Baseline Red Cell Distribution Width Research Articles

The Role of Procalcitonin and Red Cell Distribution Width as Diagnostic and Prognostic Biomarkers in Patients with Sepsis and Septic Shock at Intensive Care Unit

Abstract Background Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Organ dysfunction can be identified as an acute change in total sequential organ failure assessment (SOFA). Septic shock is a subset of sepsis with circulatory and cellular/metabolic dysfunction associated with a higher risk of mortality. Biomarkers can be used in suspected sepsis for identifying or ruling out sepsis, evaluating the severity and assessing the prognosis and evaluating patients’ response to proper treatment. This study is on procalcitonin (PCT) and red cell distribution width (RDW) as diagnostic and prognostic biomarkers in patients with sepsis and septic shock. Objective This study aims to assess the feasibility of PCT and RDW as early diagnostic and prognostic biomarkers in patients with sepsis and septic shock. Methods This is a prospective observational study, in which 100 blood samples of clinically suspected sepsis and septic shock patients’ were included following a convenience sampling technique. PCT and RDW were recorded in day 0, 3, 6, 9 and 12. Results A rise in RDW and PCT levels could serve as early indicators of outcome including mortality. We found that baseline RDW cut-off point > 15.6 with sensitivity of 80.0%, specificity of 85.71% while in day 12 cut-off point > 17.3 with sensitivity of 60.0%, specificity of 100.0%. Accordingly PCT cut-off point > 4.1 with sensitivity of 80.0% and specificity of 94.29% in baseline values. While cut-off point in day 12 was > 0.7 with sensitivity of 80.0%, specificity of 97.0%. Conclusion A significant concurrence was seen between elevated serum PCT and RDW levels with severity and prognosis of sepsis. They were found to be a good predictor of sepsis and low levels rule out an infection.

A Case-Control Study Utilizing Red Cell Distribution Width as a Bio-Inflammatory Marker in Pre-eclampsia.

This research was conducted to assess the effectiveness of red cell distribution width (RDW) as an indicator for pre-eclampsia (PE), a condition characterized by elevated blood pressure and the presence of protein in the urine occurring beyond the 20th week of pregnancy. The case-control investigation spanned 10 months, following the acquisition of informed consent and the receipt of ethical clearance. The study sample comprised a total of 70 pregnant women, evenly divided into two groups: 35 cases of PE and 35 normotensive pregnant controls. Both the cases and controls provided 3 ml venous blood samples. The study employed a semi-automated three-part hematological analyzer to establish the baseline RDW for all individuals. This study showed that the individuals with pre-eclampsia had a greater RDW compared to the healthy pregnant women. The observed difference was found to be statistically significant, with a p-value of 0.004. The receiver operating curve (ROC) analysis showed that RDW exhibited significant diagnostic accuracy in differentiating between cases and controls (area under the curve [AUC] = 0.71, P = 0.004) when employing a cut-off value of >= 18.25. The sensitivity was 80% and the specificity was 71.4%. In contrast to other indicators of inflammation, RDW is a cost-effective and easily accessible biomarker that can be acquired from routine complete blood counts. It has the potential to be valuable in predicting and diagnosing pre-eclampsia.

Red cell distribution width to albumin ratio predicts treatment failure in peritoneal dialysis-associated peritonitis.

This study aims to investigate the potential correlation between baseline red cell distribution width (RDW) to albumin ratio (RAR) levels and treatment failure in peritoneal dialysis-associated peritonitis (PDAP) patients. A retrospective single-center study was conducted on 286 PDAP patients. Logistic regression and generalized estimation equation (GEE) analyses were employed to assess the relationship between RAR and treatment failure. RAR emerged as a robust predictor of treatment failure in PDAP patients. Elevated RAR levels were associated with an increased risk of treatment failure, exhibiting a linear relationship. Even after adjusting for demographic and clinical variables, this association remained statistically significant. ROC analysis revealed that RAR outperformed RDW and albumin individually in predicting PDAP prognosis. This study highlights RAR as a superior prognostic marker for treatment failure in PDAP patients, offering new insights into risk assessment and management strategies for this challenging condition.

