether dynamic change of RDW levels, rather than the level itself, is predictive of death in elderly patients with septic shock when RDW level is beyond 15%. Methods: Between September 2013 and September 2015, the elderly septic shock patients with RDW level beyond 15% were enrolled in this study. The RDW levels were measured at enrollment (day 1), and days 4 and 7 after enrollment. Sequential Organ Failure Assessment (SOFA) scores were recorded simultaneously. Results: A total of 45 patients, including 32 males and 13 females, were included in the final analysis. Based on their hospital outcomes, these patients were divided into the survivor group (n = 26) and the nonsurvivor group (n = 19). There were no significant differences in age, gender, body mass index, initial level of RDW, Acute Physiology and Chronic Health Evaluation II scores, and SOFA scores between survivors and nonsurvivors. At days 4 and 7 measurement, both RDW level (median [interquartile range]: day 4: 15.8 [2.0]% vs. 16.7 [2.0]%, P = 0.011; and day 7: 15.6 [1.8]% vs. 17.7 [2.5]%, P = 0.001) and SOFA scores (day 4: 7.0 [4.0] vs. 16.0 [5.0], P < 0.001, day 7: 5.5 [4.0] vs. 17.0 [5.0], P < 0.001) were significantly lower in survivors than those in nonsurvivors. Dynamic changes of RDW and SOFA scores in survivor group were significantly different from those in nonsurvivor group (all P < 0.05). Continuous increase in RDW level was observed in 10 of the 13 nonsurvivors, but only in 3 of the 26 survivors. The level of RDW7 and dynamic changes significantly correlated with their counterparts of SOFA scores (all P < 0.05), whereas the levels of RDW1 and RDW4 had no significant correlation with their counterparts of SOFA scores (all P > 0.05). Conclusions: Continuous increase in RDW level, rather than the level of RDW itself, was more useful in predicting hospital death in elderly patients with septic shock when the level of RDW was >15%. The dynamic changes of RDW were highly correlated with the SOFA score in the patients.
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Affiliation(s)
- Xue-Feng Ju
- Department of Emergency Medicine, Shanghai Jiading District Central Hospital, Shanghai 201800, China
| | - Fei Wang
- Department of Critical Care Medicine, Shanghai Jiading District Central Hospital, Shanghai 201800, China
| | - Li Wang
- Department of Emergency Medicine, Shanghai Jiading District Central Hospital, Shanghai 201800, China
| | - Xiao Wu
- Department of Emergency Medicine, Shanghai Jiading District Central Hospital, Shanghai 201800, China
| | - Ting-Ting Jiang
- Department of Critical Care Medicine, Shanghai Jiading District Central Hospital, Shanghai 201800, China
| | - Da-Li You
- Department of Critical Care Medicine, Shanghai Jiading District Central Hospital, Shanghai 201800, China
| | - Bing-Hua Yang
- Department of Emergency Medicine, Shanghai Jiading District Central Hospital, Shanghai 201800, China
| | - Jian-Jun Xia
- Department of Emergency Medicine, Shanghai Jiading District Central Hospital, Shanghai 201800, China
| | - Shan-You Hu
- Department of Critical Care Medicine, Shanghai Jiading District Central Hospital, Shanghai 201800, China
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Martin SL, Desai S, Nanavati R, Colah RB, Ghosh K, Mukherjee MB. Red cell distribution width and its association with mortality in neonatal sepsis. J Matern Fetal Neonatal Med 2018; 32:1925-1930. [PMID: 29310472 DOI: 10.1080/14767058.2017.1421932] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Neonatal sepsis is a major cause of mortality in the developing countries. However, with current severity scores and laboratory parameters, predicting outcomes of neonatal sepsis is a serious challenge. Red cell distribution width (RDW) is a readily available pragmatic means to predict outcomes of various comorbidities in adults and children, without causing any additional blood loss. However, its utility in neonates remains unexplored. Hence, the objective of the present study was to evaluate the association of RDW with neonatal sepsis and its role as a predictive marker for mortality. METHODS This Prospective observational study was carried out in a Level IIIB NICU for a period of 3 years. It involved comparison of RDW values of septic neonates with those of controls (matched for gestational age and birth weight) with an equal allocation ratio. A total of 251 septic neonates along with 251 controls >28 weeks of gestational age were enrolled. The RDW was derived from complete blood count done within first 6 hours of life. After arranging the RDW (median; interquartile range (IQR)), the values were categorized as those above the 50th percentile i.e. ≥20% and those below the 50th percentile i.e. <20%. The cumulative survival rates of the above two groups were assessed using the Kaplan-Meier curve and the log rank test. RESULTS RDW levels were significantly higher among the neonatal sepsis cases (19.90%) as compared to the controls (18.90%) with a p value of < .001. RDW was significantly higher amongst the nonsurvivors than survivors (p < .003). Kaplan-Meier curve showed that septic neonates having RDW values ≥20% had significantly increased mortality (p < .02) with a hazard ratio of 0.5. CONCLUSIONS High RDW is associated with neonatal sepsis and is an independent outcome predictor for mortality associated with neonatal sepsis.
