Higher Red Blood Cell Distribution Research Articles

The Association of High Red Blood Cell Distribution Width with Metabolic Syndrome in Stable Coronary Artery Disease

The Association of High Red Blood Cell Distribution Width with Metabolic Syndrome in Stable Coronary Artery Disease

High red blood cell distribution width as a marker of hospital mortality after ICU discharge: a cohort study

BackgroundHigh red blood cell distribution width (RDW) is associated with worse outcome in diverse scenarios, including in critical illness. The Sabadell score (SS) predicts in-hospital survival after ICU discharge. We aimed to determine RDW’s association with survival after ICU discharge and whether RDW can improve the accuracy of the SS.DesignRetrospective cohort study. Setting: general ICU at a university hospital.PatientsWe included all patients discharged to wards from January 2010 to October 2016.MethodsWe analyzed associations between RDW and variables recorded on admission (age, comorbidities, severity score), during the ICU stay (treatments, complications, length of stay (LOS)), and at ICU discharge (SS). The primary outcome was hospital mortality. Statistical analysis included multivariable logistic regression and receiver operating characteristic curve (ROC) analyses.ResultsWe discharged 3366 patients to wards; median ward LOS was 7 [4–13] days; ward mortality was 5.2%. Mean RDW at ICU discharge was 15.4 ± 2.5%. Ward mortality was higher at each quartile of RDW (0.7%, 2.9%, 7.5%, 10.3%; area under ROC 0.81). A logistic regression model with Sabadell score obtained an excellent accuracy for ward mortality (area under ROC 0.863), and the addition of RDW slightly improved accuracy (AUROC 0.890, p < 0.05). Recursive partitioning demonstrated higher mortality in patients with high RDW at each SS level (1.6% vs. 0.3% in SS0, 9.7% vs. 1.1% in SS1, 21.9% vs. 9.7% in SS2), but not in SS3.ConclusionHigh RDW is a marker of severity at ICU discharge and improves the accuracy of Sabadell score in predicting ward mortality except in the more extreme SS3.

Increased Prevalence of Thalassemia in Young People in Korea: Impact of Increasing Immigration.

BackgroundThalassemia is highly prevalent in Southeast Asia but is rare in Korea; however, Southeast Asian immigrant population is recently rising in Korea. We investigated the prevalence of thalassemia in Korea in the context of increasing immigration.MethodsThis prospective, observational, multicenter study was conducted between September 2015 and August 2017. A total of 669 subjects <30 years living in Korea were grouped into the multiethnic (N=314) and Korean (N=355) groups. Hb electrophoresis and complete blood count (CBC) were performed. If low mean corpuscular volume with high red blood cell distribution width coefficient of variation or a high fetal Hb (HbF) or Hb alpha 2 (HbA2) level was observed, genetic testing of the α- and β-globin genes was performed. In addition, the number of potential thalassemia carriers in Korea was estimated by multiplying the prevalence of thalassemia in a specific ethnicity by the number of immigrants of that ethnicity.ResultsTwenty-six multiethnic and 10 Korean subjects showed abnormal results for Hb electrophoresis and CBC. Eighteen multiethnic subjects and four Korean subjects were tested for α-globin and β-globin gene mutations. Within the multiethnic group, five subjects (1.5%) were α-thalassemia carriers, and six (1.9%) were β-thalassemia minor. The SEA deletion in HBA1 and HBA2, and c. 126_129delCTTT (p.Phe42Leufs*19) mutation of HBB were the dominant inherited mutations.ConclusionsThe prevalence of thalassemia in young people in Korea is increasing due to the increasing number of Southeast Asian immigrants.

Increased red cell width distribution to lymphocyte ratio is a predictor of histologic severity in primary biliary cholangitis.