Association of red cell distribution width and its changes with the 30-day mortality in patients with acute respiratory failure: An analysis of MIMIC-IV database.

Acute respiratory failure (ARF) is a common disease in the intensive care units (ICUs) with high risk of mortality. The red cell distribution width (RDW) is one of baseline ICU indicators which can be easily available, and has been used in the long-term prognostic analyses of diseases. However, no studies have explored the role of baseline RDW and its change during hospitalization in in-hospital mortality in ARF. Herein, this study aims to explore the association between RDW and its changes and the 30-day mortality in ARF patients. Demographic and clinical data of 7,497 patients with ARF were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database in 2012-2019 in this retrospective cohort study. Univariable and multivariable Cox regression analyses were used to explore the association between RDW and its changes and 30-day mortality with hazard ratios (HRs) and 95% confidence intervals (CIs). Subgroup analyses of different baseline RDW levels were also performed. We then assessed the predictive performance of RDW changes combined with the Sequential Organ Failure Assessment (SOFA) score on 30-day mortality using receiver operator characteristic curves (ROCs) with areas under curve (AUCs). Totally, 2,254 (30.07%) patients died in 30 days. After adjusting for covariates, we found that high baseline RDW [HR = 1.25, 95%CI: (1.15-1.37)] and RDW changes ≥0.3% [HR = 1.12, 95%CI: (1.01-1.24)] were both related to an increased risk of 30-day mortality. In patients whose baseline RDW level ≥14.9%, RDW changes ≥0.3% was also associated with an increased risk of 30-day mortality [HR = 1.19, 95%CI: (1.05-1.35)]. Moreover, the predictive value of RDW changes combined with SOFA on 30-day mortality was a little better than that of single SOFA score, with AUCs of 0.624 vs. 0.620. High baseline RDW level and its changes during hospitalization was relate to the increased risk of 30-day mortality in ARF, and the predictive value of RDW changes for ARF short-term mortality is still needed exploration.

Role of Routine Blood Parameters in Predicting Mortality Among Surgical Patients With Sepsis.

Outcome prediction for surgical patients with sepsis may be conducive to early aggressive interventions. In several studies, changes in the level of numerous biomarkers like red cell distribution width (RDW), platelet count (PC), mean platelet volume (MPV), and platelet distribution width (PDW)have been demonstrated to be associated with mortality in critically ill patients. We aimed at investigating the prognostic significance of dynamic changes in RDW, PC, MPV, and PDW in surgical patients with sepsis. We prospectively enrolled 110 surgical patients of sepsis in our study admitted to the surgical ward and ICU. We measured RDW, PC, MPV, and PDW on days 1, day 4, and day 8. Receiver operating characteristics (ROC) were generated for prognostic validation of these parameters and mortality in surgical patients with sepsis. Results: We found that higher RDW and PDW on day 1 amongnon-survivors as compared to survivors on day 1 were significantly associated with mortality. ROC curves showed that RDW and PDW on day 1 could be used to predict mortality in surgical patients with sepsis and it was dynamic changes in PC on day 4 and day 8 along with a change in MPV on day 8, which was significantly associated with mortality. The major findings of our study were baseline value of RDW and PDW on day 1 and continuous decrease in PC and increase in MPV over one week weresignificantly associated with mortality. So, it is better to monitor dynamic changes in PC and MPV in combination with baseline RDW and PDW. So, these parameters can bepromising markers to assess prognosis in surgical patients with sepsis.

Association between red blood cell distribution width and all-cause mortality in unselected critically ill patients: Analysis of the MIMIC-III database.

