Red Blood Cell Distribution Width Levels Research Articles

Prognostic Value of Red Blood Cell Distribution Width and Hemoglobin in Patients with Spontaneous Intracerebral Hemorrhage.

The association between baseline red blood cell distribution width (RDW) and hemoglobin levels and outcomes after acute intracerebral hemorrhage (ICH) is not well studied. We aimed to investigate the association between baseline RDW and hemoglobin levels with early hematoma expansion (HE) and mortality at 3 months and 1 year in acute ICH patients. A total of 393 ICH patients from January 2014 to February 2019 were included. Patients were divided into four groups based on quartiles of RDW and hemoglobin levels at admission, respectively. Logistic regression models were used to estimate the effect of the levels of RDW and hemoglobin on early HE (absolute hematoma growth >6 mL from baseline to follow-up) and allcaused mortality at 3 months and 1 year. There were no significant associations between baseline RDW and hemoglobin levels and early HE. The 3-month mortality (adjusted odds ratio [OR] 2.88; 95% confidence intervals [CI] 0.96-8.64) and 1-year mortality (adjusted OR 3.16, 95% CI 1.08-9.21) was significantly higher in patients with the highest RDW level (Q4) compared to those with the lowest RDW level (Q1). Moreover, patients with the lowest hemoglobin level were significantly associated with increased odds of all-cause mortality at 3-month (adjusted OR 3.95, 95% CI 1.26-12.4) and 1-year (adjusted OR 4.42, 95% CI 1.56-12.5) compared to those with highest hemoglobin level. In patients with acute ICH, a higher level of RDW at admission significantly increased the risk of all-cause mortality at 1 year. Moreover, a decreased hemoglobin level at admission was also associated with a higher risk of all-cause mortality at 3 months and 1 year.

Diagnostic performances of D-dimer, prothrombin time, and red blood cell distribution width for coronary artery lesion in children with acute stage Kawasaki disease.

To evaluate the performances of D-dimer, prothrombin time (PT), and red blood cell distribution width (RDW) for the diagnosis of coronary artery lesion (CAL) in acute stage Kawasaki disease (KD). Between January 2018 and January 2021, a total of 102 children with acute stage KD were included in this retrospective study. Among them, 36 KD children with CAL were divided into the CAL group, and 66 KD children without CAL were divided into the NCAL group. Independent predictors of CAL in acute stage KD were identified by using univariate and multivariate logistic regression analysis. Spearman correlations were used to evaluate the association between CAL in acute stage KD and different indicators. The diagnostic performance of different indicators for CAL in acute stage KD was analyzed by the receiver operating characteristic (ROC) curve. Compared with the NCAL group, children in the CAL group had significantly higher white blood cell count, lymphocyte count, platelet count, D-dimer, and RDW levels, but lower PT levels (all p < 0.05). Logistic regression analysis revealed that D-dimer (OR = 1.0, 95% CI: 1.004-1.012, p < 0.001), PT (OR = 0.4, 95% CI: 0.2-0.8, p = 0.01), and RDW (OR = 7.0, 95% CI: 2.6-19.2, p < 0.001) were independent predictors of CAL in children with acute stage KD. CAL showed a positive correlation with D-dimer (r = 0.4, p < 0.001) and RDW (r = 0.5, p < 0.001), and had a negative association with PT (r = -0.2, p < 0.05). The ROC curve analysis showed that the combination of the three indicators had the highest diagnostic performance for CAL in acute stage KD with an area under the curve (AUC) of 0.922 (sensitivity, 86.1%; specificity, 89.4%), compared with D-dimer (AUC = 0.736), PT (AUC = 0.640), and RDW (AUC = 0.819) alone. A combination of D-dimer, PT, and RDW may help predict CAL in children with acute stage KD.

