Is there any relationship between RDW levels and atrial fibrillation in hypertensive patient?

A new biomarker to predict atrial fibrillation and its adverse events after coronary artery bypass surgery: red blood cell distribution volume

OBJECTIVE

Recent studies suggest that increased red blood cell distribution width may be associated with increased risk of atrial fibrillation. This study aimed to evaluate the relationship between pre-operative and postoperative erythrocyte distribution volume, postoperative atrial fibrillation and related adverse events in patients undergoing isolated coronary artery bypass surgery.

METHODS

A total of 790 patients (611 males, mean age 58.3 ± 6.2 years) in pre-operative sinus rhythm, who underwent isolated coronary artery bypass grafting with cardiopulmonary bypass at the same centre and by the same surgical team between January 2015 and December 2021, were enrolled retrospectively. Two groups were created, group 1 (n = 183) and group 2 (n = 607), with regard to the occurrence of atrial fibrillation in the early postoperative period or not, respectively. Clinical and demographic data, biochemical and complete blood count parameters, and intra-operative and postoperative data of the patients were recorded. Univariate and subsequent multivariate logistic regression analysis was done to determine significant clinical factors and independent predictors of postoperative atrial fibrillation.

RESULTS

Among the patients, 182 (23.2%) developed atrial fibrillation during the 72 hours postoperatively. Pre-operative and postoperative first-, third- and seventh-day red blood cell distribution volume (p = 0.0001), C-reactive protein (p = 0.0001) and erythrocyte sedimentation rate (p = 0.0001) were significantly increased in group 1. Multivariate logistic regression analysis showed elevated pre-operative and postoperative first-, thirdand seventh-day red blood cell distribution volume, erythrocyte sedimentation rate and C-reactive protein as independent predictors of early postoperative atrial fibrillation.

CONCLUSIONS

Pre-operative and postoperative red blood cell distribution volume was found to be an independent predictor of atrial fibrillation and associated adverse events in the early postoperative period of isolated coronary artery bypass grafting.

Association between red blood cell distribution width and non-valvular atrial fibrillation in hemodialysis patients: a single-center Chinese population study

Background

Red blood cell distribution width (RDW) has emerged as a prognostic marker of atrial fibrillation (AF) in various clinical settings. However, the relationship by which RDW was linked to AF in hemodialysis (HD) patients was not clear. We sought to reveal the relationship between RDW and AF occurrence in HD patients.

Methods

We enrolled 170 consecutive maintenance HD patients, including 86 AF patients and 84 non-AF patients. All participants’ medical history and detailed clinical workup were recorded before the first dialysis session of the week. Electrocardiography, laboratory and transthoracic echocardiography examination indices were compared between the AF group and non-AF group. Multivariable logistic regression analysis was performed to identify the independent predictors of AF occurrence in HD patients.

Results

There were all paroxysmal AF patients in AF group. Compared to the non-AF group, patients with AF group had a significantly older age (61.0 ± 1.48 vs. 49.71 ± 1.79, p < 0.001), lower BMI (24.3 ± 4.11 vs. 25.8 ± 3.87, p < 0.05), higher RDW (15.10 ± 0.96 vs. 14.26 ± 0.82, p < 0.001) and larger LAD (39.87 ± 3.66 vs. 37.68 ± 5.08, p < 0.05). Multivariable logistic regression analyses demonstrated that values of age (OR: 1.030, 95%CI: 1.004-1.057, per one- year increase), BMI (OR: 0.863, 95%CI: 0.782–0.952, per 1 kg/m² increase), RDW (OR: 2.917, 95%CI: 1.805–4.715, per 1% increase) and LAD (OR: 1.097, 95%CI: 1.004–1.199, per 1 mm increase) were independently associated with AF occurrence (p < 0.05, respectively). The best cutoff value of RDW to predict AF occurrence was 14.65% with a sensitivity of 68.6% and a specificity of 72.6%.

Conclusions

The increased RDW was significantly associated with the paroxysmal AF occurrence in HD patients.