Although red cell distribution width (RDW) is widely observed in clinical practice, only a few studies have looked at all-cause mortality in unselected critically ill patients, and there are even fewer studies on long-term mortality. The goal of our study was to explore the prediction and inference of mortality in unselected critically ill patients by assessing RDW levels. We obtained demographic information, laboratory results, prevalence data, and vital signs from the unselected critically ill patients using the publicly available MIMIC-III database. We then used this information to analyze the association between baseline RDW levels and unselected critically ill patients using Cox proportional risk analysis, smoothed curve fitting, subgroup analysis, and Kaplan-Meier survival curves for short, intermediate, and long-term all-cause mortality in unselected critically ill patients. A total of 26,818 patients were included in our study for the final data analysis after screening in accordance with acceptable conditions. Our study investigated the relationship between RDW levels and all-cause mortality in a non-selected population by a smoothed curve fit plots and COX proportional risk regression models integrating cubic spline functions reported results about a non-linear relationship. In the fully adjusted model, we found that RDW values were positively associated with 30-day, 90-day, 365-day, and 4-year all-cause mortality in 26,818 non-selected adult patients with HRs of 1.10 95%CIs (1.08, 1.12); 1.11 95%CIs (1.10, 1.13); 1.13 95%CIs (1.12, 1.14); 1.13 95%CIs (1.12, 1.14). In unselected critically ill patients, RDW levels were positively associated with all-cause mortality, with elevated RDW levels increasing all-cause mortality.

Predictive Value of Red Cell Distribution Width in the Diagnosis of Peripherally Inserted Central Catheter (PICC)-Related Thrombosis Among Cancer Patients.

This study aimed to investigate the predictive value of red cell distribution width (RDW) in patients with peripherally inserted central catheter (PICC)-related thrombosis. This was a case‒control study. A total of 98 cancer patients undergoing PICC placement from January 2017 to December 2019 at the ICU Venous Access Center of Peking University Cancer Hospital were retrospectively analyzed. These included 47 cases in the thrombosis group and 51 cases in the nonthrombosis group according to the occurrence of PICC-related thrombosis within 90 days after the PICC procedure. a) RDW was significantly higher in the thrombosis group (15.98±1.93) than in the nonthrombosis group (13.98±1.09). Additionally, the number of smoking histories in the thrombosis group (18, 38.30%) was significantly higher than that in the nonthrombosis group (5, 9.80%). b) Logistic regression analysis indicated that RDW and smoking history were independent risk factors for PICC-related thrombosis (OR: 3.028, P<0.001; OR: 5.640, P=0.023). c) The area under the receiver operating characteristic (ROC) curve of the combination of RDW and smoking history was 86.8%, and the sensitivity and specificity for predicting thrombosis after PICC were 85.1% and 80%, respectively. d) Cox regression analysis revealed that RDW and smoking history were independent risk factors for PICC-related thrombosis (p<0.001). e) Results from Kaplan‒Meier analysis showed that incidence of PICC-related thrombosis in patients with RDW less than 14.75% is significantly lower than those with RDW 14.75% and above (p<0.001). e) Baseline RDW was not different between the two groups (P>0.05), ΔRDW was significantly different between the two groups (p<0.001). The combined use of RDW and smoking history has early evaluation and predictive value in the diagnosis of PICC-related thrombosis.

Evaluation of Dynamic Variation in Red Cell Distribution Width as a Septic Marker in Comparison with Procalcitonin Levels and Clinical Scores in Patients with Sepsis or Septic Shock: A Prospective Observational Study

BACKGROUND: Sepsis is a dysregulated host response to infection resulting in potentially life-threatening organ dysfunction. Elevation in red cell distribution width (RDW), a simple routinely done investigation, could be a prognostic marker in these patients. AIM: We performed this prospective observational study to assess role of dynamic variation of RDW in predicting 30-day mortality in patients with sepsis or septic shock presenting and getting admitted in intensive care unit (ICU) in Fayoum, Egypt. METHODS: Between January 2019 and January 2021, 150 patients with sepsis or septic shock at admission were prospectively evaluated for association between RDW value on admission, on day 4, on day 7, and 30-day mortality. To find out factors associated independently with 30-day mortality, we applied multivariate logistic regression analysis and used the analysis to develop nanogram for prediction of mortality on admission. RESULTS: Among 150 patients, 89 (59.3%) were male. Mean age of the patients was 59.6 ± 12.28 years. Regarding RDW on admission (RDW-0), the mean was 14.1 ± 1.9 while on day 4 (RDW-4), the mean was 14.5 ± 1.97, and on day 7 (RDW-7), the mean was 14.4 ± 2.03. Seventy-four (49.3%) patients died during the period of 30 days follow-up. Multiple logistic regression models for the parameters associated with the mortality outcome at admission were done, for age, higher age was associated with higher probability of mortality, OR = 1.07 (95% CI: 1.02, 1.13). Male sex was associated with lower probability of mortality as compared to females, OR = 0.02 (95% CI: 0.06, 0.80). Higher acute physiologic assessment and chronic health evaluation (APACHE) II score, RDW value, and procalcitonin level, all were associated with higher mortality probability. For APACHE II score, higher level was associated with higher odds of mortality, OR = 1.16. For RDW value on admission, higher value was associated with higher odds of mortality, OR = 1.66. For procalcitonin level at admission, higher level was associated with higher odds of mortality, OR = 1.54. Odds for mortality for those who showed any increase in RDW in day 4 as compared to day 0 are higher as compared to those who showed a decrease or no change in RDW, OR = 2.8, p-value = 0.007. CONCLUSIONS: We found that an increase in RDW value on admission and on day 4 is significantly associated with mortality. And that, an increase in RDW value from day 0 to day 4 is also significantly associated with mortality Therefore, a combination of baseline RDW value and an increase in serial RDW values can be a promising independent prognostic marker in patients with sepsis or septic shock.

