Baseline Red Cell Distribution Width Research Articles

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...

Red Blood Cell Distribution Width is Associated with Glomerulonephritis in Diabetic Patients with Albuminuria.

BackgroundThe aim of this study was to explore predictive factors to inform accurate diagnosis of glomerulonephritis (GNs) in patients with diabetes.Material/MethodsClinical characteristics and laboratory data were retrospectively analyzed from 200 patients with diabetes including 115 patients who had undergone a renal biopsy. Eligible patients were categorized into three groups: pure type 2 diabetes mellitus (T2DM), isolated diabetic nephropathy (DN), and GN. Odds ratios (ORs) were calculated to evaluate the contributions of predictive factors for GN. A receiver operating characteristic curve (ROC) was created to obtain cut-off values for predictive factors for GNs and investigate their corresponding predictive accuracy.ResultsRed cell distribution width (RDW) was significantly higher in the GN group than in the DN group. Multivariate regression analysis revealed that baseline RDW level (OR=1.988, 95% CI=1.237~3.194, P=0.005) was an independent predictive factor for development of GNs.ConclusionsIncreased RDW levels are independently associated with a greater risk of GN in patients with diabetes who have albuminuria, and may be an additional valuable and noninvasive predictive tool for differentiating GNs and DN.

Prognostic value of baseline elevated red cell distribution width in DLBCL.

e20031 Background: Elevated red cell distribution width (RDW) has been associated with all-cause mortality, risk of developing cancer and cancer mortality in large retrospective studies. The underlying mechanism may be due to inflammatory and nutritional abnormalities. We hypothesized DLBCL patients with an elevated RDW at the time of diagnosis would have a worse prognosis. Methods: A retrospective single-institution study included 541 DLBCL patients diagnosed between 2001 and 2016. RDW over 14.5% was considered high, as this was the upper limit of normal at our institution. The overall and progression free survival was estimated using Kaplan-Meier methods, and the difference between groups was compared using the log-rank test. Univariate and multivariate analyses were performed with Cox proportional hazards regression. Results: We identified 410 DLBCL pts with available baseline RDW, 229 (56%) had RDW > 14.5. Median follow up from diagnosis was 60 months. The complete response rate was 63.8% in the group with high RDW (n = 152) and 88.4% in the normal RDW group (n = 216, p < 0.0001) . For patients with high RDW, 1-year overall survival (OS) was 65% (95%CI 0.58-0.72) vs 90% (95%CI 0.87-0.94) for pts with normal RDW < / = 14.5; 2-year OS was 57% (95%CI 0.50-0.65) vs 84% (95%CI 0.79-0.89), respectively (p < 0.0001). This difference remained statistically significant when the analysis was restricted to patients treated with anthracycline-containing regimens given with curative intent (2y OS = 66% vs. 87.5%, p < 0.0001). Univariate analysis revealed that R-IPI, high RDW, elevated LDH, albumin < 3.5mg/dl, Hgb < 10g/dl, advanced stage disease, bulky disease, extra nodal disease, and ECOG performance status 3-4 were associated with worse OS. In multivariate analysis, older age (HR 2.07, 95%CI 1.38-3.1), high RDW (HR 1.68, 95%CI 1.15-2.5), albumin < 3.5mg/dl (HR 1.76, 95%CI 1.18-2.6) and ECOG 3-4 (HR 2.47, 95%CI 1.47-4.2) were independent prognostic factors for OS. Conclusions: High RDW is associated with worse response rates and independently associated with worse OS in patients with DLBCL. Based on our study, DLBCL patients with high RDW at diagnosis should be considered at higher risk of mortality and treatment failure. Further research is needed to clarify the underlying mechanism and to evaluate the utility of incorporating RDW into prognostic indices.

Association between red cell distribution width and response to methotrexate in rheumatoid arthritis.

