Cell Distribution Width Ratio Research Articles

The correlation between the hemoglobin-to-red cell distribution width ratio and all-cause mortality in patients with malignant tumors and sepsis: A retrospective cohort study using the MIMIC-IV database

Abstract Objective The aim of the study was to investigate the correlation between the hemoglobin-to-red cell distribution width ratio (HRR) and all-cause mortality in patients with malignant tumors and sepsis. Methods All patients who met the inclusion criteria of the Medical Information Mart for Intensive Care (MIMIC)-IV were selected and divided into four groups according to the quartile range of HRR distribution. Kaplan-Meier (K-M) analysis was used to plot the 28-day survival curve, and the log-rank test was used to compare the prognosis in each HRR group. A Cox proportional hazards regression model was used to evaluate the prognosis of HRR as both a continuous and categorical variable, and a restricted cubic spline was used to study the effect of HRR, as a continuous variable, on the mortality in patients with malignant tumors and sepsis. Interaction and subgroup analyses were performed to evaluate the consistency of correlations. Results A total of 3926 patients were included in the study, including 934 patients in the HRR ≤ 4.97 group, 988 patients in the 4.97 < HRR ≤ 6.26 group, 1005 patients in the 6.26 < HRR ≤ 7.84 group, and 999 patients in the HRR ≥ 7.84 group. According to the K-M analysis, the 28-day survival rate was the lowest in the HRR ≤ 4.97 group (59.53%), and there were significant differences in survival rates among different HRR levels (P < 0.001). The Cox proportional hazards regression model found that after adjusting for various potential confounding factors, HRR was negatively correlated with 28-day and 365-day mortality, and the risk of death in the HRR ≥ 7.84 group was significantly lower than that in the HRR ≤ 4.97 group (P = 0.030 and P = 0.008, respectively). The restricted cubic spline plot revealed a linear and negative relationship between the HRR and the 28-day and 365-day mortality rates. Subgroup analysis revealed an interaction between HRR, blood urea nitrogen, and SAPS II scores (P = 0.010 and P = 0.048, respectively). Conclusion Low HRR is an independent risk factor for all-cause mortality in patients with malignant tumors and sepsis and could be used as a prognostic indicator for these patients.

A new prognostic marker in small cell lung cancer: red cell distribution width ratio of hemoglobin

Aim: The ratio of hemoglobin (Hb) to red cell distribution width (RDW) (HRR) has been defined as an effective prognostic factor in various cancer types. The aim of this study is to investigate the prognostic role of HRR value in small cell lung cancer (SCLC). Material and Method: A total of 1039 patients diagnosed with SCLC between 2010-2021 were included in the study. After exclusion of 199 patients without positron emission tomography-computerized tomography (PET-CT), age, gender, additional disease histories, smoking history, pathological stages, survival status, disease progression times, treatments applied, first hemoglobin obtained after diagnosis, red cell distribution width and ratios, and other laboratory parameters of 840 patients were recorded. The log-rank test and the Cox proportional hazards model were used to identify predictors of mortality. Results: A total of 840 patients were included in the study. The median overall survival (OS) and the progression-free survival (PS) times of the patients were 9 months, and 7 months, respectively. The cut-off value for HRR was determined 0.580 (sensitivity 78.73%, specificity 37.88%). In this study, each one-unit increase in HRR reduces death and survival by 1.6 times detected, and it was revealed that HRR had a statistically significant effect on OS and PS. When the patients were divided into two as limited and extensive disease, there was a statistically significant difference between the groups in terms of OS (12-6 months) and PS (10-6 months), but no significant difference was found in terms of HRR between these two groups. Conclusion: HRR is an easily accessible, inexpensive parameter that can be used as a prognostic marker in patients with SCLC.

Hemoglobin/Red Cell Distribution width Ratio (HRR): A Novel and Promising Red Cell Parameter in Ductal Closure.

