Elevated Red Blood Cell Distribution Width Research Articles

Red Blood Cell Distribution Width in Patients With Chronic Obstructive Pulmonary Disease and Healthy Subjects

BackgroundChronic obstructive pulmonary disease (COPD) increases the risk of cardiovascular disease (CVD). Red blood cell distribution width (RDW) is accepted as a powerful predictor of outcomes in patients with CVD. AimsTo study RDW in patients with COPD, and to compare the value of this measurement with clinical, echocardiographic, nutritional and laboratory status. Secondly, we aimed to determine the effect of smoking on RDW values in healthy subjects. MethodsOne hundred and seventy-five patients with stable COPD and 210 healthy controls were enrolled in the study. Demographic, clinical, nutritional status, echocardiographic, and laboratory characteristics, RDW values were recorded and compared. ResultsRDW values were higher in the COPD group than in controls (15±2.3% vs 13.8±2.5%, p<0.001). In COPD patients, RDW levels positively correlated with CRP levels (r=0.27, p<.001), albumin levels (r=0.23, P=.04), right ventricular dysfunction (RVD) (r=0.24, P=.001), pulmonary hypertension (PAH) (r=0.1, P=.02), and presence of CVD (r=0.24, P=.02). In multivariable logistic regression suggested that presence of CVD (4.3; 95% CI: 1.3–11; P=.01), and presence of RVD (3.1; 95% CI: 1.7–8.3; P=.02) were independently related to elevated RDW levels in COPD patients. In the healthy population, correlations analysis showed only a significant correlation between RDW and cigarette smoking years (r=0.57, p<.001). ConclusionRDW is independently associated with CVD and RVD in patients with COPD. In the healthy population, RDW is also associated with smoking status.

Amplitud de distribución eritrocitaria en pacientes con enfermedad pulmonar obstructiva crónica y en sujetos sanos

BackgroundChronic obstructive pulmonary disease (COPD) increases the risk of cardiovascular disease (CVD). Red blood cell distribution width (RDW) is accepted as a powerful predictor of outcomes in patients with CVD. AimsTo study RDW in patients with COPD, and to compare the value of this measurement with clinical, echocardiographic, nutritional and laboratory status. Secondly, we aimed to determine the effect of smoking on RDW values in healthy subjects. MethodsOne hundred and seventy-five patients with stable COPD and 210 healthy controls were enrolled in the study. Demographic, clinical, nutritional status, echocardiographic, and laboratory characteristics, RDW values were recorded and compared. ResultsRDW values were higher in the COPD group than in controls (15±2.3% vs. 13.8±2.5%, p<0.001). In COPD patients, RDW levels positively correlated with CRP levels (r=0.27, P<.001), albumin levels (r=0.23, P=.04), right ventricular dysfunction (RVD) (r=0.24, P=.001), pulmonary hypertension (PAH) (r=0.1, P=.02), and presence of CVD (r=0.24, P=.02). In multivariable logistic regression suggested that presence of CVD (4.3; 95% CI: 1.3 to 11; P=.01), and presence of RVD (3.1; 95% CI: 1.7 to 8.3; P=.02) were independently related to elevated RDW levels in COPD patients. In the healthy population, correlations analysis showed only a significant correlation between RDW and cigarette smoking years (r=0.57, P<.001). ConclusionRDW is independently associated with CVD and RVD in patients with COPD. In the healthy population, RDW is also associated with smoking status.

Elevated Red Cell Distribution Width is Associated with Cerebral Infarction in Aneurysmal Subarachnoid Hemorrhage.

