High Red Cell Distribution Width Levels Research Articles

Red Cell Distribution Width and the Early Detection of Ovarian Cancer

Ovarian Cancer is a leading cause of mortality and morbidity, lacking clinical manifestations and effective early diagnostic techniques. The majority of cases are diagnosed at later stages; however, asymptomatic screening is currently not recommended due to its low predictive value and invasive nature. Furthermore, the current CA-125 biomarker used to monitor Ovarian Cancer is elevated in other conditions, including endometriosis or pelvic inflammation. Red Cell Distribution Width (RDW) is a parameter measured in a complete blood count, measuring the range of variation in red blood cell size and heterogeneity of red blood cell volume. RDW levels positively correlate with Ovarian Cancer progression, additionally increased in Ovarian Cancer groups compared to benign ovarian tumour groups. RDW possesses high sensitivity in distinguishing between cancerous and benign ovarian tumours, in line with ideal screening method standards. RDW additionally shows potential as a diagnostic biomarker in combination with other blood parameters, such as hemoglobin. The hemoglobin-RDW ratio (HRR) acts as an independent predictor of Ovarian Cancer stage. RDW’s mechanism of action is not fully elucidated but can be associated with iron/folic acid deficiency, ineffective hematopoiesis caused by chronic inflammation, or inflammatory cytokines such as IL-1 and IL-17. High RDW levels additionally possess prognostic value, acting as an indicator of low cumulative overall survival and poor chemotherapy responses in various cancers. Further research is needed on RDW’s mechanism of action and its implication as a marker in female cancers, particularly Ovarian Cancer, to implement effective early screening techniques and reduce fatalities.

Hematological indices in psoriatic enthesopathy: relation to clinical and ultrasound evaluation

BackgroundEnthesopathy is considered a crucial aspect of assessment and outcome in psoriatic arthritis (PsA). Musculoskeletal ultrasound (MSUS) is a critical tool for accurately detecting enthesitis. Recent research focuses on identifying simple biomarkers for detecting and monitoring psoriatic enthesopathy. Red cell distribution width (RDW), mean platelet volume (MPV), and neutrophil/lymphocyte ratio (NLR) are components of a complete blood count (CBC) and are reliable bio-inflammatory markers in various rheumatic diseases.Aim of workTo measure MPV, RDW, and NLR in psoriatic enthesopathy and determine their relationship to disease activity and MSUS findings.Patients and methodsThis study focused on 30 people with psoriatic arthritis (PsA) as per CASPAR criteria, along with 20 control subjects. Enthesopathy was evaluated clinically using the Leeds Enthesitis Index (LEI). The modified Disease Activity Index of Psoriatic Arthritis (DAPSA28) was calculated, and RDW, MPV, NLR, CRP, and ESR were measured. Each enthesis in LEI was radiologically assessed using plain radiography and MSUS according to OMERACT definitions.ResultsThere was a significant relationship between clinical tenderness, the presence of enthesophytes on plain radiography, and MSUS findings at entheses sites (p < 0.001 for each). Psoriatic patients had higher levels of RDW and MPV (p < 0.001 and 0.01, respectively) than controls, with no significant differences in NLR (p = 0.189) between the two groups. RDW and MPV levels were positively correlated with the DAPSA28 score.ConclusionMonitoring PsA disease activity can be improved by considering RDW and MPV as reliable indicators and using them to screen for psoriatic enthesopathy with MSUS indices.Key points• Clinically identifying enthesitis in patients with PsA can be challenging. Imaging MSUS indices hold promise for objective analysis, but there is no consensus on which indices to use in clinical trials and daily practice.• Patients with psoriatic enthesopathy have higher RDW and MPV levels, which are positively correlated with DAPSA28 score.• RDW and MPV can be considered in the turn of improved screening of psoriatic enthesopathy with MSUS scores.