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Affiliation(s)
- Snehal L Martin
- a Department of Haematogenetics , National Institute of Immunohaematology (ICMR), KEM Hospital campus , Mumbai , India
| | - Saumil Desai
- b Department of Neonatology , KEM Hospital , Mumbai , India
| | - Ruchi Nanavati
- b Department of Neonatology , KEM Hospital , Mumbai , India
| | - Roshan B Colah
- a Department of Haematogenetics , National Institute of Immunohaematology (ICMR), KEM Hospital campus , Mumbai , India
| | - Kanjaksha Ghosh
- a Department of Haematogenetics , National Institute of Immunohaematology (ICMR), KEM Hospital campus , Mumbai , India
| | - Malay B Mukherjee
- a Department of Haematogenetics , National Institute of Immunohaematology (ICMR), KEM Hospital campus , Mumbai , India
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Red blood cell distribution width independently predicts 1-month mortality in acute decompensation of cirrhotic patients admitted to emergency department. Eur J Gastroenterol Hepatol 2018; 30:33-38. [PMID: 29064853 DOI: 10.1097/meg.0000000000000993] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The aim of this study was to explore whether red blood cell distribution width (RDW) can help predict the risk of short-term mortality in patients with acute decompensation of cirrhosis. PATIENTS AND METHODS We carried out a retrospective analysis of all patients consecutively admitted to the emergency department (ED) of the University Hospital of Verona (Italy) for acute decompensation of liver cirrhosis, between 1 June 2013 and 31 December 2016. The RDW value was measured at ED admission, along with collection of clinical features and other laboratory data, and was then correlated with severity of disease (Chronic Liver Failure Consortium Acute Decompensation score; CLIF-C AD score) and 1-month mortality. RESULTS The final study population consisted of 542 patients, 80 (14.8%) of whom died within 30 days after ED admission. The median RDW of patients who died was significantly higher than the median RDW of those who survived (17.4 vs. 15.5%; P<0.001). The percentage of patients who died significantly increased across different RDW quartiles (6.8, 9.7, 11.5 and 32.1%, P<0.001). In univariate analysis, significant correlation was observed between RDW and clinical severity of acute decompensate cirrhosis (Child-Pugh score: r=0.198, P<0.001; Model for End-Stage Liver Disease score: r=0.311, P=0.001; CLIF-C AD: 0.127, P=0.005). The combination of RDW and CLIF-C AD score exhibited better performance for predicting 1-month mortality than the CLIF-C AD score alone (area under the curve=0.769 vs. 0.720; P=0.006). In multivariate analysis, RDW was independently associated with a 1.2-2.3 higher risk of 1-month mortality. CONCLUSION The assessment of RDW at ED admission may improve risk stratification of patients with acute decompensation of cirrhosis.
