high-RDW Group Research Articles

Prognostic value of red blood cell distribution width in sepsis induced cardiomyopathy patients.

The potential association between red blood cell distribution width (RDW) at admission and prognosis in patients with sepsis-induced cardiomyopathy(SIC) remains uncertain. The purpose of this study was to explore the prognostic value of RDW on mortality in patients with SIC. Data for this retrospective study were obtained from the MIMIC IV2.2 database. We used propensity score matching (PSM) and Cox proportional hazards regression analysis to evaluate the main risk factors associated with mortality in SIC patients. This analysis was utilized to develop a predictive nomogram. To assess the predictive accuracy and clinical usefulness of the model, we employed the concordance index (C-index) and decision curve analysis. To define the high- and low-RDW groups among patients with SIC, we determined the optimal cut-off value by maximizing the Youden index. According to the screening criteria, we identified a cohort of 1051 patients diagnosed with SIC. When comparing the high-RDW group to the low-RDW group, it was found that the high-RDW group exhibited longer Los_ICU(4.5 days vs.3.8 days, respectively, P = 0.009) and higher mortality rates at 28 days (33.8% vs. 7.8%, respectively, P < 0.001). A nomogram model was created using matched patients which included various factors such as Age, RDW, LDH, CKMB, creatinine and the administration of β-blocker. The C-index predicting 28-day survival probability was 0.846. Decision curves analysis demonstrated that the inclusion of RDW in the model provided a greater net benefit compared to excluding RDW. The prognosis of patients with SIC can be predicted by the RDW value. The nomogram model provides a useful tool in identifying and managing SIC patients.

Association of preoperative red blood cell width and postoperative 30-day mortality in patients undergoing non-cardiac surgery: a retrospective cohort study using propensity-score matching

BackgroundIn terms of predicting surgery mortality, it is controversial whether red blood cell width works independently. In non-cardiac surgery patients older than 18 years, we intend to examine the relationship between red blood cell width and postoperative 30-day mortality.MethodsIn this retrospective cohort study, 90,785 Singapore General Hospital patients were matched by propensity score between January 1, 2012 and October 31, 2016. It was determined that red blood cell width at baseline and mortality within 30 days after surgery were the independent and dependent variables. We used a non-parametric multivariate logistic regression to balance the confounders among 7807 patients with high RDW and 7807 patients with non-high RDW in the propensity score matching. We investigated the association between RDW and 30-day mortality after surgery using the doubly robust estimation method.ResultsCohorts matched according to propensity score, the risk of 30-day mortality after surgery increased by 114.6.0% among the high RDW group (OR = 2.146, 95% CI 1.645–2.799, P < 0.00001). In the crude model, there was a significant association between RDW and 30-day mortality after surgery (OR = 1.877, 95% CI 1.476–2.388, P < 0.00001). In the propensity-score adjusted model, the risk of 30-day mortality after surgery in the high RDW group compared to the control group was not as high as in the non-adjusted model (OR = 1.867, 95% CI 1.467–2.376, P < 0.00001). Compared to non-high RDW group, the risk of 30-day mortality after surgery increased by 117.0% and 127.7% among high RDW group in the original cohort (OR 2.170, 95% CI 1.754–2.683, P < 0.00001) and the weighted cohort (OR 2.272, 95% CI 2.009–2.580, P < 0.00001), respectively.ConclusionsAccording to the results of this observational, propensity score-matched cohort study, uncontrolled high RDW before surgery is associated with an increased risk of death within 30 days after surgery, that is to say, patients over the age of 18 with high preoperative RDW who undergo non-cardiac surgery have a worse postoperative prognosis than those with normal RDW.