Elevated red blood cell distribution width (RDW) has been associated with thrombotic disorders including myocardial infarction, venous thromboembolism, and ischemic stroke, independent of other inflammatory and coagulation biomarkers. The purpose of this study was to determine whether elevated RDW is associated with cerebral infarction and poor outcome after aneurysmal subarachnoid hemorrhage (aSAH). In this retrospective single-center cohort of aSAH patients (October 2009-September 2014), elevated RDW was defined as a mean RDW >14.5% during the first 14days after aSAH. Outcomes included cerebral infarction (CI) by any mechanism and poor functional outcome, defined as discharge modified Rankin Scale (mRS) >4, indicating severe disability or death. Of 179 patients, 27% had a high Hunt-Hess grade (IV-V), and 76% were women. Twenty-four patients (13.4%) underwent red blood cell (RBC) transfusion and compared to patients with normal RDW, patients with an elevated RDW were at greater odds of RBC transfusion (OR 2.56 [95% CI, 1.07-6.11], p=0.035). In univariate analysis, more patients with elevated RDW experienced CI (30.8 vs. 13.7%, p=0.017). In the multivariable model, elevated RDW was significantly associated with CI (OR 3.08 [95% CI, 1.30-7.32], p=0.011), independent of known confounders including but not limited to age, sex, race, high Hunt-Hess grade, and RBC transfusion. In multivariable analysis, RDW elevation was also associated with poor functional outcome (mRS>4) at discharge (OR 2.59 [95% CI, 1.04-629], p=0.040). RDW elevation is associated with cerebral infarction and poor outcome after aSAH. Further evaluation of this association is warranted as it may shed light on mechanistic relations between anemia, inflammation, and thrombosis after aSAH.

Associations between accelerometer-assessed sedentary behavior, physical activity and objectively-measured cardiorespiratory fitness with red blood cell distribution width

BackgroundEmerging work identifies red blood cell distribution width (RDW) as a unique biomarker independently associated with cardiovascular disease and mortality. Encouragingly, recent research demonstrates individual associations of sedentary behavior, physical activity and cardiorespiratory fitness with RDW. However, no study has evaluated their independent and combined associations on RDW, which was this study's purpose. MethodsData from the 2003–2004 National Health and Nutrition Examination Survey were used (N=627 adults 20–49yrs). Sedentary behavior and MVPA were objectively assessed (accelerometry) with cardiorespiratory fitness determined from a submaximal treadmill-based test. Participants were classified as above or below the median values for each of these three parameters, with a PACS (Physical Activity Cardiorespiratory Sedentary) score ranging from 0 to 3, indicating the participant number of these three positive characteristics. A blood sample was obtained from each participant to assess RDW. ResultsOnly above median MVPA (OR=0.47; 95% CI: 0.32–0.68) was independently associated with a reduced odds of having an elevated RDW. With regard to the additive model, and after adjustment, the odds ratio (95% CI) for the PACS score of 1 (vs. 0), 2 (vs. 0), and 3 (vs. 0), respectively, were 0.81 (0.45–1.45; P=0.46), 0.66 (0.44–0.99; P=0.04) and 0.35 (0.18–0.68; P=0.004). ConclusionWhen considering sedentary behavior, MVPA, and cardiorespiratory fitness, only MVPA was associated with reduced odds of elevated RDW, but those with all three characteristics had the lowest odds of elevated RDW.

Predictive Values of Red Blood Cell Distribution Width in Assessing Severity of Chronic Heart Failure.

BackgroundThis retrospective study was performed to evaluate the value of baseline red blood cell distribution width (RDW) for predicting the severity of chronic heart failure (CHF) compared with N-terminal prohormone brain natriuretic peptide (NT-ProBNP) and other hematological and biochemical parameters.Material/MethodsHematological and biochemical parameters were obtained from 179 patients with New York Heart Association (NYHA) CHF class I (n=44), II (n=39), III (n=41), and IV (n=55). Receiver operator characteristic (ROC) curves were used for assessing predictive values.ResultsRDW increased significantly in class III and IV compared with class I (14.3±2.3% and 14.3±1.7% vs. 12.9±0.8%, P<0.01). Areas under ROCs (AUCs) of RDW and NT-ProBNP for class IV HF were 0.817 and 0.840, respectively. RDW was markedly elevated in the mortality group compared with the survival group (13.7±1.7 vs. 15.8±1.8, P<0.01). The predictive value of RDW was lower than that of NT-ProBNP but was comparable to white blood cell (WBC), neutrophil (NEU), lymphocyte (L), and neutrophil/lymphocyte ratio (N/L) for mortality during hospitalization, with AUCs of 0.837, 0.939, 0.858, 0.891, 0.885, and 0.885, respectively. RDW and NT-proBNP showed low predictive values for repeated admission (≥3). RDW was an independent risk factor for mortality (OR=2.531, 95% CI: 1.371–4.671).ConclusionsRDW increased significantly in class III and IV patients and in the mortality group. The predictive value of RDW is comparable to NT-proBNP for class IV and lower than that of NT-proBNP for mortality. Elevated RDW is an independent risk factor for mortality.

Assessment of red blood cell distribution width as a prognostic marker in chronic lymphocytic leukemia.