Red cell distribution width (RDW) is an unconventional biomarker of inflammation. We aimed to explore its role as a predictor of treatment response in rheumatoid arthritis (RA). Eighty-two RA patients (55 females), median age [interquartile range] 63 years [52-69], were selected by scanning the medical records of a rheumatology clinic, to analyze the associations between baseline RDW, disease activity scores and inflammatory markers, as well as the relationship between RDW changes following methotrexate (MTX) and treatment response. The lower the median baseline RDW, the greater were the chances of a positive EULAR response at three months, 13.5% [13.0-14.4] being among those with good response, vs 14.0% [13.2-14.7] and 14.2% [13.5- 16.0] (p=0.009) among those with moderate and poor response, respectively. MTX treatment was followed by a significant RDW increase (p<0.0001). The increase of RDW was greater among patients with good EULAR response, becoming progressively smaller in cases with moderate and poor response (1.0% [0.4-1.4] vs. 0.7 [0.1-2.0] vs. 0.3 [-0.1-0.8]; p=0.03). RDW is a strong predictor of early response to MTX in RA. RDW significantly increases after MTX initiation in parallel to treatment response, suggesting a role as a marker of MTX effectiveness.

Clinical relationship between anemia and atrial fibrillation recurrence after catheter ablation without genetic background

BackgroundAnemia is a known adverse prognostic factor among patients with cardiovascular diseases. We investigated whether the hemoglobin level was associated with the rhythm outcome after atrial fibrillation (AF) catheter ablation (AFCA). MethodsWe included 2627 patients who underwent AFCA and a guidelines-based rhythm follow-up (age 58 ± 10.9 years, 73% men, 30.6% with persistent AF), and evaluated the association of pre-AFCA anemia (haemoglobin <13 g/dL in men and <12 g/dL in women) and rhythm outcomes. We studied the mechanistic relationship between anemia and AF recurrence using a Mendelian randomization analysis (1775 subjects with genome-wide association study) after reviewing already proven 12 hemoglobin-associated genetic polymorphisms. ResultsThe body mass index, paroxysmal AF, warfarin use, and baseline red cell distribution width were independently associated with anemia in patients with AF. During a 23-month follow-up (interval OR 9–48 months), the clinical AF recurrence rate was significantly higher in patients with than without anemia (log-rank p = 0.001; propensity score-matched log-rank p = 0.004). This pattern was more significant in male patients (Log-rank p < 0.001) or patients with paroxysmal AF (Log-rank p < 0.001). Anemia (hazard ratio [HR] 1.45 [1.17–1.80], p = 0.001), left atrial diameter (HR 1.03 [1.01–1.04], p < 0.001), a female sex (HR 1.17 [1.00–1.36], p = 0.047), and persistent AF (HR 1.58 [1.36–1.84], p < 0.001) were independently associated with post-AFCA clinical recurrence. In the Mendelian randomization, we could not find a significant direct causal relationship between anemia and AF recurrence at the genetic level. ConclusionsPre-AFCA anemia is an independent predictor of post-AFCA clinical recurrence, especially in male patients, without a genetically direct causal relationship.

The Effect of Red Cell Distribution Width Admission Value on the Outcome of Patients with First-ever ST-elevation Myocardial Infarction in Basrah.

BackgroundRed cell distribution width (RDW) reflects the volumetric heterogeneity of red blood cells (RBCs) and has proven to be a prognostic predictor for cardiovascular (CV) morbidity and mortality in ST-elevation myocardial infarction (STEMI). The study aims to evaluate the effect of the RDW admission value on the outcome of patients with STEMI.Materials and methodsThis is a cross-sectional observational study on (207) patients with first-ever STEMI, grouped according to their baseline RDW and thrombolysis eligibility into two groups. We calculated the in-hospital Global Registry of Acute Coronary Events (GRACE) score within 48 hours of presentation.ResultsThe study demonstrated the impact of RDW on the primary STEMI outcomes (left ventricular ejection fraction (LVEF%), ST-resolution, arrhythmias, and cardiovascular mortality risk). It was nearly a gender-matched study, with a mean RDW of 14.20±1.86%. RDW>14% and age≥65 years were the strongest statistically significant independent predictors of STEMI outcome with LVEF % < 45%, ST-resolution, and CV mortality regardless of thrombolysis. The thrombolysis offers a logical significant negative relation with CV mortality. At the same time, hypertension, diabetes mellitus (DM), and smoking may cause an additional mortality burden, especially in elderly patients with high RDW who are not eligible for thrombolysis. There was a significant association between high GRACE to high RDW, with excellent specificity and sensitivity in predicting CV outcome.ConclusionThe RDW is a simple to acquire index, with a good prognostic prediction of major adverse cardiovascular events (MACEs) and CV mortality in the STEMI patients. It is excellent in predicting STEMI outcomes, especially the response to thrombolysis.