It is still unclear how effective hematological parameters are in the closure of patent ductus arteriosus (PDA). The primary aim of our study is to investigate the effect of hemoglobin (HB)-to-red cell distribution width (RDW) ratio (HRR) on the closure of PDA. Premature babies with very low birth weight (VLBW: <1500 g) and <32 gestational weeks were included in the study, and all data were recorded retrospectively. Demographic characteristics, clinical results, red cell parameters, and HRR and their ratios were compared between hemodynamically significant PDA (hsPDA) and non-hsPDA groups. All results were statically analyzed, and P<0.05 was considered statistically significant. A total of 677 premature babies, 269 in the hsPDA group and 408 in the non-hsPDA group, were included in the study. Hemoglobin (HB), hematocrit (HCT), mean cell volume (MCV), red blood cell (RBC), red cell distribution width (RDW), mean platelet volume (MPV), MCV/RBC ratio, HB/RBC ratio, RDW/RBC ratio, and RDW/MPV ratio were found to be similar between hsPDA and non-hsPDA groups, (p>0.05). HRR was found to be significantly lower in the hsPDA group [median (Quartile 1 (Q1) - Q3) (Q1 - Q3): 0.93 (0.8-1.0)] compared to non-hsPDA [median ( Q1 - Q3): 1.07 (1.0-1.2)] (p<0.001). The AUC for the diagnostic value of HRR in hsPDA was 0.816, and the cutoff value was ≤0.98 (p<0.001, 95% [CI]: 0.785-0.845, sensitivity: 90%, specificity: 92%). HRR value was found to be both an effective and powerful parameter in diagnosing hsPDA.

Prognostic Test of Red Blood Cell Distribution Width Ratio with Platelets as a Predictor of Mortality in Burn Patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

Introduction: Burns is a traumatic condition with a very high mortality rate. In an effort to prevent greater mortality in burn conditions, a predictor is needed to optimize the prediction of death in burn patients. This study aimed to determine the efficacy of red blood cell distribution width ratio (RDW) to platelets (PLT) as a predictor of mortality in burn patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.&#x0D; Methods: This study was a retrospective cohort analytic observational study. A total of 51 research subjects participated in this study. Observation of clinical data and sociodemographic and laboratory evaluations were carried out. Data analysis was carried out with SPSS in univariate, bivariate, and diagnostic tests.&#x0D; Results: The RPR diagnostic test on observation ≥ 7 days is more sensitive and specific than that on observation ≥ 3 days. This study shows that both observations ≥ 3 days and observations ≥ 7 days show similarity, where the RPR value is much higher in cases of mortality than in cases of alive.&#x0D; Conclusion: RPR value ≥ 7 days has prognostic value with better sensitivity and specificity in predicting mortality in burn patients.

Clinical Significance of the Combination of Serum HE4 Levels, Hemoglobin-to-Red Cell Distribution Width Ratio, and CT Imaging for the Pretreatment Assessment of Adnexal Masses.

Background: This study aimed to determine the optimal combination of biomarkers that can predict epithelial ovarian cancer (EOC) and compare the combination with the risk of ovarian malignancy algorithm (ROMA) or Copenhagen index (CPH-I). Methods: Data from 66 patients with EOC and 599 patients with benign ovarian masses who underwent definitive tissue diagnosis of adnexal masses between January 2017 and March 2021 were analyzed. The Mann-Whitney U test or Kruskal-Wallis test was used for between-group comparisons of medians. Logistic regression was used to establish an EOC predictor model. Area under the curve (AUC) comparisons between models were performed using the Delong nonparametric approach. Results: The median age of the patients was 43 years. Twenty-nine (43.9%) patients had early-stage disease (stages I-II) and 37 (56.1%) patients had advanced-stage disease (stages III-IV). The median age, body mass index, white blood cell count, hemoglobin-to-red cell distribution width ratio (HRR), platelet count, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, serum albumin level, cancer antigen 125, human epididymal secretory protein 4 (HE4), ROMA, and CPH-I were significantly different between the stage I-IV EOC and benign ovarian mass groups. Multivariate logistic regression analysis revealed that HE4, HRR, and computed tomography (CT) imaging were significant predictors of both stages I-IV and I-II EOC. Using these covariates, an interim model (IM) (consisting of HE4 and HRR) and a full model (FM) (consisting of HE4, HRR, and CT imaging) were constructed. When predicting stage I-IV EOC, the AUC of IM was comparable to that of ROMA or CPH-I, whereas the AUC of FM outperformed ROMA or CPH-I. In predicting stage I-II EOC, the AUC of IM was comparable to that of CPH-I but higher than that of ROMA, and the AUC of FM outperformed ROMA or CPH-I. Conclusion: FM outperformed ROMA or CPH-I in predicting stage I-IV EOC and stage I-II EOC. Therefore, FM could be a promising model for improving preoperative prediction of EOC at an early stage. However, further prospective studies are required to validate these results.