Identification of red blood cell distribution width as a prognostic factor in acute myeloid leukemia

Many prognostic factors have been identified in acute myeloid leukemia (AML). In this study, we investigated novel prognostic biomarkers using machine learning and Cox regression models in a prospective cohort of 591 patients with AML and tried to identify potential therapeutic targets based on transcriptomic data. We found that elevated red blood cell distribution width (RDW) at diagnosis was an adverse prognostic factor for AML, independent of the 2022 European LeukemiaNet (ELN2022) genetic risk. As a continuous variable, higher RDW was associated with shorter overall survival (OS) (hazard ratio [HR] 1.087, 95% confidence interval [CI] 1.036-1.139, p < 0.001) and event-free survival (EFS) (HR 1.078, 95% CI 1.033-1.124, p < 0.001). Elevated RDW returned to normal after consolidation therapy, which indicated that leukemia cells resulted in abnormal RDW. We further investigated the relationship between RDW and transcriptome in another cohort of 191 patients with AML and public datasets using gene set enrichment analysis (GSEA) and cell-type identification by estimating relative subsets of RNA transcripts (CIBERSORT). We found that patients in the high-RDW group were significantly enriched in the positive regulation of erythroid differentiation and inflammation-related pathways. Finally, we identified the inflammation-associated gene IL12RB2 and verified its prognostic relevance with patients with AML in public databases, suggesting it as a potential therapy target.

Predictive value of red blood cell distribution width and platelet-to-lymphocyte ratio for acute kidney injury in critically ill patients.

The purpose of this study was to explore the value of red blood cell distribution width (RDW) and platelet-to-lymphocyte ratio (PLR) in predicting the occurrence of acute kidney injury (AKI) in critically ill patients. Among 1,500 adult patients in the intensive care unit (ICU) between January 2016 and December 2019, we examined the associations of baseline RDW and PLR with the risk of AKI development using logistical analysis. In addition, we explored the value of RDW and PLR in predicting in-hospital mortality. Overall, 615 (41%) patients were diagnosed with AKI. We divided the groups into two subgroups each; the high-RDW (≥14.045%) group had a high risk of developing AKI (OR=5.189, 95% CI: 4.088-6.588), and the high-PLR (≥172.067) group had a risk of developing AKI too (OR=9.11, 95% CI: 7.09-11.71). The areas under the receiver operating characteristic curves (AUCs) for the prediction of AKI incidence based on RDW and PLR were 0.780 (95% CI: 0.755-0.804) and 0.728 (95% CI: 0.702-0.754) (all p < 0.001), with cut-off values of 14.045 and 172.067, respectively. Moreover, a higher RDW was associated with a higher rate of hospital mortality (OR: 2.907, 2.190-3.858), and the risk of in-hospital mortality related to PLR was 1.534 (95% CI: 1.179-1.995). A higher RDW was related to a higher risk of AKI occurrence and in-hospital mortality in the ICU.

Red blood cell distribution width as a prognostic factor in patients with aplastic anemia treated with cyclosporin A plus androgen or cyclosporine A alone: a retrospective study

ABSTRACTObjective:To explore the prognostic value of red blood cell distribution width (RDW) in newly diagnosed aplastic anemia (AA) patients treated with cyclosporine A (CsA) plus androgen or CsA alone.Methods:We retrospectively analyzed the clinical outcome of 220 patients with AA. According to the baseline level of RDW before treatment, the patients were divided into the high-RDW group (RDW ≥ 15%) and the normal-RDW group (RDW < 15%).Results:The median RDW of non-severe AA (NSAA) and severe AA (SAA) patients was 15.65% and 15.35%, respectively; this were significantly higher than that of very severe AA (VSAA) patients (13.35%). With median follow-up being 46 months, AA patients in the high-RDW group showed better 5-year OS and PFS than the normal-RDW group (93%: 75.3%; 74.3%: 61%). There was a higher ORR in the high-RDW group than the normal-RDW group (68.7%: 52.3%). The ORR of NSAA patients in the high-RDW group was better than that in the normal RDW group (75.8%: 60%). The 5-year OS of SAA/VSAA patients in the high-RDW group was significantly higher than the normal-RDW group (81.8%: 50.8%).Conclusion:This is the first documentation on the prognostic value of RDW in AA patients receiving CsA treatment with long-term follow-up, which had shown that high RDW at diagnosis was a better prognostic factor.