Primary biliary cholangitis (PBC) is a chronic disease that is increasingly being recognized in recent years. In this study, we sought to identify noninvasive markers of the severity of cirrhosis in patients with PBC based on routinely investigated laboratory parameters.Ninety-four patients with histologically-confirmed PBC based on liver biopsy performed between January 2013 and December 2017 at the First Hospital of Jilin University were divided into 2 groups: early-stage cirrhosis (fibrosis stage F1 and F2; n = 74) and advanced-stage cirrhosis (fibrosis stage F3 and F4; n = 20).Patients with advanced-stage had significantly higher red blood cell distribution width (RDW) (15.2 vs 13.7; P = .003) and significantly lower platelet (163.35 vs 202.73; P = .032) and lymphocyte counts (1.47 vs 1.79; P = .018) as compared with patients with early-stage cirrhosis. Advanced-stage cirrhosis was associated with significantly higher RDW to platelet ratio (RPR), RDW to lymphocyte ratio (RLR), aspartate aminotransferase to platelet ratio index (APRI), and fibrosis index based on the 4 factors (FIB-4) as compared with early-stage cirrhosis. RLR showed the highest area under receiver operating characteristic curve (AUROC) (0.744). The sensitivity and specificity of RLR were 65% and 78.3%, respectively. RLR had higher AUROC than the other 3 noninvasive markers.The noninvasive markers RPR, RLR, APRI, and FIB-4 showed good diagnostic accuracy for advanced-stage cirrhosis. These markers are easily acquired by routine laboratory tests and are reproducible predictors of the severity of PBC. RLR is a novel marker that may serve as a valuable supplement to APRI and FIB-4 for predicting the severity of cirrhosis.

Red blood cell distribution width to platelet ratio levels in assessment of histologic severity in patients with primary biliary cholangitis

We aimed to investigate the relationship between the histologic severity and red blood cell distribution width to platelet ratio (RPR) in patients with primary biliary cholangitis (PBC). One hundred and seven consecutive patients with liver biopsy-proven and as yet treatment-naïve PBC were enrolled as the primary and validation cohort. The histologic stages were divided into early stage (Scheuer’s stage 1 & 2) and late stage (Scheuer’s stage 3 & 4). The overall patient demographics, clinical manifestations, hematological tests and biochemical profile were retrospectively collected from our database. Both groups were compared in terms of RPR, aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis index based on the 4 factors (FIB-4) and AST/ALT ratio (AAR). Of the 77 patients in the primary cohort, a total of 24 (31.2%) had early stage PBC, whereas 53 (68.8%) represented late stage. Patients with late stage PBC showed significantly higher red blood cell distribution width (15.5 vs. 14.1%, p = .016), RPR (0.15 vs. 0.09, p < .001), direct bilirubin (32.4 vs. 12.9 μmol/L, p = .041), FIB-4 (3.41 vs. 6.34, p = .001) and significantly lower platelet (132.8 vs. 185.8 × 109/L, p = .002). The area under the curve, cut-off value, sensitivity, specificity, positive predictive value, negative predictive value for determining late stage were 0.74, 0.14, 49.1%, 95.8%, 96.3% and 46.0%, respectively. Additionally, high RPR may also serve as a prognostic indicator for 18-month mortality. In conclusion, RPR can be used as a non-invasive and effective predictor of histologic severity in patients with PBC.

Red blood cell distribution width as a predictor of atrial fibrillation.

Current evidence suggests that a higher red blood cell distribution width (RDW) may be associated with increased risk of atrial fibrillation (AF) development. Given that some controversial results have been published, we conducted a systematic review of the current literature along with a comprehensive meta-analysis to evaluate the association between RDW and AF development. We performed a systematic search of the literature using electronic databases (PubMed, Ovid, Embase, and Web of Science) to identify studies reporting on the association between RDW and AF development published until June 2016. We used both fix-effects and random-effects models to calculate the overall effect estimate. An I2 >50% indicates at least moderate statistical heterogeneity. A sensitivity analysis and subgroup analysis were performed to find the origin of heterogeneity. A total of 12 studies involving 2721 participants were included in this meta-analysis. The standardized mean difference in the RDW levels between patients with and those without AF development was 0.66 units (P<.05; 95% confidence interval 0.44-0.88). A significant heterogeneity between the individual studies was observed (P<.05; I2 =80.4%). A significant association between the baseline RDW levels and AF occurrence or recurrence following cardiac procedure or surgery was evident (SMD: 0.61; 95% confidence interval 0.33-0.88; P<.05) with significant heterogeneity across the studies (I2 =80.7%; P<.01). Our comprehensive meta-analysis suggests that higher levels of RDW are associated with an increased risk of AF in different populations.

Can red blood cell distribution width predict outcome after cardiac arrest?

