Prognostic value of red blood cell distribution width in hepatocellular carcinoma

Red blood cell distribution width (RDW) - A new nutritional biomarker to assess nutritional risk and response to nutritional therapy?

BACKGROUND & AIMS

Red cell distribution width (RDW) has been proposed as a surrogate marker for acute and chronic diseases and may be influenced by nutritional deficits. We assessed the prognostic value of RDW regarding clinical outcomes and nutritional treatment response among medical inpatients at nutritional risk.

METHODS

This is a secondary analysis of EFFORT, a randomized, controlled, prospective, multicenter trial investigating the effects of nutritional support in patients at nutritional risk in eight Swiss hospitals. We examined the association between RDW and mortality in regression analysis.

RESULTS

Among 1,244 included patients (median age 75 years, 46.6 % female), high RDW (≥15 %) levels were found in 38 % of patients (n = 473) with a significant association of higher malnutrition risk [OR 1.48 (95%CI 1.1 to 1.98); p = 0.009]. Patients with high RDW had a more than doubling in short-term (30 days) mortality risk [adjusted HR 2.12 (95%CI 1.44 to 3.12); p < 0.001] and a signficant increase in long-term (5 years) mortality risk [adjusted HR 1.73 (95%CI 1.49 to 2.01); p < 0.001]. Among patients with high RDW, nutritional support reduced morality within 30 days [adjusted OR 0.56 (95%CI 0.33 to 0.96); p = 0.035], while the effect of the nutritional intervention in patients with low RDW was markedly smaller.

CONCLUSIONS

Among medical patients at nutritional risk, RDW correlated with several nutritional parameters and was a strong prognostic marker for adverse clinical outcomes at short- and long-term, respectively. Patients with high baseline RDW levels also showed a strong benefit from the nutritional intervention. Further research is needed to understand whether monitoring of RDW over time severs as a nutritional biomarker to assess effectiveness of nutritional treatment in the long run.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02517476.

Association of red blood cell distribution width with hospital admission and in-hospital mortality across all-cause adult emergency department visits

Objectives

To test the association between the initial red blood cell distribution width (RDW) value in the emergency department (ED) and hospital admission and, among those admitted, in-hospital mortality.

Materials and Methods

We perform a retrospective analysis of 210 930 adult ED visits with complete blood count results from March 2013 to February 2022. Primary outcomes were hospital admission and in-hospital mortality. Variables for each visit included demographics, comorbidities, vital signs, basic metabolic panel, complete blood count, and final diagnosis. The association of each outcome with the initial RDW value was calculated across 3 age groups (<45, 45-65, and >65) as well as across 374 diagnosis categories. Logistic regression (LR) and XGBoost models using all variables excluding final diagnoses were built to test whether RDW was a highly weighted and informative predictor for each outcome. Finally, simplified models using only age, sex, and vital signs were built to test whether RDW had additive predictive value.

Results

Compared to that of discharged visits (mean [SD]: 13.8 [2.03]), RDW was significantly elevated in visits that resulted in admission (15.1 [2.72]) and, among admissions, those resulting in intensive care unit stay (15.3 [2.88]) and/or death (16.8 [3.25]). This relationship held across age groups as well as across various diagnosis categories. An RDW >16 achieved 90% specificity for hospital admission, while an RDW >18.5 achieved 90% specificity for in-hospital mortality. LR achieved a test area under the curve (AUC) of 0.77 (95% confidence interval [CI] 0.77-0.78) for hospital admission and 0.85 (95% CI 0.81-0.88) for in-hospital mortality, while XGBoost achieved a test AUC of 0.90 (95% CI 0.89-0.90) for hospital admission and 0.96 (95% CI 0.94-0.97) for in-hospital mortality. RDW had high scaled weights and information gain for both outcomes and had additive value in simplified models predicting hospital admission.

Discussion

Elevated RDW, previously associated with mortality in myocardial infarction, pulmonary embolism, heart failure, sepsis, and COVID-19, is associated with hospital admission and in-hospital mortality across all-cause adult ED visits. Used alone, elevated RDW may be a specific, but not sensitive, test for both outcomes, with multivariate LR and XGBoost models showing significantly improved test characteristics.

Conclusions

RDW, a component of the complete blood count panel routinely ordered as the initial workup for the undifferentiated patient, may be a generalizable biomarker for acuity in the ED.