Sleep measures and cardiovascular disease in type 2 diabetes mellitus

The objective of this study was to assess whether poor sleep is independently associated with cardiovascular disease in people with type 2 diabetes mellitus (T2DM). A cross-sectional study was performed in subjects with T2DM aged between 40 and 80 years. Sleep assessment was achieved by actigraphy and Pittsburgh Sleep Quality Index (PSQI) score. The study population comprised 108 subjects with T2DM. The mean age was 64.9 years, the median diabetes duration was 6 years and 73.1% were men. No association was shown between sleep parameters as assessed by actigraphy and T2DM-associated micro- and macrovascular complications. However, sleep quality as assessed by PSQI was significantly associated with macrovascular disease in univariate analysis. Multivariate logistic regression analysis showed red blood cell distribution width (RDW) (odds ratio (OR) 1.79, p=0.018) and good sleep quality (OR 0.35, p=0.017) to be independently associated. Binary logistic regression analysis revealed that body mass index (BMI) (OR 1.11, p=0.024), RDW (OR 1.95, p=0.007) and Center for Epidemiologic Studies Depression score (OR 1.06, p=0.012] were independently associated with abnormal carotid intima-media thickness (CIMT). Poor sleep quality and higher RDW levels are associated with macrovascular disease in a T2DM population. Increased BMI as well as depression also appear to have an independent role in subclinical atherosclerosis, as assessed by CIMT.

Haematological values in cattle reared in humid and subhumid tropics of Mexico.

The objective of this study was to determine some factors that influence the haematological values of cattle reared in the humid and subhumid tropics of Mexico. Whole blood samples were taken from 1355 crossbred cattle in the years 2017 to 2019. Haematocrit (HTC, %), total plasma protein (TPP, g/dL) and peripheral eosinophils count (PEOS, × 103/µL) were determined manually, and the main haematological variables were recorded with an automatic analyser. The statistical analysis considered as classification variables age, sex, season (cold, dry and rainy), year (2017, 2018 and 2019) and origin of the cattle. The mean of the haematological parameters was determined along with the confidence limits (CL) of the different categories of animals according to age. Calves younger than 1-year-old presented higher levels of HTC, red blood cell count (RBC), haemoglobin (HGB), red blood cell distribution width (RDW), platelet number (PLT), white blood cell count (WBC) and lymphocyte count (LYMF) than animals older than 2years of age. However, they showed the lowest mean cell volume (MCV) and TPP values. In cows, the highest levels of PEOS, granulocytes (GRAN), MCV and medium cells (MID) were observed and the lowest HTC, RBC, RDW and WBC levels. Intervals were determined with the 1st quartile (Q1) or lower confidence interval (90% CI) as the minimum values and the 3rd quartile (Q3) or upper confidence interval (90% CI) as the maximum values. The haematological parameters of cattle reared in the Southeast of Mexico are significantly affected by age, sex and environmental conditions.

Sleep measures and cardiovascular disease in type 2 diabetes mellitus.

The objective of this study was to assess whether poor sleep is independently associated with cardiovascular disease in people with type 2 diabetes mellitus (T2DM). A cross-sectional study was performed in subjects with T2DM aged between 40 and 80 years. Sleep assessment was achieved by actigraphy and Pittsburgh Sleep Quality Index (PSQI) score. The study population comprised 108 subjects with T2DM. The mean age was 64.9 years, the median diabetes duration was 6 years and 73.1% were men. No association was shown between sleep parameters as assessed by actigraphy and T2DM-associated micro- and macrovascular complications. However, sleep quality as assessed by PSQI was significantly associated with macrovascular disease in univariate analysis. Multivariate logistic regression analysis showed red blood cell distribution width (RDW) (odds ratio (OR) 1.79, p=0.018) and good sleep quality (OR 0.35, p=0.017) to be independently associated. Binary logistic regression analysis revealed that body mass index (BMI) (OR 1.11, p=0.024), RDW (OR 1.95, p=0.007) and Center for Epidemiologic Studies Depression score (OR 1.06, p=0.012] were independently associated with abnormal carotid intima-media thickness (CIMT). Poor sleep quality and higher RDW levels are associated with macrovascular disease in a T2DM population. Increased BMI as well as depression also appear to have an independent role in subclinical atherosclerosis, as assessed by CIMT.

Assessment of Red Cell Distribution Width among Sudanese Patients with Subclinical Hypothyroidism