Relationship of the Hemoglobin/Red Cell Distribution Width Ratio and Inflammatory Biomarkers with Prognosis in Nasopharyngeal Cancer

Relationship of the Hemoglobin/Red Cell Distribution Width Ratio and Inflammatory Biomarkers with Prognosis in Nasopharyngeal Cancer

The Hemoglobin-to-Red Cell Distribution Width Ratio to Predict All-Cause Mortality in Patients with Sepsis-Associated Encephalopathy in the MIMIC-IV Database.

The hemoglobin-to-red cell distribution width ratio (HRR) is associated with the prognosis of sepsis-associated encephalopathy (SAE). This study aimed to determine the relationship between HRR and SAE and to clarify the possible mechanism of HRR as a prognostic factor for SAE. A multivariate Cox proportional-hazards regression model was used to assess the correlation between HRR and all-cause mortality. Piecewise linear regression and smooth-curve Cox proportional-hazards regression models were used to observe whether there was a nonlinear relationship between HRR and all-cause mortality in SAE. This study included 8853 patients with SAE. A nonlinear relationship between HRR and SAE was observed through a two-segment regression model. The left inflection point for the HRR threshold was calculated to be 15.54, which was negatively correlated with all-cause mortality (HR = 0.83, 95% CI = 0.76-0.91, p < 0.001). Subgroup analyses revealed significant interactions between white blood cell count, glucose, and patients who received dialysis and HRR. The inverse correlation between HRR and SAE was more pronounced in patients who did not receive vasopressin (HR = 0.91, 95% CI = 0.87-0.96, p < 0.001) than in those who did receive vasopressin (HR = 0.94, 95% CI = 0.88-1.02, p=0.152) and was significantly more pronounced in patients without myocardial infarction (HR = 0.91, 95% CI = 0.88-0.96, p < 0.001) than in those with myocardial infarction (HR = 0.94, 95% CI = 0.87-1.02, p < 0.114). This large retrospective study found a nonlinear relationship between all-cause mortality and HRR in patients with SAE in intensive care units, with low HRR being inversely associated with increased all-cause mortality in patients with SAE.

Relationship between the Hemoglobin-to-Red Cell Distribution Width Ratio and All-Cause Mortality in Septic Patients with Atrial Fibrillation: Based on Propensity Score Matching Method.

(1) Objective: To reveal the correlation between the hemoglobin-to-red cell distribution width ratio (HRR) and all-cause mortality (ACM) among the septic patients with atrial fibrillation. (2) Methods: Specific clinical information was collected from the Medical Information Mart for Intensive IV (MIMIC-IV) database. The optimal cut-off value of HRR was calculated through ROC curve analysis conducted by using the maximum Youden index for the prediction of survival status. In addition, univariable and multivariable Cox regressive analyses were carried out to assess the prognostic significance of HRR and the Kaplan-Meier (K-M) analysis was conducted to draw the survival curves. Then, the 1:1 propensity score matching (PSM) method was adopted to improve the reliability of research result while balancing the unintended influence of underlying confounders. (3) Results: There were 9228 patients participating in this retrospective cohort study. The optimal cut-off value of the HRR was determined as 5.877 for in-hospital mortality. The PSM was performed to identify 2931 pairs of score-matched patients, with balanced differences exhibited by nearly all variables. According to the K-M analysis, those patients with a lower HRR than 5.877 showed a significantly higher level of in-hospital mortality, 28-day mortality, and 90-day mortality, compared to the patients with HRR ≥ 5.877 (p &lt; 0.001). After the adjustment of possible confounders, those patients whose HRR was below 5.877 had a significantly higher level of in-hospital mortality than the patients with HRR ≥ 5.877, as revealed by the multivariable Cox regression analysis (HR = 1.142, 95%CI: 1.210-1.648, p &lt; 0.001). Similarly, the ACM remained substantially higher in those patients with a lower HRR than in the patients with higher HRR after PSM. (4) Conclusion: A lower HRR (&lt;5.877) was evidently associated with an increased risk of ACM, which made it applicable as a prognostic predictor of clinical outcomes for those septic patients with atrial fibrillation.