Peripheral Inflammatory Indexes Neutrophil/Lymphocyte Ratio (NLR) and Red Cell Distribution Width (RDW) as Prognostic Biomarkers in Advanced Solitary Fibrous Tumour (SFT) Treated with Pazopanib.

Simple SummaryPazopanib treatment in advanced solitary fibrous tumour patients, assessed in the prospective GEIS-32 phase II clinical trial, has shown longer progression-free survival and overall survival versus chemotherapy treatment in control patients. In recent years, the interest in the prognostic and predictive value of different peripheral inflammatory indexes, such as neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and red cell distribution width, has been increased in sarcomas, showing significant results in different soft tissue sarcomas. However, they have not been previously analysed in solitary fibrous tumour (SFT) patients. These indexes were retrospectively analysed in the typical- and malignant-SFT cohorts treated with pazopanib of the GEIS-32 trial to evaluate their predictive or prognostic value.Pazopanib was assessed prospectively in the GEIS-32 phase II study (NCT02066285) on advanced solitary fibrous tumour (SFT), resulting in a longer progression-free survival (PFS) and overall survival (OS) compared with historical controls treated with chemotherapy. A retrospective analysis of peripheral inflammatory indexes in patients enrolled into GEIS-32 was performed to evaluate their prognostic and predictive value. Patients received pazopanib 800 mg/day as the first antiangiogenic line. The impacts of baseline neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and red cell distribution width (RDW) on PFS, OS, and Choi response were evaluated by univariate and multivariate analysis. Metastasis-free interval (MFI), mitotic count, and ECOG were also included as potential prognostic factors. Sixty-seven SFT patients, enrolled in this study, showed a median age of 63 years and a female/male distribution of 57/43. The median follow-up from treatment initiation was 16.8 months. High baseline NLR, PLR, and standardised RDW were significantly associated with worse PFS and OS. NLR, RDW, MFI, and mitotic count were independent variables for PFS, while RDW and ECOG were independent for OS. Further, NLR and mitotic count were independent factors for Choi response. High baseline NLR and RDW values were independent prognostic biomarkers for worse outcome in advanced SFT patients treated with pazopanib.

Red cell distribution width is associated with short-term mortality in critically ill patients with heart failure.

There is limited evidence for the correlation between short-term mortality and red cell distribution width (RDW) in critical patients with heart failure. Herein, a retrospective cohort study was conducted to investigate whether RDW was independently associated with short-term mortality in critically ill patients with heart failure. As a retrospective cohort study, it involved a total of 9465 patients with heart failure from the MIMIC-IV database. The target-dependent and independent variables were in-hospital mortality, 90day mortality and RDW measured at baseline, respectively. The relationship between all-cause death and baseline RDW in hospital and after 90days of admission to ICU was evaluated by using the Kaplan-Meier plot and Cox proportional hazard analysis. The average age of participants was 74.4 (64.2, 83.5) years old, among whom about 54.6% were male. Results of the adjusted Cox proportional hazard model revealed that RDW had a positive association with both in-hospital and 90day mortality risk after the adjustment of confounders (HR=1.09, 95% CI: 1.04-1.15, P<0.001; HR=1.11, 95% CI: 1.08-1.14, P<0.001, respectively). A non-linear relationship was found between RDW and 90day mortality, which had a threshold of 14.96%. The effect sizes and confidence intervals below and above the threshold were 1.36 (1.14 to 1.62) and 1.09 (1.04 to 1.15), respectively. It was also found by subgroup analysis that there were stronger correlations in male and patients with normal renal function. Our data suggest that the short-term mortality of critically ill patients with HF is independently predicted by RDW. At the same time, large prospective research and longer follow-up time are required to further validate the findings of this study.