Potential value of red blood cell distribution width in predicting in-hospital mortality in intensive care US population with acute pancreatitis: a propensity score matching analysis

The association between red blood cell distribution width (RDW) and in-hospital mortality in intensive care patients with acute pancreatitis (AP) is inconclusive. We extracted the baseline data, Bedside Index for Severity in Acute Pancreatitis (BISAP) score, Sequential Organ Failure Assessment (SOFA) score, and in-hospital prognosis of intensive care patients with AP from the Medical Information Mart for Intensive Care IV database. Performing binary logistic regression analysis to determine whether RDW is an independent risk factor for in-hospital mortality. By drawing receiver operating characteristic (ROC) curves and comparing the areas under the ROC curves (AUC) to determine the predictive value of RDW for in-hospital mortality, and by conducting survival analysis to evaluate the impact of RDW on survival time in hospital. Before and after the propensity score matching (PSM) analysis, RDW was always a risk factor for in-hospital mortality in patients with AP. The AUC of RDW was comparable to BISAP, while the AUCs of combining RDW and BISAP or SOFA were greater than that of BISAP or SOFA alone. The median survival time of the high-RDW group (RDW > 15.37%, before PSM; RDW > 15.35%, after PSM) was shorter than that of the low-RDW group. Compared with the low-RDW group, the hazard ratios of the high-RDW group were 3.0708 (before PSM) and 1.4197 (after PSM). RDW is an independent risk factor for in-hospital mortality in patients with AP. The predictive value of RDW for in-hospital mortality of patients with AP is comparable to BISAP, and the combination of RDW and BISAP or SOFA scoring system can improve the predictive performance to a certain extent.

Diagnostic value of procalcitonin and red blood cell distribution width at admission on the prognosis of patients with severe burns: A retrospective analysis.

The plasma procalcitonin (PCT) concentration and red blood cell distribution (RDW) value after severe burns can be used as prognostic indicators, but at present, it is difficult to give consideration to sensitivity and specificity in diagnosing the prognosis of severe burns with a single indicator. This study analysed the diagnostic value of plasma PCT concentration and RDW value at admission on the prognosis of severe burn patients to improve its sensitivity and specificity. A total of 205 patients with severe burns who were treated in the First Affiliated Hospital of Anhui Medical University from November 2017 to November 2022 were retrospectively analysed. The optimal cut-off values of plasma PCT concentration and RDW were analysed and counted through the subject curve (ROC curve). According to the cut-off value, patients were divided into high PCT group and low PCT group, high RDW group and low RDW group. The independent risk factors of severe burns were analysed by single-factor and multiple-factor COX regression. Kaplan-Meier survival was used to analyse the mortality of high PCT group and low PCT group, high RDW group and low RDW group. The area under the curve of plasma PCT concentration and RDW value at admission was 0.761 (95% CI, 0.662-0.860, P < .001), 0.687 (95% CI, 0.554-0.820, P = .003) respectively, and the optimal cut-off values of serum PCT concentration and RDW were 2.775 ng/mL and 14.55% respectively. Cox regression analysis found that age, TBSA, and RDW were independent risk factors for mortality within 90 days after severe burns. Kaplan-Meier survival analysis showed that there was a significant difference in the 90-day mortality rate of severe burns between the PCT ≥ 2.775 ng/mL group and the PCT < 2.775 ng/mL group (log-rank: 24.162; P < .001), with the mortality rate of 36.84% versus 5.49%, respectively. The 90-day mortality rate of severe burns was significantly different between the RDW ≥ 14.55% group and the RDW < 14.55% group (log-rank: 14.404; P < .001), with the mortality rate of 44% versus 12.2% respectively. The plasma PCT concentration and RDW value at admission are both of diagnostic value for the 90-day mortality of severe burns, but the plasma PCT concentration has higher sensitivity and the RDW value has higher specificity. Age, TBSA, and RDW were independent risk factors for severe burns, and then plasma PCT concentration was not independent risk factors.