Effect of Baseline RDW and Troponin Levels on Prognosis in Patients with Acute Chest Pain

Introduction: Red cell distribution width (RDW) is a measure of the mean corpuscular/erythrocyte volume. The aim of this study was to investigate the effect of RDW levels on the prognosis in patients with elevated levels of troponin I in the emergency department with chest pain. Materials and methods: The study included 3,922 patients aged over 18 years who presented to the emergency department with the complaint of chest pain between August 1, 2018 and August 1, 2019. Troponin values and RDW levels were compared to determine the ability to diagnose acute ischemic heart disease and determin the prognosis in these patients. Results: The median RDW was 13.3 (IQR 1.20) in patients with normal troponin and 13.3 (IQR 1.40) in patients with elevated troponin (p = 0.001), but there was no difference in clinical outcomes between the groups. There was no significant difference in RDW between the patients discharged from the emergency department, those discharged from the hospital (good outcome) and those that required intensive care or died (poor outcome) (p &gt; 0.05). Conclusion: RDW levels may vary in patients with elevated troponin values and acute ischemia, but this has no affect on clinical outcomes.

The Utility of Rise in Red Cell Distribution Width in Determining the Risk of Renal Relapse in Lupus Nephritis.

We hypothesized that the levels of red cell distribution width (RDW) would correlate with lupus nephritis (LN) disease activity, therapeutic response after induction therapy, and its rise would be associated with future renal relapse in patients who had achieved clinical remission. The associations of RDW and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), renal response, and renal relapse after induction therapy were examined in 172 biopsy-proven LN patients at the Division of Nephrology, Huashan Hospital Fudan University between 2007 and 2017. The median RDW of LN patients was significantly higher than that of healthy individuals (p < 0.001). Baseline RDW demonstrated positive correlation with baseline SLEDAI (r = 0.239, p = 0.004). Overall RDW after induction treatment was significantly decreased (p = 0.005), especially in the complete remission (CR) group (p = 0.02), and the partial remission (PR) group had a decreasing trend (p = 0.09), while the change of RDW in the no response (NR) group was not statistically significant (p = 0.70). Among the 153 patients who achieved remission after induction therapies, 37 (24.2%) patients developed 42 episodes of subsequent renal flare during a median follow-up of 36.0 (IQR, 20 - 66) months. The median time from remission to renal flare was 18.0 (IQR, 7.0 - 45.0) months. The overall renal flare rate was 0.065 relapse per patient-year. During follow up, 54 RDW rises (defined as more than 0.5% increase in RDW) were identified. There were 33 episodes (61.1%) of renal flares in patients with RDW rises, while there were only 9 renal flares (8.65%) in 104 patients without RDW rise (p < 0.001). Survival analysis showed that RDW rise was associated with a significantly higher risk of future renal relapse (adjusted HR, 14.03; 95% CI, 5.29 to 37.20; p < 0.001). In addition to correlating with disease activity and therapeutic response to induction therapy in patients with LN, RDW rise is a significant predictor of future renal relapse in patients who achieve remission.

The association between red cell distribution width and incident hypertension in Korean adults.

Red cell distribution width (RDW), a measure of variation in red blood cell size, is routinely reported in the results of a complete blood count. Recent studies have found that RDW is a predictor of high cardiovascular morbidity and mortality. Furthermore, previous cross-sectional studies have shown a possible association between high RDW and hypertension. However, the longitudinal relationship between high RDW and incident hypertension is uncertain. The aim of this study was to investigate the association between RDW and the development of hypertension. In this retrospective cohort study, we analyzed 124,261 participants without hypertension at baseline who underwent two health checkups at 4-year intervals from 2005 to 2016. The subjects were divided into quartiles (Q1-Q4) according to their baseline RDW levels. Multivariate logistic regression was used to estimate the OR and 95% CI for the development of hypertension after 4 years. After 4 years, 6827 cases (5.5%) of incident hypertension were observed. The incidence rates of hypertension were 4.66%, 5.66%, 5.99%, and 5.46% for Q1, Q2, Q3 and Q4 of RDW, respectively. The ORs (95% CIs) for incident hypertension compared with Q1 were 1.19 (1.10-1.29), 1.28 (1.18-1.39), and 1.32 (1.22-1.44) for Q2, Q3, and Q4 of RDW, respectively. High RDW was significantly and independently associated with the development of hypertension in Korean adults. Further research is warranted to verify the mechanism underlying this relationship.