Red cell distribution width is associated with cardiovascular risk in adults.

Red cell distribution width (RDW) is a measure of erythrocyte size variability. Recent studies have shown that RDW is a predictive, and prognostic marker of mortality and cardiovascular (CVD) events in the general population and in CVD patients. This study aimed to investigate the association between RDW and CVD risk in a large sample of adults. A subsample of CVD free participants of the ELSA-Brasil cohort were included (n=4,481). In the cross-sectional approach, multiple regression analysis was used to investigate the association between RDW and the Framingham Risk Score (FRS). Linear mixed effect model evaluated whether baseline RDW predicted changes in CVD risk after about four-year follow up. Cross-sectional analysis showed that RDW was independently associated with FRS, participants in the fourth-quartile of RDW distribution had a 29% higher FRS than those in the first-quartile RDW (p<0.001). A longitudinal analysis revealed that RDW remained associated with increased FRS. In this large cohort of adult Brazilians, RDW was independently associated with increased CVD risk, as measured by the FRS, both at baseline and after four-year follow-up. However, RDW did not predict change in CVD risk in this short-term follow up.

Preferential Metabolic Improvement by Intermittent Fasting in People with Elevated Baseline Red Cell Distribution Width: A Secondary Analysis of the WONDERFUL Randomized Controlled Trial.

Red cell distribution width (RDW) predicts cardiovascular outcomes, but it is unstudied with regard to intermittent fasting. In WONDERFUL trial subjects, the effect of the interaction between baseline RDW and intermittent fasting on changes in insulin and other cardiometabolic endpoints and the effect of fasting on changes in RDW were evaluated. The subjects enrolled were aged 21–70 years and were free of statins, anti-diabetes medications, and chronic diseases, and had ≥1 metabolic syndrome feature, as well as elevated low-density lipoprotein cholesterol. Subjects were randomized to 24-h, water-only fasting (twice per week for 4 weeks, once per week for 22 weeks) or 26 weeks of ad libitum eating. Subjects (N = 71; n = 38 intermittent fasting, n = 33 controls) had more substantial changes in insulin in intermittent fasting vs. controls (−3.45 ± 2.27 vs. 0.48 ± 3.55 mIU/L) when baseline RDW size distribution (RDW-SD) was ≥median (42.6 fL) than <median (−1.99 ± 2.80 vs. −1.08 ± 3.40 mIU/L) (p-interaction = 0.039). Results were similar but weaker for glucose, HOMA-IR, and metabolic syndrome score. RDW-SD (intermittent fasting: 1.27 ± 9.6 fL vs. control: −0.37 ± 1.76 fL, p = 0.34) was unchanged by fasting at 26 weeks. Intermittent fasting decreased insulin more in subjects with higher baseline RDW. RDW may identify individuals who derive the most health benefits from intermittent fasting and who have the most cause to adhere to a fasting regimen.