Red blood cell distribution width (RDW) is a quantitative measure of the variability in size of circulating erythrocytes. It was recently reported that RDW is a prognostic factor for infection diseases, cardiovascular and pulmonary diseases, as well as some neoplasms. Moreover, RDW is remarkably strong predictor of longevity, including all causes of death, for adults aged 45 years and older. To explain this occurrence it was proposed that persistent IGFs/mTOR signaling is one of the factors that play a role in affecting the RDW and mortality.The above observations induced us to analyze the prognostic role of RDW in chronic lymphocytic leukemia (CLL) being the most frequent type of adult leukemia in Western countries. The obtained results have shown that RDW may be considered as a potential CLL prognostic marker. Elevated RDW level at the moment of diagnosis was associated with advanced disease and presence of other poor prognostic factors. It is also connected with overall survival indicating shorter time in patients with elevated RDW. It is possible that the presently observed correlation between mortality and RDW of the CLL patients is affected by their metabolic (IGF-1/mTOR driven)- rather than chronological- aging. The patients with high level of RDW are expected to have an increased persistent level of IGF-1/mTOR signaling. Within the framework of personalized therapy, these CLL patients therefore would be expected to be more sensitive to the treatment with mTOR inhibitors.

Red cell distribution width and mortality in acute heart failure patients with preserved and reduced ejection fraction.

BackgroundElevated red blood cell distribution width (RDW) is a valid predictor of outcome in acute heart failure (AHF). It is unknown whether elevated RDW remains predictive in AHF patients with either preserved left ventricular ejection fraction (LVEF) ≥50% or reduced LVEF (<50%).Methods and resultsProspective local registry including 402 consecutive hospitalized AHF patients without acute coronary syndrome or need of intensive care. The primary outcome was all‐cause mortality (ACM) at 1 year after admission. Demographic and clinical data derive from admission, echocardiographic examinations (n = 269; 67%) from hospitalization.The Cox proportional hazard model including all patients (P < 0.001) was adjusted for age, gender, and RDW quartiles. Independent predictors of 1‐year ACM were cardiogenic shock (HR 2.86; CI: 1.3–6.4), male sex (HR 1.9; CI: 1.2–2.9), high RDW quartile (HR 1.66; CI: 1.02–2.8), chronic HF (HR 1.61; CI: 1.05–2.5), valvular heart disease (HR 1.61; CI: 1.09–2.4), increased diastolic blood pressure (HR 1.02 per mmHg; CI: 1.01–1.03), increasing age (HR 1.04 by year; CI: 1.02–1.07), platelet count (HR 1.002 per G/l; CI: 1.0–1.004), systolic blood pressure (HR 0.99 per mmHg; CI: 0.98–0.99), and weight (HR 0.98 per kg; CI: 0.97–0.99). A total of 114 patients (28.4%) died within the first year; ACM of all patients increased with quartiles of rising RDW (χ2 18; P < 0.001). ACM was not different between RDW quartiles of patients with reduced LVEF (n = 153; χ2 6.6; P = 0.084). In AHF with LVEF ≥50% the probability of ACM increased with rising RDW (n = 116; χ2 9.9; P = 0.0195).ConclusionsHigh RDW is associated with increased ACM in AHF patients with preserved but not with reduced LVEF in this study population.

Enlarging Red Blood Cell Distribution Width During Hospitalization Identifies a Very High-Risk Subset of Acutely Decompensated Heart Failure Patients and Adds Valuable Prognostic Information on Top of Hemoconcentration.

Red blood cell distribution width (RDW) may serve as an integrative marker of pathological processes that portend worse prognosis in heart failure (HF). The prognostic value of RDW variation (ΔRDW) during hospitalization for acute heart failure (AHF) has yet to be studied.We retrospectively analyzed 2 independent cohorts: Centro Hospitalar do Porto (derivation cohort) and Lariboisière hospital (validation cohort). In the derivation cohort a total of 170 patients (age 76.2 ± 10.3 years) were included and in the validation cohort 332 patients were included (age 76.4 ± 12.2 years). In the derivation cohort the primary composite outcome of HF admission and/or cardiovascular death occurred in 78 (45.9%) patients during the 180-day follow-up period.Discharge RDW and ΔRDW were both increased when hemoglobin levels were lower; peripheral edema was also associated with increased discharge RDW (all P < 0.05). Discharge RDW value was significantly associated with adverse events: RDW > 15% at discharge was associated with a 2-fold increase in event rate, HR = 1.95 (1.05-3.62), P = 0.04, while a ΔRDW >0 also had a strong association with outcome, HR = 2.47 (1.35-4.51), P = 0.003. The addition of both discharge RDW > 15% and ΔRDW > 0 to hemoconcentration was associated with a significant improvement in the net reclassification index, NRI = 18.3 (4.3-43.7), P = 0.012. Overlapping results were found in the validation cohort.As validated in 2 independent AHF cohorts, an in-hospital RDW enlargement and an elevated RDW at discharge are associated with increased rates of mid-term events. RDW variables improve the risk stratification of these patients on top of well-established prognostic markers.