Red blood cell distribution width may predict the prognosis of vestibular neuritis

Objectives: The study aimed to determine whether red cell distribution width (RDW), as well as other inflammatory markers of complete blood count, have any predictive value for the etiology, diagnosis, and prognosis of vestibular neuritis (VN). Patients and Methods: Forty-two VN patients (28 females, 14 males; mean age: 46.7±11.0 years; range, 20 to 75 years) and 50 controls (32 females, 18 males; mean age: 44.4±6.0 years; range, 22 to 55 years) were included in the retrospective study between May 2016 and May 2018. Red cell distribution width and neutrophil, lymphocyte, platelet, and monocyte levels were documented from the hemogram records of all patients. Additionally, the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and lymphocyte-monocyte ratio were calculated. Results: In the VN group, NLR and PLR values were significantly high (p=0.001 and p&lt;0.001, respectively). Red cell distribution width, platelet, lymphocyte, and monocyte levels were significantly high and hemoglobin was significantly low in VN patients with long-lasting spontaneous nystagmus (p&lt;0.001, p=0.026, p=0.033, p=0.047, and p=0.006, respectively). Conclusion: High RDW and low hemoglobin levels may predict a poor prognosis in adult VN patients. Moreover, a low lymphocyte-monocyte ratio and high NLR and PLR values are supportive findings in the diagnosis of vestibular neuritis.

Relation of Red Cell Distribution Width to Glucose Metabolism and Adverse Long-Term Prognosis in Patients with Acute Coronary Syndrome

Red cell distribution width (RDW) reflects the heterogeneity of red blood cell size. However, few studies examined whether RDW is related to glucose metabolism indices, such as fasting blood glucose (FBG) and hemoglobin A1c (HbA1c), diabetic mellitus (DM) state or long-term outcomes of acute coronary syndrome (ACS) patients. A total of 448 consecutive patients with ACS were enrolled in this study. All patients were followed up for major cardiovascular adverse events (MACEs), and the mean follow-up was 952 days. Linear regression analysis showed that RDW inversely correlated with FBG but not HbA1c or DM. Kaplan-Meier survival curve analysis demonstrated that higher RDW levels were significantly positively associated with MACEs in the whole study population and the ACS patients with high FBG but not the low FBG group. Cox multivariate regression analysis revealed the independent function of RDW on MACEs in all ACS patients and ACS patients with high FBG. The receiver operating characteristic (ROC) curve demonstrated the optimal cutoff value of RDW for MACEs. We first reported that higher RDW was associated with decreased FBG but not HbA1c or DM and an increased risk of MACEs in patients with ACS. This relationship was also found in ACS patients with higher FBG levels but not in ACS patients with lower FBG.

The evaluation of red cell distribution width in type 2 diabetic patients with acute ST- segment elevation myocardial infarction in Erbil city: a cross sectional study

Background: The relationship of high red cell distribution width (RDW) with many hematological and angiographic characteristics in type 2 diabetic patients with acute ST-segment elevation myocardial infarction (STEMI) is still a matter of debate.&#x0D; Objective: To evaluate the relationship of high RDW with multiple hematological and angiographic characteristics in type 2 diabetic patients with acute STEMI.&#x0D; Patients and Methods: In this cross-sectional study, one hundred patients with acute STEMI who underwent coronary angiography were enrolled. The patients were divided into two groups according to the presence of type 2 diabetes mellitus (T2DM); group I, diabetic patients and group II, non-diabetic patients. Further division was made to group I patients based on how high or low RDW level was; subgroup A patients with high RDW level, and subgroup B patients with low RDW level. The groups were evaluated and compared regarding baseline demographic, laboratory and angiographic characteristics.&#x0D; Results: The mean RDW was higher (P=0.04) in group I compared to group II. The mean values of white blood cell (WBC) , RDW, CK-MB, Troponin T high sensitive (hs) , and HbA1C levels were significantly higher in subgroup A compared to subgroup B (P=0.007, 0.003, 0.03 and &lt; 0.001, respectively). Subgroup A patients have significantly more extension of coronary diseases than subgroup B (P=0.001). A positive correlation was detected between RDW and WBC, CK-MB, Troponin T hs, HbA1C as well as number of diseased vessels in diabetic patients (0.76, 0.4, 0.98 and 0.79, respectively).&#x0D; Conclusion: Diabetic patients with acute STEMI had higher levels of RDW than non-diabetics and higher levels were positively correlated with inflammatory and poor outcome cardiovascular markers as well as multiple vessel diseases involvement. It was also correlated with poor glycemic control represented by high HbA1C.