Red blood cell distribution width improves the prediction of 28-day mortality for patients with sepsis-induced acute kidney injury: A retrospective analysis from MIMIC-IV database using propensity score matching

BackgroundThe predictive value of red blood cell distribution width (RDW) for mortality in patients with sepsis-induced acute kidney injury (SI-AKI) remains unclear. The present study aimed to investigate the potential association between RDW at admission and outcomes in patients with SI-AKI. MethodsThe Medical Information Mart for Intensive Care (MIMIC)-IV (version 2.0) database, released in June of 2022, provides medical data of SI-AKI patients to conduct our related research. Based on propensity score matching (PSM) method, the main risk factors associated with mortality in SI-AKI were evaluated using Cox proportional hazards regression analysis to construct a predictive nomogram. The concordance index (C-index) and decision curve analysis were used to validate the predictive ability and clinical utility of this model. Patients with SI-AKI were classified into the high- and low-RDW groups according to the best cut-off value obtained by calculating the maximum value of the Youden index. ResultsA total of 7574 patients with SI-AKI were identified according to the filter criteria. Compared with the low-RDW group, the high-RDW group had higher 28-day (9.49% vs. 31.40%, respectively, P <0.001) and 7-day (3.96% vs. 13.93%, respectively, P <0.001) mortality rates. Patients in the high-RDW group were more prone to AKI progression than those in the low-RDW group (20.80% vs. 13.60%, respectively, P <0.001). Based on matched patients, we developed a nomogram model that included age, white blood cells, RDW, combined hypertension and presence of a malignant tumor, treatment with vasopressor, dialysis, and invasive ventilation, sequential organ failure assessment, and AKI stages. The C-index for predicting the probability of 28-day survival was 0.799. Decision curve analysis revealed that the model with RDW offered greater net benefit than that without RDW. ConclusionThe present findings demonstrated the importance of RDW, which improved the predictive ability of the nomogram model for the probability of survival in patients with SI-AKI.

Analysis of Mean Corpuscular Volume and Red Cell Distribution Width in Patients with Aplastic Anemia

To explore the characteristics of hemogram in patients with aplastic anemia (AA), especially mean corpuscular volume (MCV) and red cell distribution width (RDW). We examined the blood routine of 180 new-onset AA patients and used 166 patients with myelodysplastic syndrome (MDS) as controls. Among the 180 AA patients, 105 (58.3%) were diagnosed with severe AA (SAA), while 75 (41.7%) were diagnosed with non-severe AA (NSAA). Compared to MDS, patients with SAA generally had unfavorable hemogram, including significantly lower white blood cell (WBC), absolute neutrophil count (ANC), hemoglobin (Hb), platelet (PLT) and reticulocyte counts (RET). However, WBC, ANC and lymphocyte counts were higher in the NSAA group than in the MDS group; Hb and Ret were comparable between the two groups. 8.5% of SAA patients and 58.1% of NSAA patients presented with macrocytic anemia, whereas 25.7% of SAA and 64.0% of NSAA had a high RDW. In the MDS group, 54.7% of patients presented with macrocytic anemia, and 84.7% had increased RDW. WBC, ANC, PLT, and Ret in a high-RDW group (25.7% of SAA) were significantly higher than in a normal-RDW group (74.3% of SAA). Overall, most SAA patients exhibited normocytic–normochromic anemia, and their hemograms decreased more significantly; more than half of NSAA patients showed macrocytic-heterogeneous anemia, and their hemograms were similar to those of MDS. Patients with elevated RDW may have better residual bone marrow hematopoietic function than those with normal RDW but with more severe anemia.

Evaluation of clinicopathological and prognostic significance of RDW in gastric cancer

Objective: We aimed to reveal possible relationships between pre-operative RDW values and clinicopathological features of gastric cancer (GC) and to evaluate its predictive impact on progression and prognosis of GC. &#x0D; Material And Method: A total of 92 patients who underwent curative surgery were retrospectively included the study. GC patients were divided into two groups: high-RDW group (&gt;14.5%, n=58) and low-RDW (

Red blood cell distribution width as a predictor of mortality among patients regularly visiting the nephrology outpatient clinic