Red blood cell distribution width and atrial fibrillation

Atrial fibrillation (AF) is the most frequent arrhythmia encountered in clinical practice and is a major health problem associated with remarkable morbidity, mortality and has considerable healthcare costs. Red blood cell distribution width (RDW) reflects the heterogeneity of the volume and size of red blood cells. It is an easily measured and inexpensive index that has been associated with several cardiovascular disease states. Accumulating evidence suggests that RDW is a prognostic marker of AF in various clinical settings. In this article, we review the available data regarding the prognostic role of RDW in AF development and perpetuation in diverse disease states as well as its role on the prediction of adverse outcomes.

Relationship between red blood cell distribution width levels and atrial fibrillation in hypertensive patients

Background

Information on the relationship between red blood cell distribution width (RDW) and atrial fibrillation (AF) in patients with essential hypertension are scarce. The study aimed to assess the relationship between AF and RDW in hypertensive patients.

Methods

We enrolled 432 hypertensive patients, including 350 AF patients and 82 patients as controls. Patients' demographic, clinical, laboratory and echocardiographic characteristics were recorded. The AF patients were further divided into the persistent and paroxysmal AF subgroups. Electrocardiograms were monitored to identify the cardiac rhythm during blood sampling, and based on the rhythm, the paroxysmal AF group was categorized into the presence (with AF rhythm during blood sampling) and absence (with sinus rhythm during blood sampling) groups.

Results

The AF group had elevated RDW levels than the controls (12.7% ± 0.8% vs. 12.4% ± 0.7%, P = 0.002), and the persistent AF subgroup had higher RDW levels than the paroxysmal AF subgroup (12.9% ± 0.8% vs. 12.6% ± 0.8%, P = 0.007). Furthermore, in the paroxysmal AF group, the presence group had higher RDW levels than the absence group (13.0% ± 0.6% vs. 12.5% ± 0.9%, P = 0.001). There was no significant difference in RDW levels between the persistent AF subgroup and presence group of the paroxysmal AF subgroup (P = 0.533) and between the absence group of the paroxysmal AF subgroup and control group (P = 0.262). In multivariate regression analysis, in hypertensive patients, the presence of AF rhythm is an independent predictor for increased RDW concentration (P = 0.001).

Conclusions

The RDW may be associated with the presence of AF rhythm, which implies the importance of maintaining the sinus rhythm in hypertensive patients.

[Comparative analysis of RDW variability depending on belonging to a defined nosological group of diseases according to ICD-10 classification.]

The aim of this study was to investigate RDW variability and conduct a comparative analysis of the RDW level in patients depending on their belonging to a defined nosological group of diseases according to the ICD-10 classification. All patients who complete blood count tests in our hospital from January to December 2016 were included in the study. The identification of the patient's belonging to a specific nosological group according to the ICD-10 classification was carried out on the basis of the disease analysis code indicated in the direction of the blood test. 8056 patient records were included in the final analysis. Deviations beyond the upper reference range for the RDW indicator (> 14.5%) in this study were identified for patients of the following nosological groups according to ICD-10: C - neoplasms; D - blood diseases; S - injuries; T - poisoning. Significant intergroup differences were obtained according to the Kruskal-Wallis rank analysis of variance (Kruskal-Wallis test: H (19, n= 7622) = 214.9672 p = 0.0000). According to the results of this study, we can conclude that RDW has specificity for certain diseases (neoplasms; blood diseases; injuries; poisoning). In case of cardiovascular and other diseases, deviations of this indicator beyond the limits of the upper reference values were not found in this study.

Red blood cell distribution width: A marker of anisocytosis potentially associated with atrial fibrillation

The incorporation of biomarkers in the actually used risk scores seem to be helpful for early identifying atrial fibrillation (AF) patients at higher risk. The aim of this critical review of the scientific literature is to investigate the potential clinical significance of red blood cell distribution width (RDW) in AF. A systematic electronic search was carried out to identify all articles describing an epidemiological association between RDW and AF in adult human populations. Data abstraction was conducted on a final number of 35 articles (13 cross-sectional, 12 prospective and 10 retrospective studies). The results of these epidemiological investigations were all virtually concordant to emphasize that an enhanced RDW value is not only a predictive factor and a marker of AF but its measurement may also be helpful for predicting the risk of developing many adverse complications in patients with AF, such as recurrence and duration of AF, hospitalization for heart failure, bleeding, left atrial thrombosis and stasis, thromboembolic events and mortality. AF patients with RDW values exceeding the local reference range may be more aggressively investigated and managed, in order to identify and attenuate the impact of possible underlying disorders causing both anisocytosis and AF.