Acute graft-versus-host disease presenting as Stevens–Johnson syndrome and toxic epidermal necrolysis: A retrospective cohort study

Cutaneous manifestations resembling Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) have been reported in patients with acute graft-versus-host disease (aGVHD); however, the clinicopathological characteristics of SJS/TEN-like aGVHD remain unexplored. To investigate the clinicopathology, complications, and outcomes of patients with SJS/TEN-like aGVHD. We analyzed a multicenter cohort of patients with aGVHD between 2000 and 2021. We analyzed 31 patients with aGVHD, including SJS/TEN-like (n=15) and non-SJS/TEN-like (n=16). Patients with SJS/TEN-like aGVHD had significantly more extensive erythema and skin detachment/mucositis. SJS/TEN-like aGVHD was significantly associated with higher aGVHD grading and systemic complications, including pancytopenia, leukopenia, anemia, severe thrombocytopenia, coagulation abnormality, hepatitis, diarrhea, renal dysfunction, and bacteremia. A significantly lower hemoglobin/red cell distribution width ratio was identified in SJS/TEN-like aGVHD. Histopathology showed significant severe dyskeratosis and interface change. Patients with SJS/TEN-like aGVHD had lower 2-month survival rates and 5.35-fold higher 5-year mortality rates than those with non-SJS/TEN-like aGVHD. Total mortality rates of patients with SJS/TEN-like aGVHD reached 80% during follow-up; sepsis predominated the causes of death. Retrospective, nonrandomized study with a small sample size. SJS/TEN-like aGVHD is associated with multiple systemic complications and high mortality. Early recognition, differential diagnosis from drug-induced-SJS/TEN, and appropriate treatment are critical.

Relationship between certain hematological parameters and risk of breast cancer.

Aim: To explore the association between preoperative hemoglobin-to-red cell distribution width ratio (HRR), platelet-to-monocyte ratio or monocyte-to-high-density lipoprotein ratio and risk of breast cancer. Materials & methods: The clinical data of 226 patients with breast cancer were retrospectively analyzed and compared with 199 healthy controls by multivariate logistic regression analysis. Results: Multivariate logistic regression analysis revealed that HRR (p <0.001) and monocyte-to-high-density lipoprotein ratio (p <0.001) were independent predictors of breast cancer and lower HRR was associated with longer hospitalization, larger red cell distribution width value and lower hemoglobin level (p <0.05). Conclusion: A significant association was found between HRR and clinical characteristics in breast cancer patients. Therefore, HRR is expected to become a novel and promising predictor of breast cancer.

Predictive value of hemoglobin-to-red blood cell distribution width ratio for contrast-induced nephropathy after emergency percutaneous coronary intervention.

Although the relationship of either hemoglobin or red blood cell distribution width (RDW) with contrast-induced nephropathy (CIN) has been reported individually. To date, no studies have evaluated the predictive value of hemoglobin-to-red blood cell distribution width ratio (HRR) for CIN. A total of 1658 elderly patients with ST-segment elevation myocardial infarction (STEMI) undergoing emergency percutaneous coronary intervention (PCI) were retrospectively screened. Preoperative complete blood count was collected and the HRR was calculated as the ratio of hemoglobin to RDW. CIN was defined as an absolute ≥0.5mg/dL (44.2μmol/L) or a relative ≥25% increase in creatinine level at 72h after contrast administration. Univariate and multivariate regression analysis were conducted to determine the effective predictors for CIN. The ROC curve analysis was plotted to determine the optimal cutoff value for HRR in predicting CIN. The overall incidence of CIN was 8.38%. The HRR was significantly lower in the CIN group compared with the non-CIN group (0.87 ± 0.15 vs 1.24 ± 0.23, p < 0.001). After multivariate regression analysis was performed, HRR was noted to be an effective predictor for the development of CIN (OR 1.617, 95% CI 1.439-2.706, p = 0.014), along with age, creatinine, eGFR, hs-CRP and contrast volume. An optimal cutoff value of 0.94 or lower for HRR was identified with 82.4% sensitivity and 63.5% specificity to predict CIN. Lower HRR on admission was an effective predictor for CIN in elderly patients with STEMI undergoing emergency PCI. HRR may be a convenient, economical and reliable biomarker for risk stratification.