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Han F, Shang X, Wan F, Liu Z, Tian W, Wang D, Liu Y, Wang Y, Zhang B, Ju Y. Clinical value of the preoperative neutrophil-to-lymphocyte ratio and red blood cell distribution width in patients with colorectal carcinoma. Oncol Lett 2017; 15:3339-3349. [PMID: 29435077 DOI: 10.3892/ol.2017.7697] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 09/09/2017] [Indexed: 12/13/2022] Open
Abstract
The aim of the present study was to investigate the clinical value of the preoperative neutrophil-to-lymphocyte ratio (NLR) and red blood cell distribution width (RDW) in the peripheral blood of colorectal carcinoma (CRC) patients. Clinical data obtained from 240 patients with CRC undergoing radical surgical resection in Shandong Provincial Hospital Affiliated to Shandong University (Jinan, Shandong, China) between January 2011 and April 2015 were retrospectively analyzed. Data were also collected from 110 patients with colon polyps and 48 healthy volunteers to serve as controls for comparative analysis. The clinicopathological characteristics of the patients in the low and high NLR and RDW groups were compared. The NLR and RDW values were compared prior to and following surgery. Kaplan-Meier analyses and Cox regression modeling were performed to predict overall survival (OS) and disease-free survival (DFS). The NLR and RDW levels in the CRC patients were markedly higher than those in the colon polyp patients and the healthy controls. The optimum NLR and RDW cutoff points for CRC were 2.06 and 13.45%, respectively. Significant differences were detected in tumor location, diameter, degree of differentiation, tumor depth, carcinoembryonic antigen and carbohydrate antigen 199 when comparing the high and low NLR groups (P<0.05). A high RDW was significantly associated with distant metastasis and older age in CRC patients. No significant difference was detected in the NLR and RDW levels of CRC patients prior to and following surgery (P>0.05). CRC patients with an increased RDW had significantly worse OS and DFS rates, particularly those with metastatic CRC (P<0.05). Patients with a high NLR exhibited a reduced DFS time in CRC (P=0.053), although this difference was not significant, and a significantly worse DFS time in metastatic CRC (P=0.047). In conclusion, it is convenient to use preoperative NLR and RDW to predict prognosis following surgery for patients with CRC.
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Affiliation(s)
- Fuyan Han
- Department of Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Xuming Shang
- Department of Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Furong Wan
- Department of Laboratory Medicine, Qianfoshan Hospital Affiliated to Shandong University, Jinan, Shandong 250014, P.R. China
| | - Zhanfeng Liu
- Department of Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Wenjun Tian
- Department of Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Dan Wang
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Yiqing Liu
- Department of Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Yong Wang
- Department of Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Bingchang Zhang
- Department of Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Ying Ju
- Department of Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
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Fontana V, Spadaro S, Bond O, Cavicchi FZ, Annoni F, Donadello K, Vincent JL, De Backer D, Taccone FS. No relationship between red blood cell distribution width and microcirculatory alterations in septic patients. Clin Hemorheol Microcirc 2017; 66:131-141. [PMID: 28128746 DOI: 10.3233/ch-160154] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Increased red cell distribution width (RDW), a quantitative measure of erythrocyte size variability, has been associated with increased mortality in critically ill patients. METHODS In this post-hoc analysis of prospectively collected data, we studied 122 septic patients with and without shock who had undergone sublingual microcirculatory assessment using Sidestream Dark Field (SDF) videomicroscopy. Patient demographics, comorbidities, the Acute Physiology and Chronic Health Evaluation (APACHE) II score on admission and the Sequential Organ Failure Assessment (SOFA) score on the day of the microcirculatory assessment were collected. The RDW was retrospectively collected on the day of the microcirculatory evaluation from the routine daily blood count analysis. RESULTS Median patient age was 68[55-77] years, and median APACHE II and SOFA scores were 22[17-28] and 10[8-12], respectively; ICU mortality was 43%. On the day of the microcirculatory analysis, the median RDW was 13.8[12.8-15.5]% and was elevated (>13.4%) in 74 (61%) patients. There was no correlation between RDW and microcirculatory parameters (functional capillary density, r2 = 0.12; proportion of small perfused vessels, r2 = 0.17; mean flow index, r2 = 0.14). RDW was not related to disease severity, the presence of shock or survival. CONCLUSIONS RDW is not associated with microcirculatory alterations or prognosis in septic patients.