The association between increased red blood cell distribution width (RDW) and mortality among patients treated on an outpatient basis in the nephrology outpatient clinic is unclear. Therefore, our study aimed to investigate the association between baseline and time-averaged RDW and mortality risk in patients treated in our nephrology outpatient clinic. Our multi-center retrospective analysis was based on data of 16,417 outpatient nephrology patients with available baseline renal function and RWD values. The median baseline RDW was 13.0% (range, 10.0–32.1%). The high-RDW group was defined as the top quartile (≥ 13.8%, n = 4302). The crude mortality rate was 15.0% (n = 1806) at a median follow-up of 127.5 months. From the results of the multivariate Cox proportional hazards regression model adjusted for covariates, including eGFR, hemoglobin, and factors of anemia treatment, patients with a high time-averaged RDW had increased mortality risk (adjusted hazard ratio, 1.505; 95% confidence interval, 1.326–1.708; P < 0.001), irrespective of sex, presence of anemia, and chronic kidney disease, except in individuals aged < 45 years. Thus, increased baseline and time-averaged RDW were significantly associated with increased mortality in patients aged > 45 years treated on an outpatient basis in the nephrology clinic.

Clinical importance of preoperative red-cell volume distribution width as a prognostic marker in patients undergoing radical surgery for pancreatic cancer

Background and purposeA new noninvasive biomarker is being sought to predict the prognosis of patients with pancreatic cancer. Red-cell volume distribution width (RDW), a descriptive parameter for erythrocyte variation, has been shown to have prognostic value for some tumor types. Our purpose was to assess the RDW value to predict the prognosis of patients with pancreatic cancer.MethodsThe subjects of this retrospective study were 792 patients who underwent radical surgery for pancreatic cancer, divided into high-RDW and low-RDW groups based on receiver operating characteristic (ROC) curve analysis (15.6%). The controlling nutritional status (CONUT) score was used to assess preoperative nutritional status. Statistical analysis was conducted to investigate the differences between the high and low RDW groups, and to explore the possibility of the RDW being used as prognostic predictor for patients with pancreatic cancer.ResultsThe immune-nutritional status was worse in the high-RDW group than in the low-RDW group. The high-RDW group patients also had a poorer prognosis. Risk factor analysis showed that the RDW could be an independent risk factor for pancreatic cancer.ConclusionsThe RDW is associated with immune-nutritional status in pancreatic cancer patients and can be used as an independent prognostic factor for their postoperative survival.

Pre-treatment red blood cell distribution width as a predictor of clinically significant prostate cancer.

The present study aims to assess the relationship between red blood cell distribution width (RDW) and clinically significant prostate cancer (csPCa). A total of 458 patients with prostate-specific antigen (PSA) ≤ 10ng/ml, who subsequently underwent 11-core transperineal template-guided prostate biopsy from June 15, 2015 to November 24, 2020, were included in the present study. Receiver-operating characteristic (ROC)-derived area under the curve analysis was performed to evaluate the predictive accuracy. In addition, univariate and multivariate logistic regression analysis was carried out to determine the association between RDW and csPCa detection. A total of 89 patients were diagnosed with csPCa, and these patients presented with higher median RDW. The optimal RDW cut-off was set at 12.35%, which gained the maximal Yuden's index. In addition to csPCa, RDW demonstrated a positive correlation with age (r = 0.210, P < 0.001). It was observed that RDW was independent of prostate-specific antigen density for csPCa detection. Compared with the low-RDW group, patients in the high-RDW group had a 1.586-fold increased risk of being diagnosed with csPCa (OR = 2.586, P = 0.007). In the ROC analysis, the accuracy level increased by 3.1% for the prediction of csPCa, when RDW was added to the multivariate logistic model. A high-RDW value is an independent risk factor for csPCa detection. However, more large-scale studies are needed to confirm these findings. If validated, RDW can become an inexpensive, non-invasive, and convenient indicator for csPCa prediction.