Sex and Race-Ethnicity Secular Trends in Mean and Elevated Red Blood Cell Distribution Width Among Adults in the United States, 1999-2012.

Red blood cell distribution width (RDW) has been shown to associate with increased risk of cardiovascular and non-cardiovascular death. To our knowledge, no study has examined secular trends in RDW over the last decade. Serial cross-sectional design. Data from the National Health and Nutrition Examination Survey (NHANES), 1999-2012, were used. 34,171 adults. RDW was assessed from a blood sample derived from the coefficient of variation of the red cell volume distribution histogram and reported as a percent. Elevated RDW was defined as an RDW > 14.6%. The overall age-adjusted mean RDW increased progressively and significantly (P<.05) from 12.59% in 1999-2000 to 12.89% in 2011-2012. The overall age-adjusted prevalence of elevated RDW increased progressively and significantly (P<.05) from 4.01% in 1999-2000 to 6.25% in 2011-2012. Statistically significant increases over this time period also occurred among non-Hispanic White women, non-Hispanic Black men and women, and Mexican American men and women. Across all sex and race-ethnicity combinations, women, compared with men, had higher RDW and larger increases over time in mean and elevated RDW. Mean and elevated RDW has progressively increased from 1999-2012 among adults in the United States, with increases observed among non-Hispanic Whites, Blacks, and Mexican Americans. Future research is needed to describe the determinants and implications of this RDW rise, as well as explanations for why a greater RDW change has occurred among women.

Baseline Red Blood Cell Distribution Width Correlates with Disease Activity and Therapeutic Outcomes in Patients with Systemic Lupus Erythematosus, Irrespective of Anemia Status.

Red blood cell distribution width (RDW) has been recently found to reflect systemic inflammation in addition to anisocytosis, and its value for assessing disease activity of systemic lupus erythematosus (SLE) has been addressed in two studies, but its correlation with therapeutic outcomes and disease flare has not been evaluated. One hundred and ninety-six newly diagnosed patients with SLE (all-SLE), including 105 non-anemic patients (na-SLE) and 91 patients with anemia (a-SLE) were prospectively studied. Baseline RDW of SLE patients was compared with that of control subjects. Correlations between RDW and disease activity, traditional laboratory parameters, clinical features, therapeutic outcomes, and disease flare were examined. RDW was exclusively higher in all-SLE, na-SLE, a-SLE than in controls (p < 0.001), but no significant difference of RDW was found between na-SLE and a-SLE (p = 0.27). More active disease scored with SLE Disease Activity Index 2000 (SLEDAI-2K) was present in patients with elevated RDW (> 15%) than normal RDW (= 11 - 15%) irrespective of anemia status (p < 0.001), and positive correlation between RDW with SLEDAI-2K was also disclosed independent of anemia status (r = 0.576, 0.614, 0.542, respectively for all-, na- and a-SLE, all with p < 0.001). Additionally, RDW positively correlated with high-sensitivity C-reactive protein (hsCRP) in all-SLE (r = 0.352, p < 0.001), na-SLE (r = 0.430, p < 0.001), and a-SLE (r = 0.315, p = 0.002). Among all clinical features, only the incidence of pulmonary arterial hypertension (PAH) was likely to be higher in elevated-RDW SLE than in normal-RDW SLE (χ2 = 4.135, p < 0.05). Patients received stratified therapy of remission induction based on their disease activity. A significantly higher rate of response (complete and partial response) was observed in normal-RDW than in elevated-RDW patients (all-SLE: 92.2% vs. 74.1%, p = 0.001; na-SLE: 92.3% vs. 77.5%, p = 0.04; a-SLE: 92% vs. 70.7%, p = 0.012). During a 12-month follow-up of the 166 responders, significantly greater flare-free survival was observed in normal-RDW than in elevated-RDW patients (68.8% vs. 29.8%, p = 0.002; 53.6% vs. 28.1%, p = 0.027; 55.9% vs. 31.4%, p = 0.032, respectively, for all-, na- and a-SLE). Our findings suggest that baseline RDW is an easily available parameter not only capable of reflecting SLE overall activity, but also predicting therapeutic outcomes and the risk of disease flare irrespective of anemia status.