Physical Frailty and Hemoglobin-to-Red Cell Distribution Width Ratio in Japanese Older Outpatients

The Frailty screening should be widely performed; however, simple and inexpensive biomarkers are missing. Biomarkers that can be routinely assessed in many patients are desirable. Recently, the hemoglobin-to-red cell distribution width ratio (Hb/RDW, HRR) has been suggested as a new prognostic marker and has been reported to be associated with inflammation, one of the factors contributing to frailty. Therefore, we aimed to address the role of HRR in frailty among 557 older outpatients (aged 65–96 years). Frailty was assessed using the Japanese version of the Cardiovascular Health Study criteria, and HRR was calculated from clinical records. Participants were classified into five groups based on a sex-stratified quintile of HRR (Q1–Q5). Of the participants, 20.3% were frail. Using multiple logistic regression models with the Q5 group as a reference, after adjusting for sex, age, body mass index, polypharmacy, pre-orthopedic surgery, and the use of iron medications, the multivariable-adjusted odds ratios (95% confidence intervals) of the Q4 to Q1 groups were 0.92 (0.58–1.47), 1.04 (0.67–1.61), 1.29 (0.84–1.96), and 1.85 (1.22–2.82), respectively, indicating that a lower HRR was significantly associated with frailty. The robustness of these results was also shown in the multiple imputation analysis. The results suggest that HRR measurement may be one of the indicators to identify frail older adults in routine practice.

Hemoglobin/Red Blood Cell Distribution Width Ratio in Peripheral Blood Is Positively Associated with Prognosis of Patients with Primary Hepatocellular Carcinoma.

BackgroundThe prognostic value of the hemoglobin/red blood cell distribution width ratio in primary hepatocellular carcinoma remains unknown. This study aimed to analyze the correlation between hemoglobin/red blood cell distribution width ratio and hepatocellular carcinoma prognosis.Material/MethodsMedical records of hepatocellular carcinoma patients were analyzed retrospectively. The hemoglobin/red blood cell distribution width ratio cut-off value was determined as 0.987 by receiver operating characteristic curve analysis. Patients were divided into high- and low-level groups, and the clinical data were compared. The correlation among the ratio levels, progression-free survival, and overall survival was measured with univariate and multivariate Cox regression analyses. The prognostic utility of the ratio combined with alpha-fetoprotein was analyzed using Kaplan-Meier survival curves and log-rank detection, and the correlation between the ratio and tumor staging was studied using one-way analysis of variance.ResultsThis study included 252 patients. Sex, smoking and alcohol consumption history, body mass index, surgery, staging, platelet/lymphocyte ratio, and hemoglobin/red blood cell distribution width ratio were associated with progression-free and overall survival (P<0.05). The ratio, alpha-fetoprotein, hemoglobin, staging, and surgery were independent risk factors for progression-free survival (P<0.05), and the ratio, alpha-fetoprotein, hemoglobin, body mass index, HBsAg, staging, and surgery were independent risk factors for overall survival (P<0.05). Patients with low ratio levels and high alpha-fetoprotein levels had the worst prognosis.ConclusionsLow hemoglobin/red blood cell distribution width ratio levels are associated with poor patient prognosis and are potential tumor prognosis markers.

A Novel Prognostic Score Including the CD4/CD8 for AIDS-Related Lymphoma.