Abstract 10330: Intermittent Fasting Interacts with Red Cell Distribution Width to Differentially Improve Cardiometabolic Health

Introduction: Intermittent fasting reduces weight and cardiometabolic risk factors. In the WONDERFUL Trial (NCT02770313), intermittent fasting reduced homeostatic model assessment of insulin resistance (HOMA-IR) and the Metabolic Syndrome Score (MSS), with insulin having the largest decline. The red cell distribution width (RDW) measures the dispersion of red blood cell size, is strongly predictive of mortality and major adverse events, and may be a biomarker of general health. This post hoc study of subjects from the WONDERFUL Trial examined the interactive effect of intermittent fasting and baseline RDW on changes in insulin, glucose, HOMA-IR, and MSS. Methods: Subjects aged 21-70 years who had pre-diabetes, diabetes, or ≥1 other metabolic syndrome factor and modestly elevated LDL-C were enrolled if they were not taking anti-diabetic or statin medications and were free of chronic diseases (N=71; n=38 intermittent fasting, n=33 controls). Subjects were randomized to 24-hour water-only fasting (twice-weekly for 4 weeks followed by once-weekly for 22 weeks) or ad libitum eating (control) for 26 weeks. Results: Age averaged 49.1±11.1 years and 64.8% were female. Change scores stratified by RDW size distribution (RDW-SD) are shown in the Table. Results were similar when the RDW coefficient of variation (RDW-CV) was used. Intermittent fasting did not change RDW-SD (1.27±9.6 fL vs. control: -0.37±1.76 fL, p=0.34) or RDW-CV (-0.15%±0.55% vs. control: -0.11%±0.45%, p=0.76) over the 26-week trial. Conclusions: Compared to controls, intermittent fasting significantly decreased insulin more in subjects with higher baseline RDW than those with RDW ≤median. This differential effect may also apply to changes in HOMA-IR, glucose, and MSS. These findings should be validated and expanded in larger studies since RDW may identify people who would derive the most cardiometabolic benefit from engaging in intermittent fasting.

Red Cell Distribution Width and Patient Outcome in Cardiovascular Disease: A ''Real-World'' Analysis.

Red cell distribution width (RDW) has been shown to predict adverse outcomes in specific scenarios. We aimed to assess the association between RDW and all-cause death and a clinically relevant composite endpoint in a population with various clinical manifestations of cardiovascular diseases. We retrospectively analyzed 700 patients (median age 72.7 years [interquartile range, IQR, 62.6–80]) admitted to the Cardiology ward between January and November 2016. Patients were divided into tertiles according to baseline RDW values. After a median follow-up of 3.78 years (IQR 3.38–4.03), 153 (21.9%) patients died and 247 (35.3%) developed a composite endpoint (all-cause death, acute coronary syndromes, transient ischemic attack/stroke, and/or thromboembolic events). With multivariate Cox regression analysis, the highest RDW tertile was independently associated with an increased risk of all-cause death (adjusted hazard ratio [HR] 2.73, 95% confidence interval [CI] 1.63–4.56) and of the composite endpoint (adjusted HR 2.23, 95% CI 1.53–3.24). RDW showed a good predictive ability for all-cause death (C-statistics: 0.741, 95% CI 0.694–0.788). In a real-world cohort of patients, we found that higher RDW values were independently associated with an increased risk of all-cause death and clinical adverse cardiovascular events thus proposing RDW as a prognostic marker in cardiovascular patients.

The significance of red cell distribution width and homocysteine values in STEMI patients undergoing PCI in the population of Bosnia and Herzegovina.

We aimed to confirm whether serum on admission homocysteine level (HCY) and red cell distribution width (RDW) value are independent risk factors for MACE incidence in patients with STEMI myocardial infarction treated by percutaneous coronary intervention (PCI), as well as the possibility of their joint assessment in order to enhance the risk stratification for major adverse cardiac events (MACE). A total of 80 patients with acute myocardial infarction (AMI) were included in the study and tested for blood HCY and RDW values. Patients were followed up for six months after discharge and evaluated for MACE occurrence. The RDW value was significantly associated with HCY level (r=0.267, p=0.026). Univariate logistic regression analysis identified both the RDW and HCY as independent predictors of MACE (OR 2.179; CI 95% 1.250 to 3.797; p=0.006 and OR 1.108; CI 95% 1.013 to 1.213; p=0.025, respectively), naming RDW as a stronger predictor of unfavorable prognosis in AMI patients. Addition of HCY to RDW value in receiver operating characteristic (ROC) curve analysis increased the area under the curve (AUC) from 0.705 to 0.730 (p=0.007), while risk prediction model, which also included traditional risk factors, increased AUC up to 0.806, implying this model as good predictor of MACE both in low-risk and high-risk STEMI patients. A high baseline HCY level and RDW value in patients with STEMI undergoing PCI is independently associated with increased risk for MACE outcome. Their joint assessment increases risk prediction ability.