Red Cell Distribution Width as an Independent Predictor of Long-Term Mortality in Hip Fracture Patients: A Prospective Cohort Study.

Red blood cell distribution width (RDW) has been found to be a significant prognostic factor of mortality in many cardiovascular diseases. However, a link between RDW at admission with long-term mortality in the hip fracture population has not been well established. Therefore, we sought to evaluate the long-term prognostic value of RDW in a well-defined hip fracture cohort, and to compare the effect of RDW in patients with and without anemia. A prospective cohort study was performed on 1479 hip fracture patients admitted at the General Hospital of Chinese PLA between January 2000 and October 2011 with a follow-up study over a 2-year period. A total of 1479 patients were used for the evaluation of 2-year all-cause mortality, while 804 patients with more than 4 years of follow-up were extracted for further evaluation of 4-year all-cause mortality. Cox proportional regression was used to evaluate the association between admission RDW and long-term mortality, adjusting for potential confounding variables. Higher RDW values were strongly associated with increased all-cause mortality. After adjusting for age, mean corpuscular volume, admission hemoglobin, comorbidities, and complications, RDW had a significant independent association with both 2-year mortality with a hazard ratio (HR) of 1.183 (95% confidence interval [CI], 1.017 to 1.376) and 4-year mortality with an HR of 1.244 (95% CI, 1.052 to 1.471). In stratified analysis, the effect of RDW was even more pronounced, with 2-year mortality HR of 1.341 (95% CI, 1.095 to 1.643) and 4-year mortality HR of 1.345 (95% CI, 1.071 to 1.688) in non-anemic patients. In non-anemic patients, elevated RDW values are significantly associated with increased odds of all-cause mortality, implying that RDW may be a possible laboratory biomarker for risk stratification in non-anemic hip fracture patients. Further studies are needed to confirm the current finding in different and larger hip fracture cohorts.

Sleep duration and sleep disorder with red blood cell distribution width.

To examine the association of sleep duration and sleep disorder with red blood cell distribution width (RDW). Data from the 2005-2012 National Health and Nutrition Examination Survey were used, including 17,621 adults. A questionnaire was used to assess sleep duration and sleep disorder, with a blood sample used to assess RDW. Compared to persons getting 7-8 hours/night of sleep, those getting 5, 9, and ≥ 10 hours/night respectively had a 23%, 29%, and 67% increased odds of having an elevated RDW (p < .05 for all odds ratios). Participants with a physician-diagnosed sleep disorder had a higher RDW (β = 0.08; p = .04). Sleep duration and sleep disorder are associated with elevated RDW.

Assessment of the Relationship Between Red Cell Distribution Width and Multiple Sclerosis.

Accumulating data have shown that immune and inflammatory factors are involved in the pathogenesis of multiple sclerosis (MS), and loss of polyunsaturated fatty acids from plasma and blood cell membranes has also been reported in patients with MS, contributing to the variation of erythrocyte deformability. Therefore, the aim of this investigation was to assess the association between red blood cell distribution width (RDW) and MS.A total of 109 patients with MS and 130 healthy individuals were enrolled into the study, and MS patients receiving treatment of subcutaneous recombinant Rebif (IFN-β1a) were followed retrospectively. Complete blood cell counts and Expanded Disability Status Scale (EDSS) score were evaluated in patients with MS before and after treatment.RDW values were significantly higher in patients with MS compared with the controls (13.6 ± 0.89 vs 12.8 ± 0.38, P < 0.001); a positive correlation between RDW and EDSS score was observed in patients with MS (r = 0.789, P < 0.001). Significant differences in the value of RDW and EDSS score were observed between treatment-naive patients and treated patients (13.6 ± 0.95 vs 12.7 ± 0.44, P < 0.001; 3.6 ± 1.39 vs 1.5 ± 0.60, P < 0.001). RDW was associated independently with MS in logistic regression analysis (odds ratio = 7.007; 95% confidence interval [CI] 3.461–14.187; P < 0.001), and receiver-operating characteristics (ROC) analysis showed that a RDW measurement >13.11% evaluated MS with a sensitivity of 70.0% and a specificity of 84.7%, and the area under the ROC curve for RDW was calculated as 0.80 (95% CI 0.739–0.859, P < 0.001). The level of RDW was decreased in treatment responders with the reduction of EDSS score; a strong relationship was also observed in treatment responders between RDW and EDSS score (r = 0.733, P < 0.001), and covariance analysis indicated RDW values decreased significantly in treatment responders (P = 0.025).Our results suggest that elevated RDW values are associated with EDSS score in patients with MS, and the relationship is remarkably influenced by Rebif treatment; RDW may be a useful marker to estimate disability status and treatment effectiveness in patients with MS.