The clinical use of red cell distribution width in advanced heart failure following cardiac resynchronization therapy

Introduction High Red Cell Distribution Width (RDW) is linked to poor outcomes in advanced Heart Failure (HF). Whether or not RDW levels predict response to Cardiac Resynchronization Therapy (CRT) remains unclear. We examined the role of RDW in predicting clinical outcomes of HF following CRT insertion. Further, we examined if follow-up RDW levels correlated with response and mortality. Methodology A retrospective chart review was carried out for all patients undergoing CRT insertion from April 2009 to April 2015. RDW was measured at baseline and three different time points after CRT insertion (3 months, 6 months, and 1 year). Comparisons were done according to the median RDW value (RDW >14.1 vs. RDW ⩽14.1). Our primary endpoints were significant reduction (⩾15%) in Left Ventricular End Systolic Diameter (LVESD), HF readmissions, and all-cause mortality. The outcomes were examined over a median follow-up duration of 36 months. Results One-hundred and eighty-nine patients were eligible for the present analysis. Of which, the majority were males (72.5%) with a mean age of 59.5. Elevated baseline RDW was significantly associated with HF readmissions (29.3% vs. 9.5%; P = 0.001) but not with significant reduction in LVESD (30.4% vs. 46.9%; P = 0.064) or all-cause mortality (11.1% vs. 10.0%; P = 0.808). Multivariate analysis showed no independent role of RDW in predicting HF readmissions (OR = 2.86, 95% CI 0.79–10.29, P = 0.108). Follow-up RDW levels remained persistently elevated in patients with poor reverse ventricular remodeling, HF readmissions, and all-cause mortality (Figure). Conclusion Baseline RDW had no independent role in predicting outcomes of advanced HF after CRT insertion. During follow-up, persistently elevated RDW correlated with HF morbidity and mortality.

Red cell distribution width and renal outcome in patients with non-dialysis-dependent chronic kidney disease.

Higher red cell distribution width (RDW) has been reported to predict mortality among patients with various diseases, including chronic kidney disease (CKD). However, whether RDW is associated with renal outcome remains unclear. We investigated the relationship between RDW and renal outcome in patients with non-dialysis-dependent CKD (NDD-CKD). This prospective, observational study of patients with CKD was conducted at a single nephrology department. First, we performed regression analyses for the decline in estimated glomerular filtration rate (eGFR) during the first 3 months of observation to determine its short-term association with RDW. Next, we categorized baseline RDW into two groups by its median (13.5%) and performed Cox regression analyses to investigate whether higher RDW was an independent predictor of renal outcomes defined as a composite of the initiation of dialysis and doubling of the serum creatinine concentration. Furthermore, we repeated the analyses to confirm whether the transition of the RDW category during the first 3 months would also predict renal outcomes. We enrolled 703 patients. Baseline RDW showed a non-linear association with the eGFR decline during the first 3 months, with a greater negative correlation at the lower end of the RDW distribution. Over a median follow-up of 1.8 years, 178 patients (25.3%) reached the renal endpoint. Multivariable Cox regression analyses showed that patients with higher RDW had a higher risk of developing renal outcomes (adjusted hazard ratio [HR]: 1.47, 95% confidence interval [CI]: 1.05–2.07) than did those with lower RDW. Furthermore, patients with sustained, higher RDW demonstrated a significantly higher risk than did those with consistently lower RDW (adjusted HR: 1.65, 95% CI: 1.02–2.67). In conclusion, higher RDW was independently associated with worse renal outcome in patients with NDD-CKD. RDW could be an additional prognostic marker of the progression of CKD.

RED CELL DISTRIBUTION WIDTH AS AN INDEPENDENT PREDICTOR OF MORTALITY IN PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE IMPLANTATION IN A LARGE, LONG-TERM COHORT

The aim of this study was to estimate the long-term prognostic value of baseline red cell distribution width (RDW) in patients undergoing transcatheter aortic valve implantation (TAVI). In a large, long-term prospective single center study, we determined the impact of baseline RDW on outcome in a

Role of Red Cell Distribution Width in the Relationship between Clinical Outcomes and Anticoagulation Response in Patients with Atrial Fibrillation.