Quantitative Metabolomics to Explore the Role of Plasma Polyamines in Colorectal Cancer

Colorectal cancer (CRC) is one of the major public health and socio-economic problems, which management demands the development of non-invasive screening tests. Assessment of circulating polyamines could be a valuable tool, although analytical problems still preclude its clinical practice. We exploited ultra-high-resolution liquid chromatography and mass spectrometry, as a highly sensitive and innovative method, to profile eleven polyamines, including spermine and spermidine with their acetylated forms. These data together with an evaluation of the inflammatory indexes might represent suitable biomarkers for the identification of CRC patients. The statistical models revealed good discrimination in distinguishing CRC patients from healthy subjects. The plasma assessment of ornithine and acetylspermine, as well as lymphocyte/platelet ratio, revealed helpful information on the progression of CRC. The combined profiles of circulating polyamines and inflammatory indexes, together with the application of an innovative technology, could represent a valuable tool for discriminating patients from different clinical groups.

Red blood cell distribution width derivatives in alcohol-related liver cirrhosis and metabolic-associated fatty liver disease

BACKGROUND

Looking for undiscovered blood markers of liver fibrosis and steatosis still remains an issue worth exploring. There are still plenty of unresolved issues related to the actual role of hematological indices as potential markers of liver function.

AIM

To study red blood cell distribution width (RDW), RDW-to-platelet ratio (RPR) and RDW-to-lymphocyte ratio (RLR) in alcohol-related liver cirrhosis (ALC) and metabolic-associated fatty liver disease (MAFLD).

METHODS

The study group was composed of 302 people: 142 patients with ALC and 92 with MAFLD; 68 persons were included as controls. RDW, RPR and RLR were measured in each person. Indirect and direct parameters of liver fibrosis were also assessed [aspartate transaminase to alkaline transaminase ratio, aspartate transaminase to platelet ratio index (APRI), fibrosis-4 (FIB-4), gamma-glutamyl transpeptidase to platelet ratio (GPR), procollagen I carboxyterminal propeptide, procollagen III aminoterminal propeptide, transforming growth factor-α, platelet-derived growth factor AB, laminin]. MELD score in ALC patients and non-alcoholic fatty liver disease (NAFLD) fibrosis score together with BARD score were obtained in the MAFLD group. The achieved results were compared to controls. Then a correlation between assessed markers was done. Diagnostic value of each investigated parameter and its suggested cut-off in the research group were evaluated with area under the curve (AUC).

RESULTS

RDW, RPR and RLR values turned out to be significantly higher in ALC and MAFLD groups compared to controls (ALC: P < 0.0001; NAFLD: P < 0.05, P < 0.0001 and P < 0.0001, respectively). RPR correlated positively with MELD score (P < 0.01) and indirect indices of liver fibrosis (FIB-4 and GPR; P < 0.0001) in ALC patients; negative correlations were found between PDGF-AB and both: RDW and RPR (P < 0.01 and P < 0.0001, respectively). RPR correlated positively with NAFLD fibrosis score and APRI (P < 0.0001) in the MAFLD group; a positive relationship was observed between RDW and FIB-4, too (P < 0.05). AUC values and suggested cut-offs for RDW, RPR and RLR in ALC patients were: 0.912 (> 14.2%), 0.965 (> 0.075) and 0.914 (> 8.684), respectively. AUC values and suggested cut-offs for RDW, RPR and RLR in MAFLD patients were: 0.606 (> 12.8%), 0.724 (> 0.047) and 0.691 (> 6.25), respectively.

CONCLUSION

RDW with its derivatives appear to be valuable diagnostic markers in patients with ALC. They can also be associated with a deterioration of liver function in this group.

Preoperative red blood cell distribution width as an independent prognostic factor in metastatic renal cell carcinoma

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Patients with higher red blood cell distribution width (RDW) levels had worse OS and PFS.

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Preoperative RDW was independently associated with PFS and OS in patients with metastatic renal cell carcinoma (mRCC).

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Preoperative RDW can be utilized as a novel prognostic biomarker for patients with mRCC.

Objective

This study aimed to explore the prognostic value of preoperative red blood cell distribution width (RDW) in patients with metastatic renal cell carcinoma (mRCC).

Methods

Clinicopathological data of 230 patients with mRCC treated at the First Affiliated Hospital of Chongqing Medical University and the Chinese PLA General Hospital from January 2008 to December 2018 were retrospectively analyzed. Patients were stratified according to the optimal cut-off value of RDW calculated using X-tile software. The prognostic value of RDW was analyzed using the Kaplan-Meier curve with log-rank test and univariate and multivariate Cox proportional hazards models.