The evaluation of red cell distribution width in type 2 diabetic patients with acute ST- segment elevation myocardial infarction in Erbil city: a cross sectional study

Background: The relationship of high red cell distribution width (RDW) with many hematological and angiographic characteristics in type 2 diabetic patients with acute ST-segment elevation myocardial infarction (STEMI) is still a matter of debate. Objective: To evaluate the relationship of high RDW with multiple hematological and angiographic characteristics in type 2 diabetic patients with acute STEMI. Patients and Methods: In this cross-sectional study, one hundred patients with acute STEMI who underwent coronary angiography were enrolled. The patients were divided into two groups according to the presence of type 2 diabetes mellitus (T2DM); group I, diabetic patients and group II, non-diabetic patients. Further division was made to group I patients based on how high or low RDW level was; subgroup A patients with high RDW level, and subgroup B patients with low RDW level. The groups were evaluated and compared regarding baseline demographic, laboratory and angiographic characteristics. Results: The mean RDW was higher (P=0.04) in group I compared to group II. The mean values of white blood cell (WBC) , RDW, CK-MB, Troponin T high sensitive (hs) , and HbA1C levels were significantly higher in subgroup A compared to subgroup B (P=0.007, 0.003, 0.03 and &lt; 0.001, respectively). Subgroup A patients have significantly more extension of coronary diseases than subgroup B (P=0.001). A positive correlation was detected between RDW and WBC, CK-MB, Troponin T hs, HbA1C as well as number of diseased vessels in diabetic patients (0.76, 0.4, 0.98 and 0.79, respectively). Conclusion: Diabetic patients with acute STEMI had higher levels of RDW than non-diabetics and higher levels were positively correlated with inflammatory and poor outcome cardiovascular markers as well as multiple vessel diseases involvement. It was also correlated with poor glycemic control represented by high HbA1C.

P773: THE ELEVATION OF RED BLOOD CELL DISTRIBUTION IS AN INDEPENDENT PROGNOSTIC FACTOR FOR JUVENILE MYELOMONOCYTIC LEUKEMIA

Background: Juvenile myelomonocytic leukemia (JMML) is an overlapping myeloproliferative and myelodysplastic disorder of infants and early children. The existing clinical and laboratory prognostic features are inadequate to predict a worse outcome alone. New prognostic indicators are urgently needed since the great clinical heterogeneity. Red cell distribution width (RDW) is a parameter of the complete blood count (CBC) measured automatically by haematology analyzers to reflect the heterogeneity of erythrocyte size. In recent years, RDW has been suggested to have a high negative value for outcomes in various cancers. However, the role of RDW at diagnosis in patients with JMML is still unclear. Aims: Our aim is to investigate the prognostic role of RDW in children with JMML. Methods: We conducted a single center retrospective study to investigate the prognostic role of RDW in children with JMML. Seventy-seven patients were enrolled from January 1, 2008 to November 31, 2019. Survival rates were calculated and compared using Kaplan-Meier methods and log-rank tests. Univariate and Multivariate analysis was carried out according to the Cox proportional hazard regression model. Results: The mean red cell distribution width standard deviation (RDW-SD) for patients is 53.3(39.3-73.7) fl. Cox proportional hazard models showed that patients with RDW-SD >50.50fl at diagnosis were significantly associated with poor overall survival (OS) (HR = 5.22, CI = 1.50-18.21, P=0.010). The multivariate analysis demonstrated that the RDW-SD count was the independent risk factor for OS. Patients with PTPN11 mutation and RDW elevation displayed the worst survival rate, in comparison with other subgroups (P=0.00013). Summary/Conclusion: The results suggested that the elevated level of RDW is an independent prognostic factor for JMML. Furthermore, the PTPN11 mutation and a high RDW level may involve a synergy during the natural course of JMML.

Predictive Value Analysis of in-Stent Restenosis Within Three Years in Older Acute Coronary Syndrome Patients: A Two-Center Retrospective Study.