Red Cell Distribution Width, Anemia, and Brain Volumetric Outcomes Among Middle-Aged Adults.

Anemia and red cell distribution width (RDW) have been linked to poor cognitive performance, pending studies of underlying mechanisms. We examined cross-sectional relationships of initial RDW status (v1), RDW change (δ), and anemia with brain structural magnetic resonance imaging (sMRI) markers, including global and cortical brain and hippocampal and white matter lesion (WML) volumes, 5-6 years later. Data were used from three prospective visits within the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) study with complete v1 (2004-2009) and v2 (2009-2013) exposures and ancillary sMRI data at vscan (2011-2015, n = 213, mean v1 to vscan time: 5.7 years). Multivariable-adjusted linear regression models were conducted, overall, by sex, by race, and within non-anemics, correcting for multiple testing with q-values. In minimally adjusted models (socio-demographics and follow-up time), anemiav1 and RDWv1 were consistently associated with smaller bilateral hippocampal volumes overall, and among females (q < 0.05), without significant sex differences. RDWv1 was related to smaller select regional cortical brain gray and white matter volumes in hematological measure-adjusted models; anemiav1 was associated with larger WML volumes only among whites. In summary, baseline anemia and RDW were consistently associated with smaller bilateral hippocampal volumes, particularly among females, while anemia was linked to larger WML volume among Whites. In hematological measure-adjusted models, baseline RDW was linked to smaller regional gray and white matter volumes. Pending studies with sMRI repeats, randomized controlled trials are needed, demonstrating associations of anemia and elevated RDW with reduced brain volumes and cognitive dysfunction.

POS-068 RED BLOOD CELL DISTRIBUTION WIDTH AS PREDICTOR OF IN-HOSPITAL MORTALITY IN PATIENTS WITH SEPSIS INDUCED ACUTE KIDNEY INJURY: 5 YEAR RETROSPECTIVE REVIEW STUDY FROM 2014-2018

Sepsis is the leading cause of Acute Kidney Injury (AKI). Patients with sepsis induced AKI have an increased risk of death and a longer duration of hospitalization. Red cell distribution width (RDW) measure the range of variation in the red cell volume and variability in size of erythrocytes. Inflammation and oxidative stress are essential components of sepsis cascade, and they have been suggested to reduce Red Blood Cell survival and suppress their maturation leading to a release of increased premature RBCs into circulation, thus, an elevated RDW. The study adapt a retrospective observational analytical cross-sectional review of patients admitted at University of Santo Tomas Hospital from January 2014 to December 2018. Information was gathered across the departments of Surgery, Obstetrics and GynecologyInternal Medicine that were referred to the Section of Nephrology. Total of 421 patients were analyzed, with median age of 67 years, 53% being female, and majority with diabetes. Patients had low median hemoglobin (118 g/dl) and elevated WBC (14.54 x 1000/µL); low mean serum albumin (2.98); and elevated median serum creatinine (2.12 mg/dl). The prevalence of stages 1, 2, and 3 AKI were 70%, 13%, and 17%, respectively. One in 10 patients underwent dialysis. There were 32 patients who had RDW of at least 15.1%. This group had higher median age (77.5 years), serum creatinine (3.78 mg/dL), increase hematologic comorbidity (9%), cardiac disease (53%), septic shock (87.5%), stage 3 AKI (78%), need for Renal Replacement Therapy (44%); higher SOFA score (12); and longer hospital stay (21 days) compared to those with lower baseline RDW levels. Optimal cut-off value for RDW was 15.1%. At this level, sensitivity and specificity were 82.14 and 97.71%, respectively. On bivariate analysis, factors associated with increase in-hospital mortality were higher RDW, age, WBC, serum creatinine, SOFA score, and presence of AKI stages >1 and septic shock. With adjustment for other factors, only RDW and SOFA remained as the significant predictors, with every point increase resulting to 97.5% and 68.4% rise in odds of death, respectively. In the final multivariate Cox’s regression (after adjusting for all other factors such as RDW, age, and other factors in the initial model), only RDW and SOFA score are significant. For every unit increase in RDW, the hazard for mortality increases by approximately 15% (aHR 1.15, 95% CI 1.06 to 1.25, p = 0.001), after adjusting for age, sex and co-morbidities. For every unit increase in SOFA scores, the hazard for mortality increases by approximately 43% (aHR 1.431, 95% CI 1.25 to 1.64, p < 0.001). This model explained 28.47% in the variance of time to mortality and was statistically significant at p<0.00. The current study found that an elevated RDW is an independent predictor of in hospital mortality among patients with sepsis induced AKI. Patients with RDW of > 15.1 are approximately twice more likely to die among patients with sepsis induced AKI. This finding suggests that RDW may aid in risk stratification and can represent an inexpensive marker to predict mortality among sepsis induced AKI.