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Affiliation(s)
- Vito Fontana
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.,Department of Morphological Surgery and Experimental Medicine, Arcispedale Sant'Anna, Universitá di Ferrara, Ferrara, Italy
| | - Savino Spadaro
- Department of Morphological Surgery and Experimental Medicine, Arcispedale Sant'Anna, Universitá di Ferrara, Ferrara, Italy
| | - Ottavia Bond
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Federica Zama Cavicchi
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.,Department of Morphological Surgery and Experimental Medicine, Arcispedale Sant'Anna, Universitá di Ferrara, Ferrara, Italy
| | - Filippo Annoni
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Katia Donadello
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Daniel De Backer
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.,Department of Intensive Care and Emergency, CHIREC Hospitals, Belgium
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Red blood cell distribution width is associated with mortality in elderly patients with sepsis. Am J Emerg Med 2017; 36:949-953. [PMID: 29133071 DOI: 10.1016/j.ajem.2017.10.056] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 10/15/2017] [Accepted: 10/24/2017] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION RDW is a prognostic biomarker and associated with mortality in cardiovascular disease, stroke and metabolic syndrome. For elderly patients, malnutrition and multiple comorbidities exist, which could affect the discrimination ability of RDW in sepsis. The main purpose of our study was to evaluate the prognostic value of RDW in sepsis among elderly patients. METHODS This was a retrospective cohort study conducted in emergency department intensive care units (ED-ICU) between April 2015 and November 2015. Elderly patients (≥65years old) who were admitted to the ED-ICU with a diagnosis of severe sepsis and/or septic shock were included. The demographic data, biochemistry data, qSOFA, and APACHE II score were compared between survivors and nonsurvivors. RESULTS A total of 117 patients was included with mean age 81.5±8.3years old. The mean APACHE II score was 21.9±7.1. In the multivariate Cox proportional hazards model, RDW level was an independent variable for mortality (hazard ratio: 1.18 [1.03-1.35] for each 1% increase in RDW, p=0.019), after adjusting for CCI, any diagnosed malignancy, and eGFR. The AUC of RDW in predicting mortality was 0.63 (95% confidence interval [CI]: 0.52-0.74, p=0.025). In subgroup analysis, for qSOFA <2, nonsurvivors had higher RDW levels than survivors (17.0±3.3 vs. 15.3±1.4%, p=0.044). CONCLUSIONS In our study, RDW was an independent predictor of in-hospital mortality in elderly patients with sepsis. For qSOFA scores <2, higher RDW levels were associated with poor prognosis. RDW could be a potential parameter used alongside the clinical prediction rules.
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Prognostic values of red blood cell distribution width, platelet count, and red cell distribution width-to-platelet ratio for severe burn injury. Sci Rep 2017; 7:13720. [PMID: 29057939 PMCID: PMC5651922 DOI: 10.1038/s41598-017-13151-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 09/19/2017] [Indexed: 12/27/2022] Open
Abstract
Red blood cell distribution width (RDW), platelet count (PLT), and a RDW-to-PLT ratio (RPR) have been associated with inflammatory activity and adverse outcomes in many diseases. This study has aimed to investigate the association between these indicators and the mortality rate of severe burn patients. From 2008 to 2014, 610 cases of severe burn patients from two burn centers in eastern China were enrolled in this study. Eighty-eight patients died within 90 days after admission. The RDW, PLT, and RPR were studied through Cox regression analysis on the 3rd and 7th day. The RDW, PLT, and RPR values on the 3rd and 7th day were significantly associated with the outcomes of severe burn patients (P < 0.01). High RPR was significantly associated with a 90-day mortality rate at the two time points. However, the RDW and PLT did not provide independent predictive values. Our results indicated that the RPR values on the 3rd and 7th day were associated with the mortality rates of severe burn patients (P < 0.01). Meanwhile, the RDW and PLT values at these time points failed to provide independent values for burn mortality prediction. Thus, the RPR can serve as an independent and novel marker for mortality rates prediction in severe burn patients.