Results

A total of 230 patients were included. The optimal cut-off value of RDW obtained using X-tile software was 13.1%. The median Progression-free survival (PFS) and Overall survival (OS) of all populations were 12.06 months (IQR: 4.73–36.9) and 32.20 months (IQR: 13.73–69.46), respectively. Kaplan–Meier curves showed that patients with high RDW had worse PFS and OS than those with low RDW (median PFS of 9.7 months vs. 17.9 months, P = 0.002, and median OS of 27.8 months vs. 45.1 months, P = 0.012, respectively). Multivariate analysis showed that RDW was an independent risk factor for PFS (HR: 1.505; 95% CI: 1.111–2.037; P = 0.008) and OS (HR: 1.626; 95% CI: 1.164–2.272; P = 0.004) in mRCC after cytoreductive nephrectomy.

Conclusion

Preoperative RDW was independently associated with PFS and OS in patients with mRCC and may be a potential predictor of survival outcomes in mRCC.

Role of red cell dstribution width in colorectal cancer diagnosis and prognosis

Objective: We aimed to assess whether red cell distribution width (RDW) was associated with pre-operative clinical features or post-operative clinicopathological outcomes in patients with colorectal cancer (CRC), and to determine the utility of RDW as a diagnostic or prognostic marker of CRC. Material and Method: This retrospective cohort study was conducted between January 2018 and May 2021 at a university hospital in Turkey. A total of 188 patients histologically diagnosed with CRC who had undergone surgery were included in the study. Results: Our study included 118 (62.77%) male patients, and the mean age of the patients was 66.28±11.71 years. We found that RDW values were significantly higher in females compared to males (p=0.033), in patients with T3 or T4 tumors compared to those with T1 or T2 tumors (p

Red Blood Cell Distribution Width in Hospitalized COVID-19 Patients

Introduction: Coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is causing dramatic morbidity and mortality worldwide. The Red Blood Cell Distribution Width (RDW) has been strongly associated with increased morbidity and mortality in multiple diseases.

Objective: To assess if elevated RDW is associated with unfavorable outcomes in hospitalized COVID-19.

Methods: We retrospectively studied clinical outcomes of hospitalized COVID-19 patients for their RDW values. In-hospital mortality was defined as primary outcome, while septic shock, need for mechanical ventilation, and length of stay (LOS) were secondary outcomes.

Results: A total of 294 COVID-19 patients were finally studied. Overall prevalence of increased RDW was 49.7% (146/294). RDW was associated with increased risk of in-hospital mortality (aOR, 4.6; 95%CI, 1.5-14.6) and septic shock (aOR, 4.6; 95%CI, 1.4-15.1) after adjusting for anemia, ferritin, lactate, and absolute lymphocyte count. The association remained unchanged even after adjusting for other clinical confounders such as age, sex, body mass index, coronary artery disease, hypertension, diabetes mellitus, and chronic obstructive pulmonary disease. No association was found instead with mechanical ventilation and median LOS.

Conclusion: Elevated RDW in hospitalized COVID-19 patients is associated with a significantly increased risk of mortality and septic shock.

Risk factors for recurrence beyond Milan criteria after radiofrequency ablation in transplantable small hepatocellular carcinoma

This study aims to determine the risk factors of recurrence beyond Milan criteria in patients with transplantable early hepatocellular carcinoma (HCC) after the first Radiofrequency ablation (RFA). 95 patients with newly diagnosed transplantable small HCC with single ≤ 3 cm were analyzed retrospectively. During the 39-month median follow-up period, 12 (21.8%) patients with HCC < 2 cm and 22 (56.4%) patients with HCC ≥ 2 cm relapsed beyond Milan criteria (p = 0.001). The 1- and 3-year recurrence rates beyond Milan criteria were 6.3% and 14.7% in HCC < 2 cm group, compared with 24.1% and 55.6% in HCC ≥ 2 cm group(p < 0.0001).HCC ≥ 2 cm, red blood cell distribution width-to-lymphocyte ratio (RLR) ≥ 18.3, alpha-fetoprotein (AFP) > 15 ng/ml and early recurrence after RFA were independent predictors of recurrence exceeding Milan criteria. For patients with transplantable early single small HCC whose tumor diameter ≥ 2cm and have higher RLR and AFP levels before first RFA and early recurrence after RFA (recurrence within 2 years), close follow-up and early liver transplantation should be initiated to obtain the best survival benefit.