Usefulness of the Red Blood Cell Distribution Width to Predict Heart Failure in Patients With a Fontan Circulation

The red blood cell distribution width (RDW) is a quantitative measure of the variability in the size of circulating erythrocytes. We aimed to study whether higher levels of the RDW were associated with heart failure in a Fontan circulation and to analyze its clinical value compared to brain natriuretic peptide. This retrospective study included 38 consecutive pediatric patients with a Fontan circulation who underwent routine cardiac catheterization at the International Medical Center, Saitama Medical University from October 2010 to July 2014. We assessed the relation between the RDW and catheterization data such as the central venous pressure (CVP), mixed venous oxygen saturation (SvO2), and cardiac index (CI). The RDW was positively correlated with the CVP (p= 0.0002). The elevated RDW group had a significantly greater CVP than the normal RDW group (p= 0.0003). Also, the RDW was negatively correlated with the SvO2 (p= 0.0004). The elevated RDW group had a significantly less SvO2 than the normal RDW group (p <0.0001). The CI in the elevated RDW group was lower than that in the normal RDW group (p= 0.0421). In the multivariate regression analysis, the RDW was a significant independent predictor of the CVP and SvO2. The BNP level did not have any significant relation with the CVP, SvO2, or CI. The RDW is a convenient and powerful marker for detecting heart failure in a Fontan circulation.

ELEVATED RED BLOOD CELL DISTRIBUTION WIDTH WAS ASSOCIATED WITH ATTENUATED ENDOTHELIAL FUNCTION IN PATIENTS WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION

Recent studies have demonstrated that red blood cell distribution width (RDW) was a novel prognostic marker in patients with ST-segment elevation myocardial infarction (STEMI). Endothelial dysfunction can reflect vascular vulnerability. We hypothesized that elevated RDW level was associated with

The effect of shift work on red blood cell distribution width

Limited research demonstrates that shift work (e.g., evening shift, night shift, rotating shift) increases the risk of certain health outcomes, such as hypertriglyceridemia and metabolic syndrome. Red blood cell distribution width (RDW), which is commonly assessed and reported by physicians, is a novel biomarker of cardiovascular disease. However, no study has examined the association of shift work on RDW, which was the purpose of this study. Data from the 2005–2010 NHANES were used. RDW was assessed from a blood sample; shift work was assessed from a questionnaire, and various demographic, behavioral/psychological, occupational, and biological parameters were included as covariates. The fully adjusted model showed that the odds of having an elevated RDW for women on rotating shift vs. day shift increased by 46% (OR=1.46; 95% CI: 1.03–2.08). Women on a rotating shift had increased odds of having an elevated RDW, which is concerning as elevated RDW increases the risk of cardiovascular disease and mortality. Health care professionals are encouraged to include questions about organization of work schedules and their tolerance of such schedules during the patient's consultation.

The association between muscle strengthening activities and red blood cell distribution width among a national sample of U.S. adults

Red blood cell distribution width (RDW) is a novel biomarker indicative of cardiovascular disease. However, little research has examined the association of muscle strengthening activities (MSA) on RDW. ObjectiveExamine the association between MSA and RDW among a national sample of U.S. adults. MethodsData from the 2003–2006 (n=8257) National Health and Nutrition Examination Survey were used. Multivariable linear and logistic regression analyses were used to examine the association between MSA with RDW. Participants self-reported their extent of MSA (e.g., lifting weights, push-ups, and sit-ups) and RDW was assessed from a blood sample. ResultsIndependent of demographics, aerobic-based physical activity and established cardiovascular disease risk factors, for every 1 MSA session per day increase, the odds of having an elevated RDW (≥14.1%) reduced by 34% (p<0.05). In alignment with current resistance training guidelines by the government, for every increase of 2 MSA sessions per week, participants had an 11% reduced odds of having an elevated RDW (p=0.006). ConclusionEngagement in MSA is inversely associated with RDW. Although speculative, these findings suggest that changes in RDW may be one potential mechanism through which MSA may influence cardiovascular disease.