BackgroundA simple and clinically applicable prognostic scoring system for AIDS-related lymphoma (ARL) in the era of combination antiretroviral therapy (cART) is needed to better stratify patients’ risks and to assist in the decision-making of therapeutic strategies.MethodsWe conducted a retrospective multicenter cohort study in 138 primary ARL patients over an 8-year period from 2013 to 2020. Survival curves were estimated using the Kaplan–Meier method. Univariate and multivariate Cox proportional hazard models were performed to identify the association between patient-, lymphoma-, and HIV-specific variables with progression-free survival (PFS) and overall survival (OS). The incremental prognostic value of novel inflammatory biomarkers in the International Prognostic Index (IPI) was evaluated by comparing the receiver operating characteristic (ROC) curves, the concordance index (C-index), and the integrated Brier score (IBS).ResultsThe median age was 49.14 ± 14.20 (range 18–79) years, 81.9% were men, and the median follow-up was 44.94 (95% CI = 37.05–52.84) months. The 3-year OS and PFS were 39.4% (95% CI = 16.3–21.2) and 38.7% (95% CI = 14.5–19.7), respectively. We found that age, extranodal sites, bulky mass, CD4 T-cell counts, CD4/CD8 ratio, and hypoalbuminemia were associated with OS (all P < 0.05) at both univariate and multivariate analyses. Of the new inflammatory markers, only the CD4/CD8 ratio was an independent prognostic parameter of OS and PFS. A lower CD4/CD8 ratio was strongly associated with adverse clinical factors, including older age, advanced Ann Arbor stage, more extranodal sites, elevated erythrocyte sedimentation rate, prior history of HIV, higher red cell distribution width ratio, hypoproteinemia, and emaciation. When the CD4/CD8 ratio was added to the IPI, the composite HIV-IPI score showed significantly better discrimination than IPI alone [AUC (95% CI): HIV-IPI, 0.83 (0.77–0.89) vs. IPI, 0.72 (0.70–0.85)]. The HIV-IPI model provided good predictive performance [C-index (95% CI): HIV-IPI, 0.82 (0.81–0.83) vs. IPI, 0.75 (0.73–0.77), P < 0.001] and a satisfactory calibration function.ConclusionsThe CD4/CD8 ratio, an inexpensive and readily available marker, is a powerful independent prognostic parameter in patients with ARL. Furthermore, when the CD4/CD8 ratio is used in combination with IPI, it increases prognostic ability. The useful prediction of expected outcomes in ARL can inform treatment decisions.

Prognostic value of hemoglobin-to-red cell distribution width ratio in cancer: a systematic review and meta-analysis.

Background: The hemoglobin-to-red cell distribution width ratio (HRR) has emerged as a novel integrative biomarker predictive of overall and disease-free survival in cancer patients. This study aimed to investigate the prognostic significance of HRR in the cancer population. Methods: A literature search was performed in PubMed/MEDLINE from inception to 1July 2021, to collect studies assessing the prognostic value of HRR in cancer patients. The primary and secondary end points were all-cause mortality and occurrence of disease progression or relapse, respectively. A meta-analytic approach was employed to estimate the pooled hazard ratio with 95% CI by fitting random-effects models. Results: A total of 11 retrospective cohort studies representing 2985 cancer patients were included. Compared with patients with high HRR, patients with low HRR had a twofold risk of all-cause mortality (hazard ratio: 2.29; 95% CI: 1.76-2.98; p<0.0001). There was substantial heterogeneity in the association of HRR with mortality across the studies (I2: 66.8%; 95% CI: 35.3-82.9%; p=0.0014). Similarly, low HRR was associated with a twofold risk of disease progression or relapse (hazard ratio: 2.19; 95% CI: 1.74-2.76; p<0.0001). No significant heterogeneity was observed (I2: 16.8%; 95% CI: 0.0-60.7%; p=0.30). Conclusion: Low HRR was associated with mortality and disease progression or relapse in patients with cancer. Further studies are required to standardize the HRR cutoff value and investigate whether HRR can be incorporated into risk assessment models for predicting adverse prognosis in cancer patients.