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Orfanu AE, Popescu C, Leuștean A, Negru AR, Tilişcan C, Aramă V, Aramă ȘS. The Importance of Haemogram Parameters in the Diagnosis and Prognosis of Septic Patients. ACTA ACUST UNITED AC 2017; 3:105-110. [PMID: 29967880 PMCID: PMC5769899 DOI: 10.1515/jccm-2017-0019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 07/11/2017] [Indexed: 01/15/2023]
Abstract
Sepsis represents a severe pathology that requires both rapid and precise positive and differential diagnosis to identify patients who need immediate antimicrobial therapy. Monitoring septic patients’ outcome leads to prolonged hospitalisation and antibacterial therapy, often accompanied by substantial side effects, complications and a high mortality risk. Septic patients present with complex pathophysiological and immunological disorders and with a predominance of pro-inflammatory or anti-inflammatory mediators which are heterogeneous with respect to the infectious focus, the aetiology of sepsis or patients’ immune status or comorbidities. Previous studies performed have analysed inflammatory biomarkers, but a test or combinations of tests that can quickly and precisely establish a diagnosis or prognosis of septic patients has yet to be discovered. Recent research has focused on re-analysing older accessible parameters found in the complete blood count to determine the sensitivity, specificity, positive and negative predictive values for the diagnosis and prognosis of sepsis. The neutrophil/lymphocyte count ratio (NLCR), mean platelet volume (MPV) and red blood cells distribution width (RDW) are haemogram indicators which have been evaluated and which are of proven use in septic patients’ management.
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Affiliation(s)
- Alina Elena Orfanu
- National Institute for Infectious Diseases "Prof. Dr Matei Balș", Dr Calistrat Grozovici Street, no 1, 021105, Bucharest, Romania.,University of Medicine and Pharmacy "Carol Davila", Dionisie Lupu Street, no 37, 020021, Bucharest, Romania
| | - Cristina Popescu
- National Institute for Infectious Diseases "Prof. Dr Matei Balș", Dr Calistrat Grozovici Street, no 1, 021105, Bucharest, Romania.,University of Medicine and Pharmacy "Carol Davila", Dionisie Lupu Street, no 37, 020021, Bucharest, Romania
| | - Anca Leuștean
- National Institute for Infectious Diseases "Prof. Dr Matei Balș", Dr Calistrat Grozovici Street, no 1, 021105, Bucharest, Romania
| | - Anca Ruxandra Negru
- National Institute for Infectious Diseases "Prof. Dr Matei Balș", Dr Calistrat Grozovici Street, no 1, 021105, Bucharest, Romania.,University of Medicine and Pharmacy "Carol Davila", Dionisie Lupu Street, no 37, 020021, Bucharest, Romania
| | - Cătălin Tilişcan
- National Institute for Infectious Diseases "Prof. Dr Matei Balș", Dr Calistrat Grozovici Street, no 1, 021105, Bucharest, Romania.,University of Medicine and Pharmacy "Carol Davila", Dionisie Lupu Street, no 37, 020021, Bucharest, Romania
| | - Victoria Aramă
- National Institute for Infectious Diseases "Prof. Dr Matei Balș", Dr Calistrat Grozovici Street, no 1, 021105, Bucharest, Romania.,University of Medicine and Pharmacy "Carol Davila", Dionisie Lupu Street, no 37, 020021, Bucharest, Romania
| | - Ștefan Sorin Aramă
- National Institute for Infectious Diseases "Prof. Dr Matei Balș", Dr Calistrat Grozovici Street, no 1, 021105, Bucharest, Romania.,University of Medicine and Pharmacy "Carol Davila", Dionisie Lupu Street, no 37, 020021, Bucharest, Romania
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