We aimed to investigate prognostic factors of in-stent restenosis (ISR) within 3 years in older acute coronary syndrome (ACS) patients after drug-eluting stent (DES) implantation and establish a clinical model for predicting ISR. We retrospectively collected 215 older ACS patients who followed coronary angiography (CAG) after DES implantation, divided into ISR group and non in-stent restenosis (non-ISR) group according to the results of reviewed CAG. Logistic regression analysis was performed to screen independent predictors related to ISR and build the clinical predictive model, which clinical application was assessed by decision curve analysis (DCA) and clinical impact curve (CIC). Kaplan-Meier survival curves for ISR by independent predictors. In multivariate logistic regression analysis showed that the red cell distribution width (RDW) was higher in ISR group compared with non-ISR (odds ratio (OR) = 1.54, 95% confidence interval (CI): 1.14–2.08, p < 0.01). Instead, a negative correlation was observed between minimum stent diameter and ISR (OR = 0.28, 95%CI:0.09-0.86, p = 0.03). A novel nomogram composed of these significant features presented a concordance index (C-index) of 0.710, DCA and CIC suggested that the predictive nomogram had clinical utility. Schoenfeld residuals showed the model RDW ≥ 12.6% with minimum stent diameter <3 mm was consistent with the proportional risk assumption. The Kaplan-Meier estimate for ISR showed statistical significance. Higher levels of RDW and lower minimum stent diameter were associated with incidence of ISR within 3 years in older ACS patients after DES implantation.

The Relationship between Red Cell Distribution Width and Residual SYNTAX Scores in ST-Segment Elevation Myocardial Infarction Patients after Percutaneous Coronary Intervention.

Objective Residual SYNTAX score (rSS) values have been suggested to serve as an independent predictor of mortality in ST-segment elevation myocardial infarction (STEMI) patients following percutaneous coronary intervention (PCI). Prior work has also indicated that red cell distribution width (RDW) can predict the incidence of major adverse cardiac events (MACEs) in STEMI patients. As such, we sought to explore the relationship between RDW and rSS in STEMI patients that have undergone PCI. Methods In total, 456 eligible patients were recruited for this study. Youden's index was used to calculate the optimal RDW cut-off value, after which the relationship between RDW and rSS values was assessed through Spearman's correlation analyses. Independent predictors of high rSS levels were then identified via multivariate logistic regression analysis. Results Patients were separated into two groups based upon whether they exhibited high RDW levels (>13.9, Group 1) or low RDW levels (<13.9, Group 2). The average rSS value of patients in Group 2 was found to be significantly decreased compared to patients in Group 1 (P < 0.001). RDW values were found to be positively correlated with rSS (r = 0.604, P < 0.001), and multivariate logistic regression analysis determined that high RDW levels were independently predictive of higher rSS (OR = 27.1 [14.8-51.7]; P < 0.001). Additionally, a nomogram incorporating RDW exhibited good calibration, discriminative capacity, and clinical utility. Conclusions In summary, RDW is strongly correlated with rSS in STEMI patients following PCI, with high RDW levels serving as an independent predictor of high rSS in this patient population.

High Red Cell Distribution Width Independently Predicts Adverse Survival in Patients with Newly Diagnosed Skull Base Chordoma.

ObjectiveAccumulating studies report that levels of mean corpuscular volume (MCV) and red cell distribution width (RDW) are associated with outcomes in cancer patients, while studies including MCV and RDW in chordoma are lacking so far. Therefore, our study aims to investigate the prognostic impact of MCV and RDW on survival in skull base chordoma patients.MethodsLevels of preoperative MCV and RDW in 187 primary skull base chordoma patients were collected. X-tile software was used to find the cutoff values of MCV and RDW. Progression-free survival (PFS) and overall survival (OS) analyses were performed using the Kaplan–Meier methods, Cox analysis, and nomogram model.ResultsLow MCV level (MCV <84.2) was more commonly observed in classical chordoma patients (p=0.022). High RDW level (RDW≥12.7) was correlated with older patient age (p=0.022) and a tough tumor texture (p=0.035). Low MCV level and high RDW level were associated with poor PFS (p=0.045 and 0.007, respectively) and OS (p=0.023 and <0.001, respectively). Multivariate Cox analysis demonstrated that RDW was an independent prognostic indicator for both PFS (p=0.001) and OS (p<0.001). Importantly, a nomogram based on RDW and clinical predictors showed satisfactory performance for PFS and OS prediction (concordance index, C-index: 0.684 and 0.744, respectively).ConclusionOur data was first to reveal the prognostic role of RDW in skull base chordoma, and identified the use of RDW may contribute to a more accurate prognosis judgment and personalized treatment decision.

Usefulness of red cell distribution width to predict mortality in patients undergoing endovascular repair of abdominal aortic aneurysms.