Diagnostic accuracy of a dynamically increased red blood cell distribution width in very low birth weight infants with serious bacterial infection

ObjectiveSerious bacterial infection (SBI) remains an important cause of morbidity and mortality in preterm infants. The objective of this study was to evaluate the dynamically increased value of the red cell distribution width (RDW) in the diagnosis of SBI.MethodsThis retrospective study enrolled 334 preterm infants with birth weight less than 1500 g. The initial RDW and the maximum value of RDW during hospitalization were extracted from the MIMIC-III database (version 1.4). Infants were categorized into four groups according to baseline RDW value and ΔRDW (ΔRDW = RDW at maximum- RDW at baseline). Logistic regression analysis was used to assess the risk of developing SBI in each group. A receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic value of RDW at baseline alone, ΔRDW alone, and in combination.ResultsInfants with increased RDW at baseline (> 17%) and ΔRDW > 2% exhibited the highest risk of developing SBI, whereas the patients with normal RDW level at baseline (≤ 17%) and ΔRDW≤2% (the reference group) had the lowest risk. This association remained unaltered even after adjustment in multivariable models. Basing on ROC curve analysis, the area under the curve predicted by the combination of RDW at baseline and ΔRDW for SBI was 0.81 (95% CI, 0.76–0.87). Sensitivity and specificity were 78.16 and 72.47% respectively.ConclusionsWe observed that combination of elevated RDW at baseline and dynamic increases during hospitalization is significantly associated with SBI. Therefore, that combination could be a promising independent diagnostic indicator of SBI in newborns.

Increased Red Cell Distribution Width Is Associated With Disease Severity in Hospitalized Adults With SARS-CoV-2 Infection: An Observational Multicentric Study.

Background: There is an amenable need for clinically applicable biomarkers in patients with SARS-CoV-2 infection. Red Cell Distribution Width (RDW) has been recently suggested as a prognostic biomarker for COVID-19.Methods: This was an observational study enrolling patients between February 26 and May 15 2020. We aimed to validate the association of the previously published RDW threshold of 14.5% with markers of disease progression and mortality.Results: A total number of 193 hospitalized patients with COVID-19 were enrolled and analyzed. Median age was 61 years (95% CI: 58–64). Patients with baseline RDW ≥14.5% (n = 41, 19.2%) presented with more progressive disease compared to patients with baseline RDW <14.5% (n = 156, 80.8%) as indicated by significant differences in maximum FiO2% during hospitalization (median: 100, 95% CI: 45.2–100, vs. 35, 95% CI: 31–40, p = 0.0001, respectively). Values of RDW ≥14.5% were also strongly associated with increased risk of mortality (HR: 4.1, 95% CI: 0.88–19.23), (p = 0.02).Conclusion: Our study provides evidence to support reproducibility and validity of a specified cut-off threshold of RDW as biomarker of disease severity and mortality in patients with COVID-19.

Prognostic value of red cell distribution width in patients undergoing percutaneous coronary intervention: a meta-analysis

ObjectiveTo evaluate the prognostic value of baseline red cell distribution width (RDW) in patients with coronary artery diseases (CADs) undergoing percutaneous coronary intervention (PCI) by conducting a meta-analysis.DesignSystematic review and...