Diagnostic and Prognostic Relevance of Red Blood Cell Distribution Width for Vascular Aging and Cardiovascular Diseases

Evidence suggests association of red blood cell distribution width (RDW) with cardiovascular diseases (CVDs). On the contrary, we underline that the sole RDW values cannot represent a valid CVD biomarker. High RDW values are expression of biological effects of a lot of both endogenous and exogenous factors (i.e., age, sex, genetic background, inflammation, hormones, drugs, diet, exercise, hematological analyzers, and ranges of values), modulating the biology and physiology of erythrocytes. Thus, the singular monitoring of RDW cannot be used to predict cardiovascular disorders. Accordingly, we have reviewed the evidence for potential relationship of RDW values with alterations in the cardiovascular system (i.e., regenerative capacity, endothelial turnover, and senescence of cardiovascular cells), associated with vascular aging and disease. In addition, we highlight the inevitable impact of biases in clinical application of RDW related to CVDs. Based on our thorough review of literature, we suggest a combined evaluation of RDW with other emerging biomarkers related to vascular aging and the diagnosis and prognosis of CVDs, including telomere length of leukocytes, circulating nucleated red blood cells (nRBCs) and endothelial progenitor cells (EPCs) in future large scale studies.

Red blood cell distribution width as a predictor of atrial fibrillation

BACKGROUND

Current evidence suggests that a higher red blood cell distribution width (RDW) may be associated with increased risk of atrial fibrillation (AF) development. Given that some controversial results have been published, we conducted a systematic review of the current literature along with a comprehensive meta-analysis to evaluate the association between RDW and AF development.

METHODS

We performed a systematic search of the literature using electronic databases (PubMed, Ovid, Embase, and Web of Science) to identify studies reporting on the association between RDW and AF development published until June 2016. We used both fix-effects and random-effects models to calculate the overall effect estimate. An I²  > 50% indicates at least moderate statistical heterogeneity. A sensitivity analysis and subgroup analysis were performed to find the origin of heterogeneity.

RESULTS

A total of 12 studies involving 2721 participants were included in this meta-analysis. The standardized mean difference in the RDW levels between patients with and those without AF development was 0.66 units (P < .05; 95% confidence interval 0.44-0.88). A significant heterogeneity between the individual studies was observed (P < .05; I²  = 80.4%). A significant association between the baseline RDW levels and AF occurrence or recurrence following cardiac procedure or surgery was evident (SMD: 0.61; 95% confidence interval 0.33-0.88; P < .05) with significant heterogeneity across the studies (I²  = 80.7%; P < .01).

CONCLUSIONS

Our comprehensive meta-analysis suggests that higher levels of RDW are associated with an increased risk of AF in different populations.

Red Blood Cell Distribution Width: A Novel Predictive Indicator for Cardiovascular and Cerebrovascular Diseases

The red blood cell distribution width (RDW) obtained from a standard complete blood count (CBC) is a convenient and inexpensive biochemical parameter representing the variability in size of circulating erythrocytes. Over the past few decades, RDW with mean corpuscular volume (MCV) has been used to identify quite a few hematological system diseases including iron-deficiency anemia and bone marrow dysfunction. In recent years, many clinical studies have proved that the alterations of RDW levels may be associated with the incidence and prognosis in many cardiovascular and cerebrovascular diseases (CVDs). Therefore, early detection and intervention in time of these vascular diseases is critical for delaying their progression. RDW as a new predictive marker and an independent risk factor plays a significant role in assessing the severity and progression of CVDs. However, the mechanisms of the association between RDW and the prognosis of CVDs remain unclear. In this review, we will provide an overview of the representative literatures concerning hypothetical and potential epidemiological associations between RDW and CVDs and discuss the underlying mechanisms.