A Comprehensive Nomogram Combining CT Imaging with Clinical Features for Prediction of Lymph Node Metastasis in Stage I-IIIB Non-small Cell Lung Cancer

OBJECTIVE

The status of lymph node metastasis (LNM) is highly correlated with the recurrence and survival outcomes of patients with lung cancer. Thus, a tool that predicts LNM could benefit patient treatment and prognosis. The present study established a new radiomic model by combining computed tomography (CT) radiomic features and clinical parameters to predict the LNM status in patients with non-small cell lung cancer (NSCLC).

METHODS

Demographic parameters and clinical laboratory values were analyzed in 217 patients with stage I-IIIB NSCLC; 107 of the patients received CT scanning and radiomic characteristics were used for LNM assessment (76 in the training cohort and 31 in the validation cohort). The minimum redundancy maximum relevance (mRMR) and the least absolute shrinkage and selection operator (LASSO) regression model were used to select the most predictive features on the basis of the 76 patients in the training set. The value of the area under the receiver operator characteristic (ROC) curve (AUC) was adopted to determine the correlation between LN status and the radiomics signature in training cohorts and then validated in the 31 patients of validation set. The radiomics nomogram was analyzed using univariate and multivariate logistic regression. Decision curve analysis (DCA) was performed to evaluate the clinical utility of this model.

RESULTS

This was a retrospective study. Five radiomic characteristics were significantly correlated with LNM in the two cohorts (P < 0.05). The radiomic nomogram that incorporated the above radiomic characteristics, the RDW, and the CT-based LN status had satisfactory discrimination and calibration in the training (AUC, 0.79; 95% CI 0.69-0.89) and validation cohorts (AUC, 0.70; 95% CI 0.50-0.89).The DCA showed that the developed nomogram had promising clinical utility.

CONCLUSIONS

The developed nomogram, combined with preoperative radiomics evidence, the RDW, and the CT-based LN status, has the potential to preoperatively predict LNM with high accuracy and can facilitate the prediction of LN status for NSCLC patients.

Elevated Red Blood Cell Distribution Width as a Poor Prognostic Factor in Patients With Hematopoietic Stem Cell Transplantation

Red cell distribution width (RDW), a measure of erythrocyte size variability, has been recently reported as an effective prognostic factor in critical illness. Hematopoietic stem cell transplantation (HSCT) has become the first choice of most patients with hematological malignancies. The aim of this study was to assess the changes of RDW in patients with HSCT and analyze the relationship between RDW and HSCT. In this study, we retrospectively enrolled 114 hematopoietic stem cell transplant patients during the period from 2015 to 2019. Logistic regression and Kaplan-Meier survival analysis were used for retrospective analysis. Multivariate analysis suggested that patients with elevated RDW (>14.5%) at three months post-transplantation have a poor clinical outcome compared with those with normal RDW ≤14.5% [odds ratio (OR) 5.12; P = 0.002]. Kaplan-Meier method analysis demonstrated that patients with elevated RDW levels (>14.5%) after hematopoietic stem cell transplantation experienced shorter progression-free survival compared to those with normal RDW levels (P = 0.008). Our study demonstrated that RDW could be an easily available and potential predictive biomarker for risk stratification in patients with HSCT. Further prospective studies are determined to confirm the prognostic value of RDW in HSCT patients.

Increased red cell distribution width predicts severity of drug-induced liver injury: a retrospective study

We used a retrospective study design to evaluated the predictive value of red cell distribution width (RDW) for drug-induced liver injury (DILI) severity in Chinese patients with liver biopsy to assist with early DILI management. We included 164 DILI patients with complete laboratory information and medical history. We compared outcomes of 36 patients with severe DILI with outcomes of a control group of 128 patients with mild-to-moderate DILI. Multivariate analyses of risk factors for severe liver injury in Chinese patients with DILI revealed an estimated adjusted odds ratio (AOR) (95% CI) of 4.938 (1.088–22.412) in patients with drinking. Risk for serious liver injury was also increased significantly in patients with dyslipidemia [AOR (95% CI) 3.926 (1.282–12.026)], higher serum total bile acid (TBA) levels [AOR (95% CI) 1.014 (1.009–1.020)] and higher RDW [AOR (95% CI) 1.582 (1.261–1.986)]. The result for area under the curve of 0.905 for TBA levels indicated this variable had high diagnostic performance for predicting DILI severity. Based on an area under the curve value of 0.855, RDW also had superior diagnostic performance in prediction of DILI severity. This performance was not significantly different compared with TBA and was superior compared with other variables, which had area under values ranging from poor to failure (0.527–0.714).The risk for severe DILI was associated with drinking, dyslipidemia, higher TBA levels and RDW values. This study found that RDW and TBA levels were predictors of DILI severity in Chinese patients.