Red cell distribution width (RDW) reflecting impaired erythropoyesis, has been associated with poor prognosis and mortality in several conditions. The aim of this study was to determine the relationship between RDW and the 5-year survival after the endovascular repair of abdominal aortic aneurysms (EVAR) and its ability to improve the discriminative power of a survival predictive score. Retrospective analysis of 284 patients undergoing EVAR at a single centre. The pattern of relationship between RDW and survival was assessed with penalized smoothing splines. Categorized RDW values were added to a predictive score based in standard preoperative variables, whose improvement in discriminative power was calculated on the basis of changes in the C-statistics and the continuous Net Reclassification Index (c-NRI). The survival rate at 5 years was 66.2% and was independently associated with hemoglobin (HR=0.85, P<0.004), statin intake (HR=0.54, P<0.004), heart failure (HR=2.53, P<0.018), atrial fibrillation (HR=2.53, P<0.000) and the non-revascularized coronary artery disease (HR=2.15, P<0.005). The relationship between RDW values and 5-year survival was linear. RDW-CV and RDW-SD were categorized to cut-off values of ≥15% (N.=83, 29.2%) and ≥50 fL (N.=82, 28.9%) that were independently associated with poorer 5-year survival rates (HR=2.03, CI 95%=1.29-3.19, P=0.002 and HR=1.89, CI 95%=1.21-2.95, P=0.005, respectively). The addition of the RDW CV or the RDW-SD to the baseline predictive score significantly improved the c-NRI (0.437, P<0.001 and 0.442, P<0.001, respectively). High preoperative RDW levels were linear and adversely related to 5-year survival after EVAR, improved the discriminative power of a predictive score based in standard preoperative variables and may help in decision-making at the time of surgical planning.

The Predictive Value of Red Blood Cell Distribution Width for Survival Outcomes of Metastatic Renal Cell Carcinoma Patients Treated with Targeted Therapy

Background We aimed to investigate the prognostic value of red cell distribution width (RDW) in metastatic renal cell carcinoma (mRCC) patients treated with targeted therapy, including sunitinib and pazopanib. Methods A total of 104 mRCC patients were included. The Kaplan–Meier method was used to estimate overall survival (OS) and progression-free survival (PFS), and the long-rank test was used for comparison. Univariate and multivariate Cox proportional hazards models were used to determine the association between RDW and PFS and OS. Results The PFS and OS of all cohorts were 11.8 mo and 25.9 mo, respectively. Receiver operating characteristic analysis revealed that RDW level ≥15.4 was the optimal cutoff value for OS prediction with 73.53% sensitivity and 61.11% specificity (area under curve: 0.64, P = 0.012). RDW level ≥15.4 was found as an independent prognostic parameter for OS when adjusted for the number of covariates, including the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) scoring system (hazard ratio: 1.125, 95% confidence interval: 1.024–2.235, P = 0.014). Conclusions Our study revealed that high RDW level, a routinely and easily assessed marker, was significantly associated with worse survival outcomes in mRCC patients treated with targeted therapy.

Red Cell Distribution Width (RDW) and Complete Blood Cell Count-Derived Measures in Non-Arteritic Anterior Ischemic Optic Neuropathy.

Purpose: To assess the role of complete blood cell count (CBC) dimensional indices and CBC-derived measures in non-arteritic anterior ischemic optic neuropathy (NA-AION).Methods: In this retrospective case-control survey, 37 newly diagnosed NA-AION patients and 37 sex- and age-matched cataract controls were enrolled in 2017-2018. On the same day of NA-AION diagnosis, a blood sample was collected and CBC was determined using an automatic blood counter. CBC dimensional indices, such as mean platelet volume (MPV) and red cell distribution width (RDW), and CBC-combined indices, including neutrophil/lymphocyte ratio (NLR), derived NLR [dNLR = neutrophils/(white blood cells - neutrophils)], and platelet/lymphocyte ratio (PLR), were evaluated. Erythrocyte sedimentation rate (ESR) was also measured.Results: Mean platelet count, median MPV, RDW, NLR, and dNLR were 221±48 x 109/L, 8.2 fL (IQR=7.6-8.9), 13% (IQR=12-14.5), 2.50 (IQR=1.77-3.06), and 1.73 (IQR=1.31-2.07) in NA-AION patients and 248±56 x 109/L, 7.60 fL (IQR=7.05-8.25), 12% (IQR=11.6-13), 1.95 (IQR=1.43-2.49) and 1.36 (IQR=1.07-1.69) in controls. NA-AION patients showed significantly lower platelet count (p=0.03) and significantly higher median values of MPV (p=0.01), RDW (p=0.015), NLR (p=0.03), and dNLR (p=0.01). Multivariate logistic regression models disclosed a significant correlation only between higher levels of RDW and NA-AION (p≤0.05). The attributable risk of the association between NA-AION and RDW was 33%.Conclusions: Results suggest that RDW may be somehow involved in the pathogenesis of NA-AION. However, high-quality cohort studies are warranted to confirm whether, or not, an altered RDW may be considered a potential biomarker of this vascular disorder affecting the optic nerve.