NON-ST ELEVATION MYOCARDIAL INFARCTION: CORRELATION OF RED BLOOD CELL DISTRIBUTION WIDTH WITH SYNTAX SCORE

Objective: To determine the correlation between mean RDW values and mean SYNTAX scores in patients of non ST elevation myocardial infarction. Methodology: This descriptive study was conducted at adult Angiography Department of Faisalabad Institute of Cardiology, Faisalabad from September, 2017 to October, 2018. A total of 130 patients were enrolled in this study. Patients were divided into high (n=89) and low (n=41) SYNTAX groups. The high SYNTAX group was defined as patients with value in the third tertile (SYNTAX score, SX score ≥ 33) while the group with low SNTAX score was defined as patients with values in the lower 2 tertiles (SYNTAX score, SX score &lt; 33). The high RDW group was defined as patients with RDW value &gt; 16 % and the low RDW group as those with RDW value &lt; 16 %. Results: The mean RDW value was correlated with mean SYNTAX score in both groups. The RDW levels were significantly high in patients with high SNTAX score than those with low SYNTAX score (16.2± 1.8 vs. 14.2 ± 1.2, p &lt;0.001). Pearson’s coefficient was used to determine the correlation between RDW levels and SYNTAX scores. There was a significant positive correlation between mean RDW value and mean SYNTAX score value (r=0.831, p &lt;0.001). Conclusion: We found a positive and significant correlation between mean RDW values and mean SYNTAX scores in patients of non-ST elevation myocardial infarction. This reflects the utility of RDW being a non-invasive and readily available laboratory test to determine the severity and complexity of coronary disease in these patients.

P0422RED BLOOD CELL DISTRIBUTION WIDTH AND OUTCOME IN SUBJECTS WITH BIOPSY-PROVEN GLOMERULOPATHIES WITHOUT ANEMIA

Abstract Background and Aims Red blood cell distribution width (RDW) is a marker of anisocytosis and is mainly modified in anemia. However, elevated RDW has recently been reported to predict cardiovascular risk, was correlated with disease activity in inflammatory conditions such as systemic lupus erythematosus, rheumatoid arthritis and, not the least, was associated with increased risk of end stage kidney disease and proteinuria in chronic kidney disease (CKD) subjects. The current study aims to assess if RDW is an independent predictor for renal replacement therapy (RRT) and mortality in subjects with glomerulopathies (GP). Method This retrospective, single-center study, included 467 subjects with hemoglobin &amp;gt;12 g/dL at presentation, who were histologically diagnosed with primary and secondary glomerulopathies between 1st Jan. 2008 and 31st Dec. 2017 and who were followed for a mean of 52.8 (95%CI 50.7-55) months, until 31st May 2018. Subjects with inadequate biopsy sample were excluded. Those who deceased until the end of the follow-up were not included in the kidney survival analysis. Predictors of mortality were assessed by logistic regression. Kaplan-Meier method was used to evaluate kidney survival. Patients were stratified in two groups according to the median RDW value: low RDW group (RDW≤15%; n=342) and high RDW group (RDW&amp;gt;15%; n=125). RRT initiation and all-cause mortality were the primary endpoints of the study. Results Subjects with high RDW were older [53 (95%CI 48-56) vs. 45 (95%CI 43-47) years; p=0.03], had more frequent cerebrovascular disease (9.7% vs. 2.7%; p=0.003), congestive heart failure (8.1% vs. 1.8%; p=0.002), connective tissue disease (11.3% vs. 3%; p=0.001) and non-hematologic neoplasia (4.8% vs. 0.9%, p=0.01). Furthermore, they had more severe inflammation as suggested by higher erythrocyte sedimentation rate [54.5 (95%CI 43-60) vs. 35 (95%CI 30-40) mm/hour; p=0.002], fibrinogen [630 (95%CI 562-701) vs. 540 (95%CI 514-585 mg/dL; p=0.02], and C reactive protein [3 (95%CI 2-4) vs. 2 (95%CI 2-3); p=0.03], had lower hemoglobin [13.7 (95%CI 13.4-14) vs. 14.1 (95%CI 13.9-14.4) g/dL); p=0.008], and higher proteinuria [4.2 (95%CI 3.1-5.2) vs. 2.4 (95%CI 2.1-2.8) g/g creatinine; p=0.002]. However, the kidney function between the two groups was similar (56.5 vs. 55 ml/min MDRD; p=0.1). Secondary GP were more frequent encountered in high RDW group (42.4% vs. 18.1%; p&amp;lt;0.001), especially amyloidosis (19.2% vs. 4.7%; p&amp;lt;0.001) and lupus nephritis (9.6% vs. 3.5%; p=0.01). During the follow-up period, in high RDW group 26.4% of the subjects died, compared to 11.4% from the other group (p&amp;lt;0.001). In a multivariate logistic regression model, RDW was an independent predictor for mortality [OR 1.5 (95%CI 1.2-15); p=0.007]. Other independent predictors were older age [OR 1.06 (95%CI 1.03-1.08); p&amp;lt;0.001], presence of cerebrovascular disease [OR 3.31 (95%C I1.01-10.8); p=0.04], lower serum albumin [OR 0.48 (95%CI 0.43-0.70), p&amp;lt;0.001] and higher serum creatinine [OR 1.29 (95%CI 1.06-1.57); p&amp;lt;0.001]. There was no difference regarding the frequency of RRT initiation between groups (18% in high RDW group vs. 11% in low RDW group; p=0.07) and the time to kidney death was similar [79.7 (95%CI 72.8-86.6) vs. 87.8 (95%CI 84-91.6) months; log rank p=0.1]. Conclusion In non-anemic subjects with biopsy-proven glomerular disease, a higher RDW seems associated with a higher risk of mortality, but not with kidney survival. In addition, RDW above 15% might point out to a secondary GP, like amyloidosis and lupus nephritis.