In critically ill patients, high red blood cell distribution width (RDW) values have been associated with increased hospital mortality, but there are no data on the impact of RDW on outcomes of patients resuscitated from cardiac arrest (CA). The aim of this study was to investigate the relationship between RDW and long-term neurologic outcome in CA survivors. We performed a retrospective analysis of an institutional database including all unconscious adult patients admitted to the intensive care unit (ICU) after non-traumatic CA between January 2007 and January 2015. Patients who survived <24 hours were excluded. The RDW (normal values 10.9-13.4%) was obtained daily from the day of admission to day 3. Patients with a cerebral performance category (CPC) score of 3-5 at 3 months were considered to have an unfavourable neurological outcome. Three hundred and ninety patients were included. The ICU mortality rate was 56% (N.=220) and 64% of patients (N.=251) had an unfavorable 3-month neurological outcome. The median RDW on the day of admission was 14% (13.0-15.2%) and remained stable over the observation period. Two hundred and forty-five patients (63%) had a high RDW (>13.4%) on admission. In multivariable logistic regression analysis, older age, absence of bystander cardiopulmonary resuscitation (CPR), a non-cardiac etiology of the arrest, a non-shockable initial rhythm, high adrenaline dose during CPR and high admission RDW levels were independently associated with an unfavorable outcome at 3 months. High RDW values are associated with poor neurological outcome among CA survivors.

The Relationship Between Index Hospitalizations, Sepsis, and Death or Transition to Hospice Care During 30-Day Hospital Readmissions.

Hospital readmissions are common, expensive, and increasingly used as a metric for assessing quality of care. The relationship between index hospitalizations and specific outcomes among those readmitted remains largely unknown. Identify risk factors present during the index hospitalization associated with death or transition to hospice care during 30-day readmissions and examine the contribution of infection in readmissions resulting in death. Retrospective cohort study. A total of 17,716 30-day readmissions in an academic health system. We used mixed-effects multivariable logistic regression models to identify risk factors associated with the primary outcome, in-hospital death, or transition to hospice during 30-day readmissions. Of 17,716 30-day readmissions, 1144 readmissions resulted in death or transition to hospice care (6.5%). Risk factors identified included: age, burden, and type of comorbid conditions, recent hospitalizations, nonelective index admission type, outside hospital transfer, low discharge hemoglobin, low discharge sodium, high discharge red blood cell distribution width, and disposition to a setting other than home. Sepsis (OR=1.33; 95% CI, 1.02-1.72; P=0.03) and shock (OR=1.78; 95% CI, 1.22-2.58; P=0.002) during the index admission were associated with the primary outcome, and in-hospital mortality specifically. In patients who died, infection was the primary cause for readmission in 51.6% of readmissions after sepsis and 28.6% of readmissions after a nonsepsis hospitalization (P=0.009). We identified factors, including sepsis and shock during the index hospitalization, associated with death or transition to hospice care during readmission. Infection was frequently implicated as the cause of a readmission that ended in death.

Evaluation of frequency and intensity of asymptomatic anisocytosis in the Japanese dog breeds Shiba, Akita, and Hokkaido

Microcytosis is observed in healthy Japanese breed dogs. The aim of the study was to evaluate the frequency and intensity of asymptomatic anisocytosis using a three-grade scale in Japanese dog breeds with special emphasis on the following indices: mean cell volume, mean cell haemoglobin, mean cell haemoglobin concentration, and red blood cell distribution width. The retrospective study included analyses of blood morphology and blood smear for clinically healthy Japanese dog breeds Shiba, Akita, and Hokkaido aged from 6 months to 14 years, performed as a part of preventative care. A total of 74 dogs of both sexes were qualified for the study. The group included both neutered and non-neutered animals (Akita – 17 females, 12 males, Shiba – 24 females, 18 males, Hokkaido – 2 females, 1 male). The blood smear revealed significant anisocytosis in 60.8% and mild anisocytosis in 28.4% of the tested dogs – 89.2% in total. Microcytosis was reported for 25.7% of the tested Japanese breed dogs. Reduced mean cell haemoglobin and mean cell haemoglobin concentration were diagnosed in 75.7% and 40.5% of dogs, respectively. Red blood cell distribution width as an anisocytosis indicator exceeded the norm in 12% of the tested dogs. Compared to mixed breed dogs, the Japanese breeds had a reduced mean cell volume, mean cell haemoglobin concentration and significant anisocytosis in the blood smear as well as a higher red blood cell distribution width indicator. Veterinarians should consider these differences when interpreting the results of morphological blood tests.