The relationship between red cell distribution width and cardiac autonomic function in heart failure.

BackgroundBoth increases in red cell distribution width (RDW) levels and autonomic dysfunction are considered to be correlated with worsening heart failure. However, the relation of RDW levels to autonomic function remains uncertain. We aimed to investigate the association of RDW levels in heart failure with autonomic function, evaluated by heart rate variability (HRV) and heart rate turbulence (HRT), and prognosis.MethodsWe studied 222 hospitalized patients with stable heart failure before discharge, and Holter recordings (HRV and HRT) were performed. Additionally, RDW levels were measured, and high RDW was defined as over 14.5%. We then divided the patients into two groups based on RDW levels: high RDW group (>14.5%, n = 92) and low RDW group (≤14.5%, n = 130). The relation of RDW to autonomic function and prognosis was assessed.ResultsIn the high RDW group, severely impaired HRV and HRT were found compared to the low RDW group. In the linear regression analysis after the adjustment of multiple confounders, RDW levels were correlated with a low‐frequency (LF) to high‐frequency (HF) ratio and very low‐frequency (VLF) power (LF to HF ratio, β = −0.146, P = .027, and VLF power, β = −0.137, P = .041, respectively). During the observation period (median 1400 days), cardiac events (re‐hospitalization of heart failure, cardiac death or sudden death) were found in 73 (32.8%) patients. The Kaplan‐Meier analysis demonstrated that the high RDW group had a higher rate of cardiac events compared to the low RDW group (45.6% vs 23.8%, log‐rank P < .001).ConclusionHigh RDW levels were correlated with autonomic dysfunction, resulting in poor clinical outcomes.

Prognostic significance of red cell distribution width and its relation to increased pulmonary pressure and inflammation in acute heart failure.

Red cell distribution width (RDW) in acute heart failure (AHF) is accepted as a prognostic indicator with unclear pathophysiological ties. The aim of this study was to evaluate the prognostic value of RDW in AHF patients in relation to clinical and echocardiographic data. 170 patients with AHF were retrospectively studied. All patients had laboratory testing and an echocardiogram performed within 24 h of admission to the Cardiology Department. During the mean 193 ± 111 days of follow-up, 33 patients died. More advanced age, high RDW and low peak early diastolic velocity of the lateral mitral annulus (MVe') were independent predictors of all-cause mortality with hazard ratios of: 1.05 (95% CI 1.02-1.09), p < 0.005, 1.40 (95% CI 1.22-1.60), p < 0.001, and 0.77 (95% CI 0.63-0.93), p < 0.007, respectively. In a stepwise multiple linear regression model, RDW was correlated with hemoglobin concentration (standardized b = -0.233, p < 0.001), mean corpuscular volum (standardized b = -0.230, p < 0.001), mean corpuscular hemoglobin concentration (standardized b = -0.207, p < 0.007), the natural logarithm of C-reactive protein (CRP) (standardized b = 0.184, p < 0.004) and tricuspid regurgitation peak gradient (TRPG) values (standardized b = 0.179, p < 0.006), whereas MVe' was correlated with atrial fibrillation (standardized b = 0.269, p < 0.001). The present data demonstrates a novel relation between higher levels of RDW and elevated TRPG and high sensitivity CRP values in patients with AHF. These findings suggest that RDW, the most important mortality predictor, is independently associated with elevated pulmonary pressure and systemic inflammation in patients with AHF. Moreover, in AHF patients, more advanced age and decreased MVe' are also independently associated with total mortality risk.