Prognostic significance of red cell distribution width in bladder cancer

Background

Bladder cancer is one of the most common cancers worldwide. It ranks ninth among all cancers and fourth among cancers in male patients. Recent studies reported that red blood cell (RBC) distribution width (RDW) was a potential predictor in some cancers. This study explored the significance of RDW in patients with bladder cancer after radical cystectomy.

Methods

This study involved 169 patients who underwent radical cystectomy between March 2009 and October 2018. The overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS) were analyzed using the Kaplan-Meier method. Univariate and multivariate Cox analyses were used to evaluate the prognostic significance of RDW.

Results

The patients with bladder cancer were divided into two subgroups according to the RDW value (0.1395). A high RDW value significantly correlated with higher mortality, a decrease in hemoglobin, an increase in C-reactive protein, a decrease in RBC count, and T stage (P<0.05). Statistically significant differences in OS, CSS, and DFS were found between high- and low-RDW groups. Hence, a high RDW value was presumed to be a risk factor for poor prognosis in patients with bladder cancer after radical cystectomy (P<0.001).

Conclusions

Patients with a high RDW value had a poor prognosis. Therefore, RDW is a reliable predictor for the prognosis of patients with bladder cancer who underwent radical cystectomy.

Prognostic value of red cell distribution width (RDW) in colorectal cancer. Results from a single-center cohort on 591 patients

Increasing evidence advocates the prognostic role of RDW in various tumours. We analysed 591 patients to assess whether RDW is a prognostic factor for overall (OS) and cancer-related survival (CRS) for patients with colorectal cancer (CRC). The data were retrieved from a retrospective database. The optimal cut-off value for RDW was set at 14.1%; accordingly, two groups were considered: those with a value equal or lower than 14.1% (L-RDW), and those with a value higher than 14.1% (H-RDW). The mean value of RDW rose from pT1 to pT4 tumours. H-RDW correlated with age above the mean, colonic location of the lesion, pT and TNM stage. Finally, H-RDW was significantly associated with the intent of surgery: almost 50% of patients who underwent a non-curative resection presented H-RDW, compared to 19.3% in R0 resections. OS was significantly lower in patients with H-RDW. CRS was similar in the two groups. Stratifying patients according to TNM stage worse OS was associated with H-RDW only in early stages, whereas there was no difference for stages II-IV. Multivariate analysis confirmed that H-RDW was not an independent prognostic factor. Although H-RDW correlated with some negative clinical-pathological factors, it did not seem to independently influence OS and CRS.

Red blood cell distribution width for predicting significant liver inflammation in patients with autoimmune hepatitis

BACKGROUND

Red blood cell distribution width (RDW) was reported to be associated with the severity of liver diseases. We aimed to investigate the association between RDW and severity of liver inflammation in autoimmune hepatitis (AIH).

PATIENTS AND METHODS

Ninety-two consecutive AIH patients who underwent liver biopsy during 2016-2017 were included. Liver histology was evaluated using the Scheuer scoring system. Logistic regression analysis was used to analyze the risk factors for significant inflammation. The diagnostic accuracy was evaluated by the area under the receiver operating characteristic curve.

RESULTS

The RDW level was higher in AIH patients with significant inflammation (14.6%, interquartile range: 13.2-16.3%) than in patients with mild inflammation (13.2%, interquartile range: 12.6-13.8%). The RDW level was correlated positively with the grades of liver inflammation (r=0.356, P < 0.001). The area under the receiver operating characteristic curve of RDW in predicting significant inflammation was 0.739 (95% confidential interval: 0.634-0.843, P < 0.001), with 67.80% sensitivity and 75.76% specificity. The diagnostic performance of RDW for significant inflammation was better than alanine aminotransferase (P = 0.003) and immunoglobulin G (P = 0.049). RDW (odds ratio = 1.702, P = 0.001) was identified as an independent predictor for significant inflammation by logistic multivariable analysis.

CONCLUSION

The RDW level was correlated positively with the severity of liver inflammation in AIH patients. RDW can be a promising indicator for predicting significant liver inflammation in AIH.