High Preoperative Neutrophil-Lymphocyte Ratio (NLR) and Red Blood Cell Distribution Width (RDW) as Independent Predictors of Native Arteriovenous Fistula Failure

Objective: To study the association between a high preoperative neutrophil lymphocyte ratio (NLR) and red cell distribution width (RDW) with arteriovenous fistula (AVF) failure, as well as to determine the cut-off values in a South Asian population.Materials and Methods: A total of 150 consecutive patients with a failed fistula who presented in the Department of Vascular Surgery between January 2014 and January 2016. Patients fulfilling the inclusion criteria were selected as defined as Case. They were compared with 150 patients who had matured fistulae (Control).Results: A significant difference was found between the Case and Control groups in mean preoperative NLR (3.3±0.5 versus 2.2±0.9, P value=0.011) and RDW (15.9±2.9 versus 13.6±1.1%, P value of 0.02), respectively. Multivariate analysis revealed that NLR (Odds Ratios (OR) 1.39; 95% Confidence Intervals (CI) 1.02 to 2.08; P<0.001) and RDW (OR 1.39; 95%CI 1.11 to 1.69; P<0.001) were strong independent predictors of AVF failure. A receiver operating characteristic curve analysis showed a cut-off value of 2.65 (specificity 80%, sensitivity 98%) and 15.1 (specificity 79%, sensitivity 98%) for NLR and RDW, respectively.Conclusion: Increased preoperative NLR and RDW were associated with a high rate of AVF failure in a South Asian population.

Association of Exome Sequences With Cardiovascular Traits Among Blacks in the Jackson Heart Study.

The correlation of null alleles with human phenotypes can provide insight into gene function in humans. In individuals of African ancestry, we set out to identify null and damaging missense variants, and test these variants for association with a range of cardiovascular phenotypes. We performed whole-exome sequencing in 3223 black individuals from the Jackson Heart Study and found a total of 729 666 variant sites with minor allele frequency <5%, including 17 263 null variants and 49 929 missense variants predicted to be damaging by in silico algorithms. We tested null and damaging missense variants within each gene for association with 36 cardiovascular traits. We found 3 associations that met our prespecified level of significance (α=1.1×10(-7)). Null and damaging missense variants in PCSK9 were associated with 36 mg/dL lower low-density lipoprotein cholesterol (P=3×10(-21)). Three individuals in their 50s with complete PCSK9 deficiency (each compound heterozygote for PCSK9 p.Y142X and p.C679X) were identified, with one having a coronary artery calcification score in the 83rd percentile despite a low-density lipoprotein cholesterol of 32 mg/dL. A damaging missense variant in HBQ1 (p.G52A) was associated with a 2 pg/cell lower mean corpuscular hemoglobin (P=9×10(-13)) and rare damaging missense variants in VPS13A with higher red blood cell distribution width (P=9.9×10(-8)). A limited number of null/damaging alleles with a large effect on cardiovascular traits were detectable in ≈3000 black individuals.

High red blood cell distribution width is associated with the metabolic syndrome.

High values of Red Blood Cell Distribution Width (RDW) have been associated with adverse outcome in various clinical settings. The mechanism behind this association is not clear. The Metabolic Syndrome (MetS) is a chronic inflammatory disorder that increases the risk for cardiovascular disease and death. The aim of our study was to evaluate the association between high RDW and the MetS in a relatively large cohort of patients. A cohort of 3,529 consecutive patients undergoing coronary angiography was used to evaluate the association between RDW and the MetS. The association was assessed by using a logistic regression. Cox's regression analysis was used to evaluate the impact of RDW on long term mortality. The mean age was 65 years (range 24-97), with 27% women. Overall, 30% were diagnosed with metabolic syndrome. The prevalence of MetS was 29% in patients with RDW <14% and 34% in patients with RDW ≥14% (P = 0.003).Using multivariate analysis, RDW values above 14% were independently associated with MetS (odds ratio 1.2 [95% CI 1.0-1.4], P = 0.043). Among all the criteria of the metabolic syndrome, hypertension, elevated glucose levels and abdominal obesity were associated with high RDW, with hypertension being the strongest criteria, with an increased risk of 1.8 fold ([95% CI 1.5-2.1]; P = 0.001). During follow up (1614 ± 709 days, 2-2763 days), long term mortality was 8% in the low RDW group and 28% in the high RDW group (p < 0.001). RDW ≥14% is independently associated with higher rates of metabolic syndrome and long-term all-cause mortality.