The neutrophil-to-lymphocyte ratio on admission is a good predictor for all-cause mortality in hypertensive patients over 80 years of age

BACKGROUND

Immuno-inflammation plays a major role in the process of hypertension. We aimed to evaluate the association between inflammatory markers, neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW) and all-cause mortality in elderly patients with hypertension.

METHODS

A total of 341 hypertensive patients over 80 years of age were included to this study. The NLR and RDW were measured on admission and all the selected patients were followed up for up to 90 days. Kaplan-Meier curves were plotted to evaluate the association between the NLR and the all-cause mortality at follow-up. Using Cox regression models, we investigated the prognostic value of NLR and RDW for all-cause mortality.

RESULTS

Patients with higher quartile of NLR linked to high mortality in hypertensive patients at 90 day after admission (16.47%,13.25%,1.14%,1.17% respectively; χ² = 20.581,P = 0.000). Surviving patients had lower RDW (13.61 ± 1.37 VS 14.18 ± 1.38, p = 0.041) and NLR (4.97 ± 5.72 VS 7.95 ± 6.88,p = 0.011). The receiver operating curve (ROC) of the NLR for all-cause mortality had an area under the curve (AUC) =0.714 (95%CI: 0.629-0.798, P = 0.000), with acritical value of 2.97, with sensitivity of 92.6%, and a specificity of 52.5%. The ROC of the RDW to predict all-cause mortality, had an AUC =0.654 (95%CI:0.548-0.761, P = 0.008), with acritical value of 13.2%.The Kaplan-Meier curve showed a significant difference between different NLR levels (p = 0.002). Multivariate Cox proportional hazard analysis shown 3rd quartile of NLR(RR = 9.646, 95% CI 1.302-34.457, P = 0.041) and 4th quartiles(RR = 16.451, 95% CI 2.137-66.643, P = 0.007) were found to independently predict all-cause death in hypertensive patients over 80 years of age. Higher rank of NLR was link to higher incidence of all-cause death for such patients.

CONCLUSION

The findings of the present study demonstrate the potential utility of NLR in risk stratification of elderly patients with hypertension to provide information for clinical treatment strategies.

Prediction of New-Onset and Recurrent Atrial Fibrillation by Complete Blood Count Tests: A Comprehensive Systematic Review with Meta-Analysis

Background

Atrial fibrillation (AF) is one of the most critical and frequent arrhythmias precipitating morbidities and mortalities. The complete blood count (CBC) test is an important blood test in clinical practice and is routinely used in the workup of cardiovascular diseases. This systematic review with meta-analysis aimed to determine the strength of evidence for evaluating the association of hematological parameters in the CBC test with new-onset and recurrent AF.

Material/Methods

We conducted a meta-analysis of observational studies evaluating hematologic parameters in patients with new-onset AF and recurrent AF. A comprehensive subgroup analysis was performed to explore potential sources of heterogeneity.

Results

The literature search of all major databases retrieved 2150 studies. After screening, 70 studies were analyzed in the meta-analysis on new-onset AF and 23 studies on recurrent AF. Pooled analysis on new-onset AF showed platelet count (PC) (weighted mean difference (WMD)=WMD of −26.39×10⁹/L and p<0.001), mean platelet volume (MPV) (WMD=0.42 FL and p<0.001), white blood cell (WBC) (WMD=−0.005×10⁹/L and p=0.83), neutrophil to lymphocyte ratio (NLR) (WMD=0.89 and p<0.001), and red blood cell distribution width (RDW) (WMD=0.61% and p<0.001) as associated factors. Pooled analysis on recurrent AF revealed PC (WMD=−2.71×10⁹/L and p=0.59), WBC (WMD=0.20×10⁹/L (95% CI: 0.08 to 0.32; p=0.002), NLR (WMD=0.37 and p<0.001), and RDW (WMD=0.28% and p<0.001).

Conclusions

Hematological parameters have significant ability to predict occurrence and recurrence of AF. Therefore, emphasizing the potential predictive role of hematological parameters for new-onset and recurrent AF, we recommend adding the CBC test to the diagnostic modalities of AF in clinical practice.