Little is known as to why elevated red cell distribution width (RDW) is associated with adverse clinical outcomes in patients with atrial fibrillation (AF). We hypothesized that RDW value might predict the intensity of anticoagulation, resulting in higher adverse events in patients with AF taking warfarin. We analyzed 657 patients with non-valuvular AF who took warfarin. The intensity of anticoagulation was assessed as mean time in the therapeutic range (TTR) and defined TTR ≥60% as an optimal intensity. The primary end-point was the composite of stroke/systemic embolism and major bleeding. The secondary end-point was the composite of stroke/systemic embolism, major bleeding and death. The relationship between the baseline RDW with TTR and clinical outcomes was assessed using categorical variables as quartiles or dichotomous variables. The mean value of TTR decreased as an increment of the RDW (45.2% vs. 44.7% vs. 40.8% vs. 35.2%, p<0.001). Primary and secondary end-points were significantly increased when TTR was less than 60% and RDW was more than 13.6%. Ratio of patients achieving optimal anticoagulation were significantly decreased as an increment of RDW. A RDW of ≥13.6% was a significant predictor for poor anticoagulation control (adjusted Odds ratio [OR] 0.43, 95% confidence interval [CI] 0.23–0.82), stroke (adjusted hazard ratio [HR] 3.86, 95% CI 1.11–13.40), primary (adjusted HR 1.88, 95% CI 1.12–3.16) and secondary end-point (adjusted HR 2.46, 95% CI 1.26–4.81). RDW was negatively associated with TTR in patients with AF. Therefore, RDW might be a useful marker for the prediction of anticoagulation response and clinical outcomes in patients with AF.

Red cell distribution width predicts death and appropriate therapy in patients with implantable cardioverter defibrillator: A simple measurement with prognostic value in a variety of diseases, may help in better selection of patients who will benefit the most from this device.

Red cell distribution width (RDW) is a measure of the size variation of erythrocytes. Its prognostic value has been described in a variety of cardiac and noncardiac diseases. Implantable cardioverter defibrillator (ICD) is useful in preventing sudden cardiac death in high-risk patients, but many of these patients continue to survive without needing ICD therapy. We sought to examine whether RDW, with its prognostic values, can benefit in risk stratification of patients with ICD by predicting death and ICD therapy, and thus help in the selection of patients who will benefit the most from ICD, and minimizing its implantation in others at low risk of death and arrhythmias. In a retrospective study, we enrolled patients with ICD implanted for both primary and secondary prevention of sudden cardiac death. Baseline RDW values, demographics, and clinical characteristics, as well as the occurrence of death or first appropriate ICD therapy in postimplantation follow-up were collected. We examined whether RDW can predict higher-risk ICD-implanted patients prone to death and first appropriate ICD therapy (the combined outcome). Final population included 432 patients. Compared to others, patients in the upper RDW tertile were older and had more comorbidities and outcomes. In multivariate analysis including RDW, age, gender, and ejection fraction, RDW was the only predictor of the combined outcome. RDW may be useful in risk stratification of patients selected for ICD implantation. But larger prospective randomized trials are needed.

A Study of Red Cell Distribution Width in Neonatal Sepsis.

The objective of this study was to evaluate a new nontraditional value of the red cell distribution width (RDW) in predicting the clinical outcome of neonatal sepsis. In this retrospective study, data were collected from the medical files of 500 full-term neonates with a diagnosis of early onset or late onset sepsis. Baseline RDW and other traditional biomarkers, including C-reactive protein (CRP), total leucocytic count, and platelet count were analyzed in light of the clinical data. The primary outcome was 30-day mortality. Red cell distribution width was significantly higher in nonsurvivors compared with survivors (P < 0.0001). Red cell distribution width was significantly elevated in infants with septic shock compared with those having severe sepsis and those with sepsis (P < 0.0001). A strong positive correlation was found between RDW and CRP (r = 0.8; P <0.0001). Red cell distribution width had an area under the receiver operating characteristic curve of 0.75 for prediction of mortality, which was almost equal to that of CRP and platelet count. Furthermore, logistic regression analysis showed a positive association of RDW with mortality (odds ratio, 1.31; 95% confidence interval, 1.241-1.399). Red cell distribution width is a useful prognostic marker in neonatal sepsis. Larger prospective studies are required to confirm the value of this routinely available marker in this category of patients.