Can We Estimate the Recurrence of Epistaxis with Simple Blood Tests?

Objective: Epistaxis is often treated in the emergency department (ED) and is one of the causes of bleeding that can be successfully managed by physicians. This study aimed to investigate whether there is a relationship between recurrent epistaxis and simple blood parameters (the values of mean platelet volume (MPV) and red cell distribution width (RDW)). Method: This retrospective case-control study was designed at a tier-three ED. The patients were chosen from among those who applied to the ED for epistaxis between 1 January 2018 and 31 December 2018. Demographic data, seasonal application frequency, complete blood count results and clinical findings were retrospectively reviewed on the hospital information record system. The patients were categorized into three groups of recurrent epistaxis, non-recurrent epistaxis and healthy control groups. Results: 143 epistaxis patients in total including recurrent (n=73) and non-recurrent (n=70) patients were enrolled in this study. The healthy control group was composed of 77 patients. The MPV value was significantly higher in the recurrent epistaxis group than in the non-recurrent epistaxis group (8.91±1.16, 8.48±1.06, P = 0.006, respectively). In addition, the mean platelet and platecrit values were significantly higher in the non-recurrent epistaxis group than in the recurrent epistaxis group (P = 0.034, P = 0.043, respectively). The high RDW level was found to be statistically significant both in the recurrent and non-recurrent epistaxis groups than in the control group (P < 0.001). The logistic regression analysis concluded that the high MPV value increased epistaxis 1.367 times [OR: 1.367 (0.952-1.963), P = 0.028]. Conclusion: High MPV levels caused an increase in the bleeding tendency in the patients with recurrent epistaxis.

THE SIGNIFICANCE OF RED CELL DISTRIBUTION WIDTH REGARDING ENDOTHELIAL GLYCOCALYX INTEGRITY IN PATIENTS WITH ESSENTIAL HYPERTENSION

Objective: The red cell distribution width (RDW) is a basic parameter of the routine complete blood count, although usually overlooked by clinicians as part of the patient evaluation. Higher RDW levels have been associated with increased cardiovascular (CV) risk in several populations as well as in patients with hypertension. Endothelial dysfunction indicates target organ damage in patients with arterial hypertension. The integrity of endothelial glycocalyx (EG), a component of the endothelium, plays a vital role in vascular permeability, inflammation and elasticity and finally to CV disease. Smoking exerts a deleterious effect in arterial endothelium as well as it leads to hypertension disease. We aimed to explore any existing correlation between RDW and EG in newly diagnosed and never treated hypertensive patients regarding smoking habit. Design and method: We performed 24 h ambulatory blood pressure measurement, arterial stiffness estimation by carotid-femoral pulse wave velocity (PWV) and complete blood count in our whole population (n = 190, mean age = 50+10 years, 113 males, 24-h average SBP/DBP = 135+11/85+9). Increased perfusion boundary region (PBR) of the sublingual arterial microvessels (ranged from 5–9 micrometers) using Sideview Darkfield imaging (Microscan, Glycocheck) was measured as a non-invasive accurate index of reduced EG thickness. Results: A weak correlation between RDW and PBR 5–9 (r = 0.14, p < 0.05) was found in the whole population. Then our population was divided in two groups regarding smoking habit, smokers (n = 60, mean age = 48+9, males, 24-h average SBP/DBP = 135+11/85+9) and non-smokers (n = 130, mean age = 51+10, males, 24-h average SBP/DBP = 134+12/84+2). Smokers were younger than non-smokers (46+10 years vs. 51+10 years, p = 0.03) while no other differences were found as for BMI, 24 h SBP/DBP, renal function, cholesterol levels, PWV, RDW and PBR 5–9. Finally, we found in the smokers group an association between RDW and PBR 5–9 (beta = 0.33, p = 0.01) which was independent from blood pressure and cholesterol levels. Conclusions: It seems that that increased RDW, an inexpensive, easily counted, widely available, and detected without complex and expensive technologies, might give us valuable information regarding endothelial dysfunction in smokers, naïve hypertensive patients.

Prognostic value of red cell distribution width and echocardiographic parameters in patients with pulmonary embolism.