Red cell distribution width to platelet ratio for liver fibrosis: a systematic review and meta-analysis of diagnostic accuracy

Introduction: Red cell distribution width to platelet ratio (RPR) may be a useful marker for the evaluation of liver fibrosis in chronic liver disease (CLD). We sought to investigate its value in fibrosis-related outcomes in a meta-analysis of diagnostic accuracy. Areas covered: We searched MEDLINE (1966-2019), Clinicaltrials.gov (2008-2019), Cochrane Central Register of Controlled Trials (CENTRAL) (1999-2019), Google Scholar (2004-2019) and WHO (International Clinical Trials Register Platform) databases using a structured algorithm. The articles were assessed by Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2). In over 1,800 patients for each outcome, pooled sensitivity and specificity for a) significant fibrosis, b) advanced fibrosis and c) cirrhosis were: a) 0.635 and 0.769 with an AUC of 0.747, b) 0.607 and 0.783 with an AUC of 0.773, c) 0.739 and 0.768 with an AUC of 0.818 respectively. Similar results were found for chronic hepatitis B in all outcomes. Subgroup analysis indicated a high specificity for advanced fibrosis detection in primary biliary cirrhosis. Sensitivity analysis did not alter the results. Expert opinion: RPR is a good predictor of fibrosis, especially as severity of chronic liver disease progresses. Future research should elucidate its value in specific etiologies of chronic liver disease.

Red blood cell distribution width provides additional prognostic value beyond severity scores in adult critical illness

BACKGROUND

The prognostic value of red blood cell distribution width (RDW) in critical illness remains controversial. The aim of this study was to investigate the prognostic value of on-admission RDW for in-hospital and 4-year mortality in adults with critical illness.

METHODS

This is a retrospective cohort study from the Medical Information Mart for Intensive Care III (MIMIC III) database (version 1.4). Patients admitted to the intensive care unit (ICU) for the first time were included. Their on-admission RDW and severity scores were extracted with the Structured Query Language (SQL). The patients were categorized into a training set and a validation set. The relation of RDW to in-hospital and 4-year all-cause mortality was analyzed using receiver operating characteristic (ROC) curve, Kaplan-Meier curve, Cox model, net reclassification index (NRI), integrated discriminatory index (IDI) and nomogram.

RESULTS

A total of 36,532 patients (21,090 in training and 15,442 in validation set) were included in this study. Increased RDW was significantly associated with higher in-hospital and 4-year mortality. The prognostic value of RDW for 4-year mortality was independent of conventional severity scores. Using conventional severity scores as covariates the continuous NRI and IDI of RDW for in-hospital mortality were around 0.3-0.5 and 0.01-0.03, respectively. For 4-year mortality the NRI was around 0.2-0.3 and IDIs was around 0.03-0.08.

CONCLUSIONS

Admission RDW predicts both in-hospital and 4-year mortality in adult patients with critical illness admitted in the ICU, and can provide additional prognostic values beyond conventional clinical severity scores.

Biomarkers vs imaging in the early detection of hepatocellular carcinoma and prognosis

Hepatocellular carcinoma (HCC) is the 5^th most frequently diagnosed cancer in the world, according to the World Health Organization. The incidence of HCC is between 3/100000 and 78.1/100000, with a high incidence reported in areas with viral hepatitis B and hepatitis C, thus affecting Asia and Africa predominantly. Several international clinical guidelines address HCC diagnosis and are structured according to the geographical area involved. All of these clinical guidelines, however, share a foundation of diagnosis by ultrasound surveillance and contrast imaging techniques, particularly computed tomography, magnetic resonance imaging, and sometimes contrast-enhanced ultrasound. The primary objective of this review was to systematically summarize the recent published studies on the clinical utility of serum biomarkers in the early diagnosis of HCC and for the prognosis of this disease.

The association and diagnostic value of red blood cell distribution width in colorectal cancer

Red blood cell distribution width (RDW) is associated with several diseases. However, the diagnostic value of RDW and its related factors remain unclear in colorectal cancer (CRC).This single-center retrospective study evaluated 211 Chinese CRC patients and 103 healthy controls. The association of RDW with the clinical parameters of CRC, as well as its correlations with carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) were analyzed. The diagnostic value of RDW alone or combined with CEA and CA19-9 was evaluated using receiver operating characteristic curve analysis. A meta-analysis was also performed to combine our data with previously published data to enhance our findings.In the CRC patients, RDW was clearly elevated and was significantly associated with CRC tumor location, histological type, T status (but not N or M status), and clinical stage. However, RDW was not significantly correlated with CEA or CA19-9 levels. Using RDW to diagnose CRC provided a sensitivity of 53.1% and specificity of 77.7%. The diagnostic accuracy of RDW was enhanced by combining RDW with CEA and CA19-9 levels. We identified 5 previous studies with 633 CRC patients and 1050 controls, which were combined with our cases and controls. The meta-analysis revealed an overall sensitivity of 69%, specificity of 70%, and an area under the curve of 0.74.In CRC cases, RDW was associated with tumor location, histological type, T status, and clinical stage. Furthermore, RDW had a moderate value for diagnosing CRC and might be useful in this setting.