Background: Thyroid dysfunction has a strong association with anemia. Red blood cell distribution width (RDW) was traditionally regarded as a part of the routine evaluation of anemia. Several studies have indicated that elevated RDW level is significantly associated with subclinical hypothyroidism and hypothyroidism. The present study aimed to assess the impact of subclinical hypothyroidism (SHT) on RDW in Sudanese patients. Methods and Results: The study was designed as a case-control, laboratory-based study carried out at the National Cancer Institute – University of Gezira (NCI-UG) (Wad Medani, Gezira State, Sudan) from January to October 2020.The samples were collected randomly from 100 subjects: 50 patients (mean age 38.50±10.46 years; 36% males and 64% females) with hypothyroidism (case group) and 50 apparently healthy individuals (mean age 35.52±11.64 years; 46% males and 54% females) (control group). The case group was divided into 2 subgroups: Sub1 included 43(86%) patients with SHT grade 1 (TSH of 6-10μIU/mL), and Sub2 included 7(14%) patients with SHT grade 2 (TSH&gt;10μIU/mL). A 3ml venous blood sample was collected in an EDTA container from each participant. The parameters of the RBCs (RBC count, MCV, RDW-CV, and RDW-SD) were measured using the Sysmex XP-300 Automated Hematology Analyzer. In the case group, the average levels of RDW-SD, RDW-CV, and MCV were higher than in the control group (P=0.000 in all cases). There was a significant difference in RDW-CV between Sub1 and Sub2 (P=0.040). We found no significant differences in RDW-SD and RDW-CV between different age groups. There was a significant difference in RBC count between different age groups (P=0.022), and significant differences in RBC count and MCV between males and females. RDW-SD and RDW-CV had a significant positive correlation within TSH and a significant negative correlation within T3 and T4. Conclusion: RDW-CV may be used as a marker of SHT grade 2.

The association between symptomatic carotid stenosis and hematological parameters

Background &amp; Objectives: Symptomatic carotid artery stenosis (SCAS) is one of the most important causes of ischemic stroke. We aimed to investigate the relationship between hematological and inflammatory parameters in patients with SCAS and controls. Method: Patients who underwent digital subtraction angiography for SCAS were evaluated retrospectively. Patients with carotid stenosis greater than 50% who had a stroke in the last six months were included in the study. Clinical and sociodemographic characteristics, stent characteristics, filter use, balloon dilatation status, arch type, presence of contralateral occlusion, and complication status were recorded. Hemogram was evaluated using fluorescence flow cytometry. Data were analyzed among patients with SCAS, ischemic stroke patients without stenosis and healthy control group. Results: SCAS was higher in patients with advanced age, male, hypertension, hyperlipidemia, diabetes mellitus, coronary artery disease, and a history of stroke as compared to healthy individuals (p&lt;0.001). Smoking and atrial fibrillation were higher in group without carotid stenosis and who had ischemic stroke (p&lt;0.001). Hemoglobin and hematocrit values were higher in healthy control group (p=0.001). Red blood cell distribution width (RDW) and platelet/lymphocyte ratio (PLR) were higher in SCAS patients (p&lt;0.001); Neutrophil and neutrophil/lymphocyte ratio (NLR) was higher in the group with stroke and without stenosis (p &lt;0.001). There was no relationship between blood parameters and procedure technical features and complications (p&gt; 0.05). Conclusion: Hematologic parameters like PLR, NLR and RDW level are correlated with SCAS. PLR, NLR and RDW value can be an inexpensive and useful biomarker for predicting SCAS.

The diagnostic value of RDW in appendicitis

Introduction: Diagnosis of acute appendicitis is based on clinical manifestation .Some patients have atypical clinical symptoms, and diagnosis is difficult. Red blood cell distribution width (RDW) is a measure of heterogeneity in the size of circulating red blood cells. The aim of this study was to evaluate RDW values in diagnosis of appendicitis. Methods: This is a retrospective case-control study, in which 399 patients with pathological diagnosis of appendicitis were divided into two groups of acute appendicitis and complicated appendicitis and compared with 400 healthy controls for appendicitis. RDW, white blood cell (WBC), platelet count (PLT), and hemoglobin changes were compared in three groups of patients. Results: In all three groups, the ratio of men was significantly higher than women (P&lt;0.05). WBC (P=0.00), PLT (P=0.01), and RDW (P=0.01) had a significant difference between the three groups. However, there was no significant difference in the hemoglobin level between the three groups (P=0.3). RDW level was significantly higher in complicated appendicitis compared to acute (P=0.09) and control group (P=0.012). Conclusion: The results of this study showed that RDW value in three groups were significantly different. However, these values are not clinically useful for detecting appendicitis due to the slow progression of RDW value in patients.

Increased Red Blood Cell Distribution Predicts Severity of Chronic Obstructive Pulmonary Disease Exacerbation.