Pulmonary embolism (PTE) is a common cardiovascular emergency. We aimed to predict mortality in the acute phase and to assess the development of pulmonary hypertension in the chronic period with the combined use of red cell distribution width (RDW) and echocardiography (ECHO) for the prognosis of PTE. Cases diagnosed with acute PTE were prospectively monitored in our clinic. The initial data of 56 patients were evaluated. The subjects were separated into two groups basing on RDW; group 1 had RDW ≥ 15.2%, while group 2 had RDW < 15.2%. Ninety-eight patients were enrolled in the study. We established the sensitivity (73.3%) and the specificity (73.2%) of RDW to determine mortality in the cases with PTE. RDW ≥ 15.2% value was significant as an independent risk factor for predicting mortality (OR:7.9 95% CI, 1.5-40.9 p = 0.013) in acute PTE. The mean tricuspid annular plane systolic excursion (TAPSE) value was significantly different between the group-1 (RDW ≥ 15.2%, 2.20 cm (± 0.43)) and group-2 (RDW < 15.2%, 1.85 cm (± 0.53))(p = 0.007). The threshold value for tricuspid jet velocity was > 2.35m/s, the sensitivity and specificity were 76.9% and 61.9%, respectively for predicting mortality (AUC: 0.724, 95% CI: 0.591-0.858, p = 0.033). Our results indicate that high RDW levels are an independent predictor of mortality in acute PTE. Lower TAPSE levels show right heart failure in PTE patients; this may also be indicative of right ventricular systolic function. We believe that developing new scoring systems, including parameters such as RDW, TAPSE, and tricuspid jet velocities, may be effective in determining the prognosis of pulmonary embolism.

Preoperative Red Cell Distribution Width and 30-day mortality in older patients undergoing non-cardiac surgery: a retrospective cohort observational study

Increased red cell distribution width (RDW) is associated with poorer outcomes in various patient populations. We investigated the association between preoperative RDW and anaemia on 30-day postoperative mortality among elderly patients undergoing non-cardiac surgery. Medical records of 24,579 patients aged 65 and older who underwent surgery under anaesthesia between 1 January 2012 and 31 October 2016 were retrospectively analysed. Patients who died within 30 days had higher median RDW (15.0%) than those who were alive (13.4%). Based on multivariate logistic regression, in our cohort of elderly patients undergoing non-cardiac surgery, moderate/severe preoperative anaemia (aOR 1.61, p = 0.04) and high preoperative RDW levels in the 3rd quartile (>13.4% and ≤14.3%) and 4th quartile (>14.3%) were significantly associated with increased odds of 30-day mortality - (aOR 2.12, p = 0.02) and (aOR 2.85, p = 0.001) respectively, after adjusting for the effects of transfusion, surgical severity, priority of surgery, and comorbidities. Patients with high RDW, defined as >15.7% (90th centile), and preoperative anaemia have higher odds of 30-day mortality compared to patients with anaemia and normal RDW. Thus, preoperative RDW independently increases risk of 30-day postoperative mortality, and future risk stratification strategies should include RDW as a factor.

Hip fracture patients who experience a greater fluctuation in RDW during hospital course are at heightened risk for all-cause mortality: a prospective study with 2-year follow-up.

Prognostic values have been found in the fluctuation of some hematologic parameters. The red cell distribution width (RDW) routinely reported with all complete blood cell counts (CBC) has proven to be associated with poor outcomes in various diseases. However, whether the fluctuation in RDW is predictive of long-term mortality in hip fracture patients treated with surgery remains unknown. One thousand three hundred thirty hip fracture patients who underwent surgery from January 1, 2000 to November 18, 2012 were recruited in this prospective cohort study. Fluctuation in the RDW between admission and discharge was measured, and a Kaplan-Meier (KM) analysis and multivariable Cox regression model were applied to evaluate the relationship between this fluctuation and mortality. Risk factors for a larger fluctuation were detected by using Logistic regression analyses. In addition to the admission RDW, a high RDW level at the time of discharge was also associated with an increased risk of death, while no significant difference was found in the postoperative RDW. Fluctuation in the RDW between admission and discharge was an independent risk predictor for 2-year mortality (HR 1.45 95%CI 1.06-2.00, p = 0.022). Factors affecting the change in the RDW between admission and discharge included both the demographic characteristics of the patients and clinical interventions. Hip fracture patients who experience a greater fluctuation in RDW during the hospital course are at a heightened risk for 2-year all-cause mortality.