The Prognostic Role of Red Blood Cell Distribution Width in Coronary Artery Disease: A Review of the Pathophysiology.

Red blood cell distribution width (RDW) is a measure of red blood cell volume variations (anisocytosis) and is reported as part of a standard complete blood count. In recent years, numerous studies have noted the importance of RDW as a predictor of poor clinical outcomes in the settings of various diseases, including coronary artery disease (CAD). In this paper, we discuss the prognostic value of RDW in CAD and describe the pathophysiological connection between RDW and acute coronary syndrome. In our opinion, the negative prognostic effects of elevated RDW levels may be attributed to the adverse effects of independent risk factors such as inflammation, oxidative stress, and vitamin D3 and iron deficiency on bone marrow function (erythropoiesis). Elevated RDW values may reflect the intensity of these phenomena and their unfavorable impacts on bone marrow erythropoiesis. Furthermore, decreased red blood cell deformability among patients with higher RDW values impairs blood flow through the microcirculation, resulting in the diminution of oxygen supply at the tissue level, particularly among patients suffering from myocardial infarction treated with urgent revascularization.

Red blood cell distribution width predicts outcome of cryoballoon-based atrial fibrillation ablation.

Elevated red blood cell distribution width (RDW) has been associated with atrial fibrillation (AF) in cross-sectional and prospective studies. In this study, we aim to evaluate the relation of preablation RDW levels to late AF recurrence following cryoablation. A total of 299 patients with symptomatic paroxysmal or persistent AF despite ≥ 1 antiarrhythmic drug(s) who were scheduled for cryoballoon-based AF ablation were enrolled in this prospective study. A total of 299 patients (55.40 ± 10.60 years, 49.20 % male) were involved and followed up at a median time of 24 (6-44) months. Patients with late AF recurrence had higher RDW levels (14.30 ± 0.93 vs. 13.52 ± 0.93 %, p < 0.001). Multivariate Cox proportional hazard regression analysis showed that RDW level was an independent predictor for late AF recurrence (HR 1.88, 95 % CI 1.41-2.50, p < 0.001) along with left atrial (LA) diameter (HR 3.09, 95 % CI 1.81-5.27, p < 0.001), duration of AF (HR 1.04, 95 % CI 1.01-1.07, p = 0.02), and early AF recurrence (HR 6.39, 95 % CI 3.41-11.97, p < 0.001). A cut-off level of 13.75 % for RDW predicted late AF recurrence following cryoballoon-based pulmonary vein isolation (PVI) with a sensitivity and specificity of 78.00 and 70.00 %, respectively. These findings suggest that elevated RDW may be a predictor of late recurrence following cryoballoon-based AF ablation. Further studies are needed to establish its exact pathophysiologic and prognostic roles.

Red cell distribution width is an independent predictor of mortality in necrotizing fasciitis

IntroductionNecrotizing fasciitis (NF) is a rapidly progressing and potentially lethal infectious disease of the soft tissue. An elevated red blood cell distribution width (RDW) is associated with increased risk of death in patients with heart disease and infectious disease. We retrospectively assessed the association of elevated RDW with in-hospital mortality due to NF. MethodsAll patients had diagnoses of NF and were admitted to the emergency department of a single institution in Taiwan over a 4-year period. Demographics, comorbidities, clinical presentations, and laboratory parameters were retrospectively reviewed. Red blood cell distribution width was categorized as elevated (>14.5%) or not elevated. Multivariate regression analysis was used to identify risk factors associated with mortality. ResultsA total of 98 patients were enrolled, and the mortality rate was 23%. Univariate analysis indicated that advanced age, initial hypotension, low hemoglobin level, and elevated RDW (69.6% vs 20%, OR = 9.14, P < .001) were significantly associated with mortality. Multivariate analysis indicated that RDW was a significant and independent predictor of mortality in enrolled patients. ConclusionsElevated RDW is a significant and independent predictor of in-hospital mortality for patients with NF.