The potential value of red blood cell distribution width in patients with invasive hydatidiform mole

Background

Red blood cell distribution width (RDW) has attracted increasing attention in cancer. The aim of this study was to assess the changes of RDW in patients with invasive hydatidiform mole and analyze the relationship between RDW and invasive hydatidiform mole.

Methods

A retrospective analysis was performed on 102 patients diagnosed as invasive hydatidiform mole in the First Affiliated Hospital of Guangxi Medical University from January 2009 to March 2018. A total of 120 healthy subjects were used as a control group. The Mann‐Whitney U test was used for comparison between the invasive hydatidiform mole and control groups. Comparison of RDW with other blood parameters was performed using Spearman's. The area under the ROC curve (AUC) and 95% confidence interval (95% CI) were also determined.

Results

The RDW, platelet‐lymphocyte ratio (PLR), neutrophil‐lymphocyte ratio (NLR), and absolute lymphocyte count were significantly elevated in the invasive hydatidiform mole group compared with control group. The hemoglobin (Hb) concentration, mean red blood cell volume (MCV) and platelet count (PLT) were significantly lower in invasive hydatidiform mole group than control group. Grade III and above invasive hydatidiform mole patients had higher levels of RDW than grade I and II patients. Correlation analysis showed that RDW was negatively correlated with Hb, MCV, NLR, and neutrophil count, but positively correlated with PDW and different stages of invasive hydatidiform mole. The ROC curve showed that the AUC of the RDW was 0.660 (95% CI 0.581‐0.740; P < 0.01).

Conclusion

This study reveals the potential value of RDW in invasive hydatidiform mole.

Relationship of Red Blood Cell Distribution Width with Cancer Mortality in Hospital

Background

Red blood cell distribution width (RDW) is a clinical index used to make early diagnosis and to monitor treatment effects in iron deficiency anemia. Recently, several studies have suggested that RDW was associated with mortality from various cancers; however, there has been little evidence regarding RDW and cancer as a whole. Therefore, the purpose of our study was to investigate the relationship of RDW and overall cancer mortality in hospital.

Methods

We extracted patient data from the Multiparameter Intelligent Monitoring in Intensive Care Database III version 1.3 (MIMICIII.1.3). RDW was measured prior to hospital admission. Patients older than 18 who were diagnosed with malignant tumors were included. The primary outcome was cancer mortality in hospital. Logistic regression and multivariate analysis were used to assess the association between the RDW and hospital mortality.

Result

A total of 3384 eligible patients were enrolled. A positive correlation was observed between RDW and overall cancer mortality. Patients with higher RDW (14.4-16.3%, 16.4-30.5%) were at greater risk of death than the patients with RDW in the reference range (11.5-14.3%). On multivariate analysis, when adjusted for age and gender, the adjusted OR (95% CIs) in the mid-RDW group and high-RDW group were 1.61 (1.28, 2.03) and 2.52 (2.03, 3.13), respectively, with the low-RDW group set as the baseline. Similar trends were also observed in the model adjusted for other clinical characteristics. This suggested that elevated RDW was related to increased risk of cancer mortality, and RDW may play an important role in the prediction of short-term mortality after hospitalization in cancer patients.

Conclusion

Elevated RDW was associated with overall cancer mortality. To a certain extent, RDW may predict the risk of mortality in patients with cancers; it was an independent prognostic indicator of short-term mortality after hospitalization in cancer patients.