Low Hemoglobin-to-Red Cell Distribution Width Ratio Is Associated with Mortality in Patients with HBV-Related Decompensated Cirrhosis.

Background The prognostic role of hemoglobin-to-red blood cell distribution width ratio (HRR) in HBV-related decompensated cirrhosis (HBV-DeCi) has not been established. The present study is aimed at determining the potential of HRR as a predictive factor for the prognosis of HBV-DeCi patients. Methods The study included 177 HBV-DeCi patients. The clinical outcome was death at 30 days. Multivariate regression analysis and receiver operating characteristic curve analysis were applied to assess the predictive value of HRR for poor outcomes. Results A total of 26 patients (14.7%) had died by 30 days. Patients with unfavorable outcomes had lower HRR than patients with favorable outcomes. Multivariate analysis revealed that HRR and Model for End-Stage Liver Disease (MELD) score were independently associated with poor outcomes. Combination of HRR and MELD score may improve prognostic accuracy in HBV-DeCi. Conclusions The present findings indicate that low HRR may be a promising predictor for mortality in HBV-DeCi patients.

Relationship Between the Hemoglobin-to-Red Cell Distribution Width Ratio and All-Cause Mortality in Ischemic Stroke Patients with Atrial Fibrillation: An Analysis from the MIMIC-IV Database.

AimTo investigate the association between the hemoglobin-to-red cell distribution width (RDW) ratio (HRR) and all-cause mortality in ischemic stroke patients with atrial fibrillation (AF).DesignThis study was a retrospective cohort analysis. In total, 1018 ischemic stroke patients with AF were enrolled using the Medical Information Mart for Intensive Care database, (MIMIC)-IV. The patients were divided into four groups according to the HRR values. The primary outcome was 180-day all-cause mortality.MethodsMultivariate Cox proportional risk regression models were used to examine the association between HRR and all-cause mortality. The non-linear relationship between HRR and all-cause mortality was confirmed using a Cox proportional risk regression model fitted by cubic spline function and smooth curve fitting.ResultsA total of 246/1018 patients (24.17%) died. The serum HRR values were negatively associated with 180-day all-cause mortality (hazard ratio (HR) 0.80, 95% confidence interval (CI) 0.68–0.94). A two-piecewise regression model was used to obtain a threshold inflection point value of 9.74. The HR and the 95% CI on the left inflection point were 0.73 and 0.61–0.87 (p = 0.0005); on the right inflection point they were 1.06 and 0.82–1.38 (p = 0.6383).ConclusionThe relationship between all-cause mortality and the HRR values was non-linear in ischemic stroke patients with AF. All-cause mortality and HRR values were negatively correlated when the HRR value was ≤9.74.

Preoperative hemoglobin-to-red cell distribution width ratio as a prognostic factor in pulmonary large cell neuroendocrine carcinoma: a retrospective cohort study.

BackgroundThe hemoglobin (Hgb)/red cell distribution width (RDW) ratio (HRR) is a simple prognostic marker for small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC), but no data are available for pulmonary large cell neuroendocrine carcinoma (PLCNEC). This study aimed to assess the potential prognostic role of preoperative HRR in PLCNEC.MethodsThis single-center retrospective study included patients with PLCNEC who underwent surgery at Shanghai Pulmonary Hospital from January 2012 to August 2016. The follow-up was censored in August 2020. The participants were grouped as low/high HRR according to their optimal value calculated using a receiver operating characteristic (ROC) curve. Univariable and multivariable Cox analysis were performed to identify the risk factors for overall survival (OS).ResultsA total of 80 patients with PLCNEC were included. The optimal cutoff values were 0.969 for HRR. Compared with the high HRR group, the low HRR group had a lower mean Hgb (12.1 vs. 14.1 g/dL, P<0.001), lower mean albumin-globulin ratio (AGR) (1.4 vs. 1.6, P=0.017), and higher median RDW (14.5% vs. 12.9%, P<0.001). The median OS was 30.0 months [95% confidence interval (CI): 13.4 to 46.5 months]. Participants in the low HRR group exhibited a poorer OS than those with high HRR (20.3 months, 95% CI: 14.5 to 26.1 months vs. not reached, P<0.001). The multivariable analysis showed that low HRR was significantly associated with poor OS [hazard ratio (HR) =3.16, 95% CI: 1.69 to 5.93, P<0.001].ConclusionsLow HRR is associated with poor OS in patients with PLCNEC and can be used as an inexpensive prognostic factor in patients undergoing PLCNEC resection.