Red blood cell distribution width is a simple and novel biomarker for survival in light-chain amyloidosis.

Red blood cell distribution width (RDW) has been used for the differential diagnosis of anemia, but high RDW may also be associated with several human disorders. We evaluated the prognostic relevance of RDW in patients with light-chain (AL) amyloidosis. We retrospectively analyzed all patients with AL amyloidosis who were newly diagnosed at the Japanese Red Cross Medical Center between December 2011 and June 2018. RDW was evaluated in 94 patients; 48% (n = 45) of patients had a high RDW (≥ 13.8%) and 52% (n = 49) had a low RDW (< 13.8%). Overall survival (OS) was significantly lower in patients with a high RDW (P < 0.001). On multivariate analysis, increased RDW was an independent predictor for OS. Even in patients without cardiac amyloidosis, the OS was significantly lower in the high-RDW group (P = 0.0064). The survival rate of high-RDW patients without cardiac involvement was as poor as that of patients with cardiac involvement. In addition, in patients with revised Mayo stage I or a normal level of N-terminal pro-B-type natriuretic peptide, high RDW was negatively correlated with OS (P = 0.0086, 0.025). RDW is a simple and strong predictor of early death, and is a prognostic biomarker in patients with AL amyloidosis without cardiac involvement.

Relationship of Red Blood Cell Distribution Width with Cancer Mortality in Hospital.

Background Red blood cell distribution width (RDW) is a clinical index used to make early diagnosis and to monitor treatment effects in iron deficiency anemia. Recently, several studies have suggested that RDW was associated with mortality from various cancers; however, there has been little evidence regarding RDW and cancer as a whole. Therefore, the purpose of our study was to investigate the relationship of RDW and overall cancer mortality in hospital. Methods We extracted patient data from the Multiparameter Intelligent Monitoring in Intensive Care Database III version 1.3 (MIMICIII.1.3). RDW was measured prior to hospital admission. Patients older than 18 who were diagnosed with malignant tumors were included. The primary outcome was cancer mortality in hospital. Logistic regression and multivariate analysis were used to assess the association between the RDW and hospital mortality. Result A total of 3384 eligible patients were enrolled. A positive correlation was observed between RDW and overall cancer mortality. Patients with higher RDW (14.4-16.3%, 16.4-30.5%) were at greater risk of death than the patients with RDW in the reference range (11.5-14.3%). On multivariate analysis, when adjusted for age and gender, the adjusted OR (95% CIs) in the mid-RDW group and high-RDW group were 1.61 (1.28, 2.03) and 2.52 (2.03, 3.13), respectively, with the low-RDW group set as the baseline. Similar trends were also observed in the model adjusted for other clinical characteristics. This suggested that elevated RDW was related to increased risk of cancer mortality, and RDW may play an important role in the prediction of short-term mortality after hospitalization in cancer patients. Conclusion Elevated RDW was associated with overall cancer mortality. To a certain extent, RDW may predict the risk of mortality in patients with cancers; it was an independent prognostic indicator of short-term mortality after hospitalization in cancer patients.