Red Blood Cell Distribution Width Increases During Infection in Renal and Liver Graft Recipients.

Organ transplant is an effective treatment for patients with end-stage renal and hepatic failure. Increased use has introduced more emergency department admissions of infectious origin after transplant. Because infections usually manifest with simple complaints and fever, emergency physicians need laboratory tests and radiologic imaging procedures to quickly detect the presence and source of infection. Our aim was to analyze fever-related emergency admissions of renal and hepatic graft recipients and determine whether admitted patients had increased red blood cell distribution width and mean platelet volume levels. We reviewed the medical records of renal and hepatic graft patients who presented to our emergency department with fever during a 4-year period. Our analyses included 150 patients in which complete blood count and C-reactive protein results were available and the source of infection was determined. We compared results with a control group of 150 transplant patients without any infectious findings. In the 150 solid-organ graft recipients who presented to our emergency department with fever, significant differences were observed versus control patients with respect to white blood cell count, neutrophil-to-lymphocyte ratio, red blood cell distribution width, mean platelet volume, and C-reactive protein levels (P < .05). We determined that C-reactive protein levels, red blood cell distribution width, mean platelet volume, and lymphocyte count were independent indicators of infection on multiple logistic regression analyses. We also determined that red blood cell distribution width had a specificity of 94% and a sensitivity of 26%. We found a significantly higher red blood cell distribution width in emergency admissions of infectious origin of renal and hepatic graft recipients than in the control group (P < .001), suggesting that this measurement is a suitable marker of infection for the emergency setting by virtue of rapid availability of test results and lack of extra costs.

New insights into the impact of Lactobacillus population on host-bacteria metabolic interplay.

We aimed at evaluating the association between intestinal Lactobacillus sp. composition and their metabolic activity with the host metabolism in adult and elderly individuals. Faecal and plasma metabolites were measured and correlated to the Lactobacillus species distribution in healthy Estonian cohorts of adult (n = 16; < 48 y) and elderly (n = 33; > 65 y). Total cholesterol, LDL, C-reactive protein and glycated hemoglobin were statistically higher in elderly, while platelets, white blood cells and urinary creatinine were higher in adults. Aging was associated with the presence of L. paracasei and L. plantarum and the absence of L. salivarius and L. helveticus. High levels of intestinal Lactobacillus sp. were positively associated with increased concentrations of faecal short chain fatty acids, lactate and essential amino acids. In adults, high red blood cell distribution width was positively associated with presence of L. helveticus and absence of L. ruminis. L. helveticus was correlated to lactate and butyrate in faecal waters. This indicates a strong relationship between the composition of the gut Lactobacillus sp. and host metabolism. Our results confirm that aging is associated with modulations of blood biomarkers and intestinal Lactobacillus species composition. We identified specific Lactobacillus contributions to gut metabolic environment and related those to blood biomarkers. Such associations may prove useful to decipher the biological mechanisms underlying host-gut microbial metabolic interactions in an ageing population.

Red blood cell distribution width is increased in patients with psoriasis vulgaris: A retrospective study on 261 patients.

Circulating inflammatory cytokines and markers are increased in patients with psoriasis. Recent studies have shown that a higher red blood cell distribution width (RDW) is associated with disease activity in various disorders. Our objective was to investigate whether RDW is increased in psoriasis patients, and to evaluate its possible association with disease severity. We conducted a retrospective study of psoriasis patients seen in a university hospital in South Korea. Information about demographics, hematological parameters and disease severity were collected. Statistical analysis was performed using Student's t-test, multivariable logistic regression, Fisher's exact test and Spearman's rank correlation coefficient analysis as appropriate. A total of 261 psoriasis patients and 102 healthy controls were included in our study. The mean RDW value was significantly increased in psoriasis patients compared with healthy control (P=0.037). Compared with mild psoriasis patients (Psoriasis Area and Severity Index [PASI], <7), moderate to severe patients (PASI, ≥7) showed significantly higher RDW values (P=0.044). However, RDW did not show significant correlation with PASI (P=0.358). When patients were divided into two groups according to their RDW value (<14.6% and ≥14.6%), the mean value of PASI was not significantly different (P=0.219). Patients with psoriasis showed increased RDW values compared with healthy controls. It was also higher in the moderate and severe disease group than the mild group. Though this is only a pilot study, it is possible that RDW value can reflect the inflammatory status of psoriasis patients.