Prognostic significance of novel inflammatory markers in extensive-stage small-cell lung cancer.

Novel hematological inflammation-based parameters, such as neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), prognostic nutritional index (PNI), lymphocyte-to-C-reactive protein ratio (LCR), systemic inflammatory response index (SIRI), and hemoglobin-to-red cell distribution width ratio (HRR), have been determined to be linked to prognosis of various cancer types, although the predictive impact of these parameters on extensive-stage small-cell lung cancer (SCLC) is not exactly known. In this study, we aimed to demonstrate the prognostic significance of these novel parameters. This retrospective study included 162 patients who were under follow-up with a diagnosis of extensive-stage SCLC. The receiver operating characteristic curve analysis revealed that the optimal cutoff values for NLR, SII, PNI, LCR, SIRI, and HRR were 2.34, 787, 46.13, 0.29, 1.5, and 1.05, respectively. Cox regression analyses were done to determine the predictive impact of these parameters on progression-free survival (PFS) and overall survival (OS). Patients with higher LCRs and HRRs had longer PFS and OS than patients with lower LCRs and HRRs (P < 0.001, P < 0.001, P < 0.001, P < 0.001, respectively). PFS and OS were significantly shorter in the group with high SIRIs than in the group with low SIRIs (P < 0.001, P < 0.001, respectively). A multivariate analysis identified LCR and SIRI as independent prognosticators for both PFS and OS (P < 0.001, P < 0.001; P = 0.002, P < 0.001, respectively), and HRR as an independent prognostic factor only for OS (P = 0.046). LCR, SIRI, and HRR are independent prognostic parameters that predict survival times in patients with extensive-stage SCLC.

Correlation Analysis of Hemoglobin-to-Red Blood Cell Distribution Width Ratio and Frailty in Elderly Patients With Coronary Heart Disease

Background: Coronary heart disease (CHD) is a common chronic disease in the elderly. Frailty can accelerate the development of CHD and lead to adverse health outcomes. Risk prediction and decision-making for frailty are crucial. The peripheral hemoglobin-to-red blood cell distribution width ratio (HRR) is a novel biomarker of inflammation. Our purpose was to explore the correlation between HRR and frailty in elderly patients with CHD.Methods: This cross-sectional study evaluated 245 Chinese hospitalized patients with CHD. Blood parameters measured upon admission were obtained via the hospital electronic information medical record system. The Fried Frailty Phenotype Scale was used to evaluate the frailty status of the participants. The Receiver operating characteristic curve was used to determine the optimal cut-off values of HRR. We used univariate analysis to examine the potential factors affecting frailty. Kendall's tau-b grade correlation was used to analyze the correlation between HRR and frailty. The ordered logistic regression model was used to analyze the relationship between HRR and frailty.Results: A total of 233 elderly patients with CHD were included in our study. Among the patients, 33.48% (78) were in a state of frailty. The optimal cut-off values of HRR was 9.76. The area under the curve (AUC) for HRR in the frailty patients was 0.652, exceed Hb (AUC = 0.618) and RDW (AUC = 0.650). Kendall's tau-b grade correlation analysis showed that HRR (K = −0.296, P < 0.001) was negatively correlated with frailty. The ordered logistic regression analysis determined that lower HRR was associated with frailty (P < 0.05) after adjusted for age, body mass index, number of drugs, comorbidity index, heart failure, red blood cells, albumin, total cholesterol, triglyceride, high density lipoprotein cholesterol, and low density lipoprotein cholesterol.Conclusion: Lower HRR is an independent risk factor for frailty in elderly hospitalized patients with CHD. HRR was a more powerful prognostic indicator for frailty than either Hb or RDW alone. Clinicians should focus on timely identification of the risk of frailty in order to improve patient quality of life and to reduce the risk of complications.