The Relation between Red Cell Distribution Width (RDW) and Coronary Artery Calcium Score(CACS) in the Diabetic Patients Undergoing Coronary CT Angiography

Background: red cell distribution width is a marker associated with increased mortality and morbidity in cardiac patients, however it’s relation with coronary artery calcium score (CACS) is not well studied yet. Aim of the work: this study aimed to assess the relation between red cell distribution width (RDW) and coronary artery calcium score (CACS) in the diabetic patients undergoing coronary CT angiography. Patients and methods: this study was conducted on 60 patients presented for assessment of coronary artery disease (CAD) by coronary CT angiography and they were categorized into 2 groups, group (A) diabetics(30 patients),group(B)non-diabetics (30 patients), All patients included in this study were subjected to: History Taking, complete physical examination, multi-slice CT coronary angiography (MSCT) including calcium score(CACS), laboratory investigations including complete blood count (CBC) including RDW(SD&CV), serum calcium level(total and ionized), erythrocyte sedimentation rate (ESR), lipid profile. Results: higher RDW(SD) was associated with the presence of greater coronary complexity of CAD and higher calcium score. In our study total serum calcium and RDW (SD) were found to be independent predictors of high Ca score more than 100, while ionized calcium and systolic blood pressure(SBP) were independent predictors of high Calcium score more than 400. Cut off value of RDW to predict high calcium score (more than 100) was RDW(CV) more than 13.45 & RDW(SD) more than44.45, while Cut off value of RDW to predict high calcium score (more than 400) was RDW(SD) more than 45.1. Conclusions: a greater baseline RDW(SD) value was independently associated with the presence of a greater coronary complexity of CAD and higher calcium score.

Integration of the cancer-related inflammatory response as a stratifying biomarker of survival in hepatocellular carcinoma treated with sorafenib.

Background and AimsResponse to sorafenib is highly variable in hepatocellular carcinoma (HCC). Baseline inflammatory parameters and treatment toxicities may improve survival prediction in patients on sorafenib therapy.Results442 patients with advanced stage HCC on sorafenib were recruited (follow-up 5096 person-months at risk). 88% had BCLC stage B or greater HCC and 72.3% had Child-Pugh A cirrhosis. On Cox multivariate regression, previously-treated HCC (HR 0.579, 95% CI 0.385-0.872, p=0.009), Cancer of Liver Italian Program (CLIP) score (HR 1.723, 95% CI 1.462-2.047, p<0.0001), baseline red cell distribution width (RDW; HR 1.234, 95% CI 1.115-1.290, p<0.0001) and neutrophil to lymphocyte ratio (NLR; HR 1.218, 95% CI 1.108-1.322, p<0.0001) were significant independent risks for shorter survival, whilst sorafenib-related diarrhoea was associated with prolonged survival (HR 0.533, 95% CI 0.373-0.763, p=0.001). The combination of RD-CLIP score (CLIP score multiplied by RDW) ≥ 70 and no treatment-related diarrhoea had good utility for predicting 3-month survival (AUC of 0.808 (95% CI 0.734-0.882), positive predictive value of 86.4% and negative predictive value of 83.3%), compared with CLIP (AUC=0.642) or BCLC score alone (AUC=0.579). RD-CLIP score ≥ 35 and no treatment-related diarrhoea had an AUC of 0.787 for predicting 12-month survival.MethodsPatients with HCC were consecutively recruited from three tertiary centres (Japan, Italy and UK) and clinical data were prospectively collected. The primary study endpoint was overall survival (OS) after commencing sorafenib.ConclusionThe novel prognostic index of CLIP score combined with inflammatory marker RDW and treatment-related diarrhoea has good accuracy for predicting overall, 3 month and 12 month survival in patients on sorafenib.