Early indicators of iron deficiency in large piglets at weaning

Objective: To investigate whether large piglets at weaning have indications of iron deficiency anemia. Materials and methods: The study was carried out in five conventional high-performing farrow-finish Danish sow herds. Within each herd, litters belonging to a weekly farrowing batch close to weaning were identified, and 20 litters were randomly selected. From each litter the largest piglet (Large), a random piglet (Random), and the smallest piglet (Small) were chosen. Blood samples collected at weaning from the selected piglets were subjected to hematological analysis, including serum iron and total iron-binding capacity (TIBC). Results: A total of 296 piglets belonging to 100 litters were included in the study. The blood hemoglobin concentrations in Large, Random, and Small piglets were 119.6 ± 15.5, 121.5 ± 15.0, and 121.5 ± 13.2 g per L, respectively, which did not differ significantly. However, large piglets had significantly lower mean corpuscular hemoglobin, reticulocyte cellular volume, reticulocyte hemoglobin content, mean reticulocyte corpuscular hemoglobin concentration, serum iron, and transferrin saturation than did Random and Small piglets. In accordance with this, Large piglets had significantly higher red blood cell distribution width, reticulocyte red cell distribution width, and TIBC than did Random and Small piglets. Implications: Large piglets in a litter are at a higher risk of developing iron deficiency anemia at weaning than are smaller piglets. Alternative hematological indices might serve as better early indicators of iron deficiency rather than traditionally used hemoglobin values.

Red blood cell distribution width as a useful indicator to predict systemic vasculitis in patients with cutaneous vasculitis.

Cutaneous vasculitis can be limited to skin or a manifestation of primary systemic vasculitis. However, there are no definite markers to predict systemic involvements. Recent studies have shown that a higher red blood cell distribution width (RDW) is associated with disease activity in various disorders. We evaluated whether RDW can be used as an indicator for predicting systemic disease in patients with initial cutaneous involvements. We reviewed clinical and laboratory information of 143 patients with cutaneous vasculitis and 15 pigmented purpuric dermatosis patients seen at single academic hospital in Korea. Various parameters, including RDW, were evaluated in patients with primary cutaneous vasculitis and primary systemic vasculitis with initial cutaneous manifestations. The RDW value between cutaneous and systemic vasculitis patients was compared and RDW level was also investigated whether it can indicate systemic vasculitis in patients with cutaneous involvements. The mean age was 32.0 years, and 102 (64.6 %) patients were female. A total of 132 patients were patients with primary cutaneous vasculitis, and 11 were primary systemic vasculitis. Higher ratio of patients with high RDW was detected in systemic vasculitis group compared with cutaneous vasculitis group (36.4 vs. 7.6 %, P < 0.05). The mean RDW was significantly higher in systemic vasculitis patients (P < 0.05). RDW had the strongest association with systemic vasculitis (P < 0.05, OR 1.834). In conclusion, elevated level of RDW was significantly associated with systemic vasculitis. RDW can be used as one of the marker to predict systemic disease in patients with cutaneous vasculitis.

The relationship between red blood cell distribution width and blood pressure in patients with type 2 diabetes mellitus in Lagos, Nigeria