Predictive value of red blood cell distribution width for acute kidney injury in children with sepsis

To study the clinical value of red blood cell distribution width (RDW) in the early prediction of acute kidney injury (AKI) in children with sepsis. A total of 126 children with sepsis were divided into an AKI group (n=66) and a non-AKI group (n=60) according to the presence or absence of AKI. These patients were also classified into high-RDW and low-RDW groups according to the mean RDW. The groups were compared in terms of age, male-to-female ratio, body mass index (BMI), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, serum blood urea nitrogen (BUN), creatinine (Cr), uric acid (UA), serum C-reactive protein (CRP), and routine blood test results. Independent factors associated with RDW were analyzed by multiple linear regression. Age, male-to-female ratio, BMI, CRP, SOFA score, and APACHE II score did not differ significantly between the AKI and non-AKI groups (P>0.05), but the AKI group had significantly higher BUN, Cr, UA, and RDW levels than the non-AKI group (P<0.05). Age, male-to-female ratio, and BMI did not differ significantly between the high-RDW and low-RDW groups (P>0.05), but the high-RDW group had significantly higher BUN, Cr, UA, CRP, SOFA score, APACHE II score, Hb, and mean corpuscular volume (MCV) than the low-RDW group (P<0.05). The multiple linear regression analysis showed that age, sex, APACHE II score, Cr, Hb, and MCV were independent factors associated with RDW. RDW has a certain clinical value in the early prediction of AKI in children with sepsis.

Pre-treatment red blood cell distribution width provides prognostic information in multiple myeloma

BackgroundThe red blood cell distribution width (RDW), a credible marker for abnormal erythropoiesis, has recently been studied as a prognostic factor in oncology, but its role in multiple myeloma (MM) hasn't been thoroughly investigated. MethodsWe performed a retrospective study in 162 patients with multiple myeloma. Categorical parameters were analyzed using Pearson chi-squared test. The Mann-Whitney and Wilcoxon tests were used for group comparisons. Comparisons of repeated samples data were analyzed with the general linear model repeated-measures procedure. The Kaplan–Meier product-limit method was used to determine OS and PFS, and the differences were assessed by the log-rank test. ResultsHigh RDW baseline was significantly associated with indexes including haemoglobin, bone marrow plasma cell infiltration, and cytogenetics risk stratification. After chemotherapy, the overall response rate (ORR) decreased as RDW baseline increased. In 24 patients with high RDW baseline, it was revealed RDW value decreased when patients achieved complete remission (CR), but increased when the disease progressed. The normal-RDW baseline group showed both longer overall survival (OS) and progression-free survival (PFS) than the high-RDW baseline group. ConclusionOur study suggests pre-treatment RDW level is a prognostic factor in MM and should be regarded as an important parameter for assessment of therapeutic efficiency.

Evaluation of pretreatment red cell distribution width in patients with multiple myeloma.

Red blood cell distribution width (RDW) has been reported as an inflammatory biomarker and a predictor of prognosis in different types of cancer. However, the role of RDW at diagnosis in patients with multiple myeloma (MM) has been less explored. We aimed to investigate the association between RDW and the response to treatment and overall survival (OS) in patients with MM. We retrospectively analyzed the data for 196 MM patients between January 1, 2007 and December 31, 2015. Kaplan-Meier analysis and Cox regression model were used. High RDW values were associated with lower platelet count, lower hemoglobin levels, lower albumin levels, and higher lactate dehydrogenase (LDH) level. Among the entire cohort, the overall response rates (ORR) and complete response (CR) rate of initial therapy were markedly higher in the low-RDW group compared to the high-RDW group. RDW was significant lower in CR in comparison to Non-CR groups in patients treated with bortezomib-based regimens as induction therapy. The patients with low-RDW at diagnosis had better OS when compared to those with high-RDW. Elevated RDW was associated with worse survival in patients with MM and could predict treatment responses. Further larger and prospective studies are required.