Relation of Red Cell Distribution Width to Left Ventricular End-Diastolic Pressure and Mortality in Patients With and Without Heart Failure

Higher red cell distribution width (RDW) has been associated with poor prognosis in patients with heart failure (HF). RDW is also closely associated with iron deficiency. However, the mechanism underlying this association is unclear. The relation between left ventricular end-diastolic pressure (LVEDP) and RDW has not been studied, especially in those without HF. We examined the relation between LVEDP and RDW in 1,084 consecutive stable patients who underwent elective coronary angiography. We observed that 38% had high LVEDP (>16mm Hg) and 29% had history of HF. The median RDW was 13.4%, which was higher with increasing LVEDP (p <0.0001) and significantly higher in patients with HF (p <0.0001). Baseline RDW were independently associated with high LVEDP even after multivariable logistic regression analysis (adjusted odds ratio [OR] per unit change 1.14, 95% confidence interval [CI] 1.0 to 1.29, p= 0.044). Interestingly, result were stronger in non-HF cohort (adjusted OR per unit change 1.37, 95% CI 1.13 to 1.67, p= 0.001). In addition, elevated (third vs first tertiles) RDW levels were independently a predictor of high LVEDP and were associated with a 4.8-fold increased 5-year mortality risk (adjusted hazard ratio 4.11, 95% CI 2.12 to 7.96, p <0.0001), even with the addition of B-type natriuretic peptide to the model (adjusted OR for LVEDP 2.25, 95% CI 1.0 to 5.05, p= 0.05; adjusted hazard ratio for mortality 3.79, 95% CI 1.033 to 13.89, p= 0.044, respectively). In conclusion, high RDW levels were observed in patients with or without HF and independently associated with high LVEDP and with mortality.

The Association between Red Cell Distribution Width and Mortality in Pediatric Acute Lymphoblastic Leukemia

Background: Red cell distribution width (RDW) is one of the standard parameters with blood cell counts. Studies have revealed that RDW could be used as a predictor of mortality in different contexts. However, data about the relation of RDW with hematologic malignancies is limited. In this research, we evaluated the relation of RDW with mortality in pediatric acute lymphoblastic leukemia (ALL). Materials and methods: In the oncology department of a tertiary care children hospital, between years of 2010 to 2013, we had 83 registered cases of acute lymphoblastic leukemia (ALL) whose data was collected and analyzed retrospectively. RDW, mean corpuscular volume (MCV), hemoglobin (Hgb) and platelet (Plt) measurements were recorded and their relation with mortality, leukemia relapses and treatment cessation was examined. Results: A total 83 patients were enrolled in the study. The mean age was 5.5 years and 50 (60.2%) were male. The mean baseline RDW level was 16.0%, and it ranged from 11.2% to 23.2%. During the study period, 12(14.5%) cases had died. The rate of mortality did not significantly correlate with RDW level. Conclusions: Although a relationship between elevated RDW and mortality has been reported in several contexts, we did not find any significant correlation between the RDW level and the rate of mortality and relapse in pediatric patients with acute lymphoblastic leukemia (ALL).

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

Background and Methods Red cell distribution width (RDW) has emerged as a prognostic marker in patients with cardiovascular diseases. We investigated mortality in patients with diabetes included in the National Health and Nutrition Examination Survey, in relation to baseline RDW. RDW was divided into 4 quartiles (Q1: ≤12.4%, Q2: 12.5%–12.9%, Q3: 13.0%–13.7%, and Q4: >13.7%). Results A total of 3,061 patients were included: mean age 61 ± 14 years, 50% male, 39% White. Mean RDW was 13.2% ± 1.4%. Compared with first quartile (Q1) of RDW, patients in Q4 were more likely to be older, female, and African-American, have had history of stroke, myocardial infarction, and heart failure, and have chronic kidney disease. After a median follow-up of 6 years, 628 patient died (29% of cardiovascular disease). Compared with Q1, patients in Q4 were at increased risk for all-cause mortality (HR 3.44 [2.74–4.32], P < .001) and cardiovascular mortality (HR 3.34 [2.16–5.17], P < .001). After adjusting for 17 covariates, RDW in Q4 remained significantly associated with all-cause mortality (HR 2.39 [1.30–4.38], P = 0.005) and cardiovascular mortality (HR 1.99 [1.17–3.37], P = 0.011). Conclusion RDW is a powerful and an independent marker for prediction of all-cause mortality and cardiovascular mortality in patients with diabetes.