BackgroundHigh red blood cell distribution width (RDW) is related to impairment of erythropoiesis, reflecting chronic inflammation and increased levels of oxidative stress, both of which are telltale signs of type 2 diabetics. The aim of this study was to evaluate the relationship between the RDW and fasting blood sugar/blood pressure, and compare the results from diabetics with nondiabetic controls.MethodsThis was an unmatched case-control study involving 200 participants consisting of 100 diabetics and 100 nondiabetic controls. Blood (4.5 mL) was collected from all of the diabetics and nondiabetic controls, and placed into EDTA anticoagulant tubes. A full blood count was performed using the Sysmex KX-21N, a three-part auto analyzer able to run 19 parameters per sample, including RDW. Blood pressure was measured during sample collection and in a sitting position.ResultsThe mean fasting blood sugar level was 95.20±30.10 mg/dL in the controls, and 147.85±72.54 mg/dL in the diabetics. The mean blood pressures for diabetics was 138/90 mmHg and for non-diabetics 120/80 mmHg. The mean RDW-SD (RDW standard deviation) was 46.44±4.64 fl in the controls, and 46.84±3.18 in the diabetics. The mean RDW-CV (RDW coefficient of variation) was 14.74%±1.94% in controls, and 14.80±0.71 for diabetics. No statistically significant correlation was found between the RDW-SD and fasting blood sugar/blood pressure in the diabetics. A statistically significant positive correlation was found between the RDW-CV and blood pressure in the diabetics.ConclusionA positive correlation between the RDW-CV and blood pressure was established in the diabetics in this study.

Effect of purified eicosapentaenoic acid on red cell distribution width in patients with ischemic heart disease.

A recent study showed eicosapentaenoic acid (EPA) is a promising treatment for prevention of coronary events in hypercholesterolemic patients. Meanwhile, a high red blood cell distribution width (RDW) is a known risk factor for cardiovascular events. However, few studies have addressed the association between EPA levels and RDW. We examined whether EPA administration reduced the levels of RDW in patients with ischemic heart disease (IHD). We retrospectively analyzed the data of 66 EPA-treated IHD patients, and these EPA-treated patients were compared with control IHD patients. The median follow-up period was 189days in EPA-treated patients. All patients were not associated with anemia. In the follow-up period, the ratio of EPA levels to arachidonic acid levels (EPA/AA) was significantly increased. A significant decrease was observed in RDW at follow-up [ΔRDW (%); EPA vs. control=-0.34±0.84 (SD) vs. 0.08±0.86, P<0.01]. These RDW changes were more marked in diabetic patients with high serum levels of high-sensitive C-reactive protein (hs-CRP) [ΔRDW (%); EPA vs. control=-0.53±0.69 vs. 0.56±0.85, P<0.01]. There was no correlation between the amount of change in EPA/AA and RDW (R=0.037, P=0.32), but a significant negative correlation was observed in diabetic patients with high hs-CRP levels (N=14, R=-0.506, P=0.046). In conclusion, EPA has the potential to reduce RDW in IHD patients. This effect was intensified especially among diabetic patients with high hs-CRP levels. IHD patients with high RDW levels may be suitable for treatment with purified EPA.

High red blood cell distribution width is closely associated with nonalcoholic fatty liver disease

The red blood cell distribution width (RDW) has been reported to be a risk marker of morbidity and mortality for cardiovascular diseases in various study populations. Nonalcoholic fatty liver disease (NAFLD) is also a risk factor for cardiovascular diseases. However, the relationship between RDW and NAFLD is less certain. RDW was determined using a Coulter counter together with the hemoglobin level in 1637 normal control individuals and 619 NAFLD patients who were consecutively referred by general practitioners for routine medical check-up. The total plasma cholesterol, plasma triglyceride, and fasting glucose were determined using a multichannel analyzer, and BMI, systolic blood pressure (SBP), diastolic blood pressure (DBP), and the incidence of hypertension and coronary artery disease were measured using statistical analysis. Patients with NAFLD had a higher RDW, BMI, waist to hip ratio, SBP and DBP, fasting glucose, triglycerides, and hypertension incidence (P<0.01), and were also younger (P<0.01). NAFLD was considered as a dependent variable, whereas age, sex, BMI, waist to hip ratio, RDW, hemoglobin, SBP and DBP, fasting glucose, total cholesterol, triglyceride, and hypertension were considered as covariate variables. We found that age (β=-0.031, P<0.01), BMI (β=0.265, P<0.01), waist to hip ratio (β=6.166, P<0.01), RDW (β=0.154, P<0.01), fasting plasma glucose (β=0.301, P<0.01), and triglyceride (β=0.222, P<0.01) were significantly associated with the risk for NAFLD, analyzed by binary logistic regression analysis. Patients with NAFLD were more likely to have high levels of RDW. Moreover, NAFLD was associated with age, BMI, RDW, fasting plasma glucose, and triglyceride. If confirmed in future follow-up studies, this association might provide a rationale to introduce the easy, inexpensive RDW in algorithms for NAFLD risk prediction.