Elevated red blood cell distribution width contributes to poor prognosis in patients undergoing resection for nonmetastatic rectal cancer

Several studies have reported that elevated red blood cell distribution width (RDW) was associated with the poor prognosis of different kinds of cancers. The aim of this study was to investigate the prognostic role of RDW in patients undergoing resection for nonmetastatic rectal cancer.We retrospectively reviewed a database of 625 consecutive patients who underwent curative resection for nonmetastatic rectal cancer at our institution from January 2009 to December 2014. The cutoff value of RDW was calculated by receiver-operating characteristic curve.The results demonstrated that patients in high RDW-cv group had a lower overall survival (OS) (P = .018) and disease-free survival (P = .004). We also observed that patients in high RDW-sd group were associated with significantly lower OS (P = .033), whereas the disease-free survival (DFS) was not significantly different (P = .179).In multivariate analysis, we found elevated RDW-cv was associated poor DFS (hazard ratio [HR] = 1.56, P = .010) and RDW-sd can predict a worse OS (HR = 1.70, P = .009).We confirmed that elevated RDW can be an independently prognostic factor in patients undergoing resection for nonmetastatic rectal cancer. So more intervention or surveillance might be paid to the patients with nonmetastatic rectal cancer and elevated RDW values in the future.

Elevated red blood cell distribution width predicts poor prognosis in hilar cholangiocarcinoma

Background

Although the red blood cell distribution width (RDW) has been reported as a reliable predictor of prognosis in several types of cancer, the prognostic value of RDW in hilar cholangiocarcinoma (HC) has not been studied.

Methods

A retrospective analysis of 292 consecutively recruited HC patients undergoing radical resection was conducted. The optimal cutoff value of RDW was determined by the receiver operating characteristic curve (ROC). Survival analysis by the Kaplan-Meier method, the difference between the clinico-pathologic variables and survival were evaluated by log-rank analysis. Multivariate analysis identified independent prognostic risk factors of overall survival (OS).

Results

ROC analysis suggested that the optimal cutoff value for the RDW was 14.95. Linear correlation analysis revealed that RDW is associated with white blood cell count (P = 0.007), neutrophil-to-lymphocyte ratio (P = 0.02), and hemoglobin (P < 0.001), albumin (P < 0.001). In a multivariate analysis, the RDW was an independent prognostic factor for OS (HR = 1.755, 95% CI 1.311-2.349, P < 0.001).

Conclusions

Elevated RDW may be regarded as an indicator of systemic inflammatory response which might facilitate HC growth and metastasis. Current evidence suggests that RDW may have clinical significance in predicting OS after surgery in HC patients.

Prognostic value of admission red blood cell distribution width in acute pancreatitis: a systematic review

BACKGROUND

Red blood cell distribution width (RDW) has been proved to be a strong prognostic marker in various diseases such as cardiovascular diseases, renal failure, viral hepatitis etc. But its prognostic value in acute pancreatitis (AP) remains controversial. The aim of this systematic review is to determine the prognostic value of RDW in AP.

METHODS

PubMed, Cochrane, Google scholar, and Web of Science were searched on March 2, 2017 to identify studies that investigated the association between RDW and the prognosis of AP. The eligible studies were reviewed and summarized.

RESULTS

In total, 2008 articles were screened. Seven studies were included in the final analysis. Five studies estimated the prognostic value of RDW using receiver operating characteristic (ROC) curve analysis, and multivariable analysis was performed in only four studies. The major design weaknesses of eligible studies are their retrospective design and some of potential confounding factors were not adjusted.

CONCLUSIONS

Current evidence and findings support that high admission RDW can be used as a biomarker to identify the AP patients who are at high risk of mortality. However, due to the weaknesses of available studies, further well-designed studies with large sample size and various outcome endpoints are needed to rigorously evaluate the prognostic value of RDW in AP.

Prognostic significance of red blood cell distribution width in gastrointestinal disorders

The red blood cell distribution width (RDW) is a routinely measured and automatically reported blood parameter, which reflects the degree of anisocytosis. Recently, the baseline RDW was found to have clinical significance for assessing clinical outcome and severity of various pathological conditions including cardiovascular diseases, sepsis, cancers, leukemia, renal dysfunction and respiratory diseases. A myriad of factors, most of which ill-defined, have an impact on the red cell population dynamics (i.e., production, maturation and turnover). A delay in the red blood cell clearance in pathological conditions represents one of the leading determinants of increased anisocytosis. Further study of RDW may reveal new insight into inflammation mechanisms. In this review, we specifically discuss the current literature about the association of RDW in various disease conditions involving the gastrointestinal and hepatobiliary systems. We also present some of the related measurements for their value in predicting clinical outcomes in such conditions. According to our data, RDW was found to be a valuable prognostic index in gastrointestinal disorders along with additional inflammatory biomarkers (i.e., C reactive protein, erythrocyte sedimentation rate, and platelet count) and current disease severity indices used in clinical practice.