Increased red blood cell distribution width (RDW) has been reported to be related to underlying chronic inflammation. Our aim is to investigate the relationship of different complete blood count (CBC) parameters such as hemoglobin level, mean corpuscular volume (MCV), mean platelet volume (MPV) or RDW with COPD exacerbation severity. In the present retrospective analysis, consecutive patients admitted with the diagnosis of "COPD Exacerbation" between 1 January 2012 and 31 December 2015 were evaluated. The study population included 804 patients with COPD exacerbation. The maximal partial pressure of carbon dioxide in the arterial blood (PaCO2) during hospital stay was significantly higher in patients with high MCV (p < 0.001), and in patients with a high RDW (p < 0.001). The hospitalization duration was significantly longer in patients with high RDW (p < 0.001) and in patients with elevated C-reactive protein (CRP) levels (p < 0.001). CRP levels strongly correlated to RDW (p = 0.001). Our study demonstrated that different CBC parameters, such as MCV and RDW, are in correlation with the severity of acute exacerbation of COPD reflected by the PaCO2 level and the duration of hospitalization. Furthermore, we also found a positive correlation between RDW and CRP levels. This finding supports the hypothesis that RDW is a good biomarker of acute inflammation.

Red blood cell distribution width and all-cause mortality in congestive heart failure patients: a retrospective cohort study based on the Mimic-III database.

The red blood cell distribution width (RDW) is a metric that measures the variation in the size of red blood cells and is presented as the red blood cell volume coefficient of variation. Increased RDW levels are closely linked to an elevated risk of death from congestive heart failure (CHF) and might be a new risk marker for cardiovascular disease. This research sought to evaluate the possible link between RDW levels and all-cause mortality in CHF patients after controlling for other covariates. The publicly accessible Mimic-III database served as the source of data for our research. We employed ICU admission scoring systems to gather information on each patient's demographical data, laboratory test results, comorbid conditions, vital signs, and scores. Among CHF patients, the link between baseline RDW levels and short-, medium-, and long-term all-cause mortality was evaluated by Cox proportional hazard analysis, smooth curve fitting, and Kaplan-Meier survival curves. In total, 4,955 participants were selected for the study with an average age of 72.3 ± 13.5 years (old) and with males accounting for 53.1%. The findings recorded from the fully adjusted Cox proportional hazard model showed that higher RDW was associated with a greater risk of 30-day, 90-day, 365-day, and 4-year all-cause death; the HRs and 95% confidence intervals were 1.11 (1.05, 1.16), 1.09 (1.04, 1.13), 1.10 (1.06, 1.14), and 1.10 (1.06, 1.13), respectively. The results were stable and reliable using subgroup analysis. Smooth curve fitting and the K-M survival curve method further validated our results. The RDW levels had a u-shaped connection with 30-day mortality. The RDW level was linked to an elevated risk of short-, medium-, and long-term all-cause death among CHF patients.

Combined Role of Inflammatory Biomarkers and Red Blood Cell Distribution Width in Predicting In-hospital Outcomes of Acute Ischemic Stroke Patients undergoing Thrombolysis.

To investigate the combined effect of red blood cell distribution width (RDW) and inflammatory biomarkers on in-hospital outcomes of acute ischemic stroke(AIS) patients with thrombolysis. 417 AIS patients with thrombolysis were included. The participants were divided into four groups according to the cut-off of white blood cell (WBC) or C reactive protein (CRP) and RDW: LWLR, LWHR, HWLR, and HWHR; or LCLR, LCHR, HCLR, and HCHR (L-low, H-high, W-WBC, C-CRP, R-RDW). Logistic regression models were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) of in-hospital pneumonia and functional outcome across the four subgroups. Patients with higher RDW and inflammatory biomarkers levels have the highest risk of in-hospital outcomes. Compared with patients in the LWLR group, the ORs (95% CIs) of those in the HWHR group were 12.16 (4.21-35.14) and 9.31 (3.19-27.17) for in-hospital pneumonia and functional outcome. The ORs (95% CIs) of those in the HCHR group were 6.93 (2.70-17.78) and 3.38(1.10-10.39) for in-hospital pneumonia and functional outcome, compared with patients in the LCLR group. Simultaneously adding RDW and WBC or CRP to the basic model with established risk factors significantly improved risk discrimination and reclassification for pneumonia and functional outcome (all P<0.05). Combined RDW and inflammatory biomarkers within 4.5 hours had a better predictive power for in-hospital outcomes of AIS patients with thrombolysis.

Association between red blood cell distribution width and ischemic stroke recurrence in patients with acute ischemic stroke: a 10-years retrospective cohort analysis

Numerous studies have reported that a higher red blood cell distribution width (RDW) level was associated with adverse outcomes in patients with the first stroke. However, no studies have examined the association between RDW and recurrent ischemic stroke. We performed a population-based cohort data analysis from 2007 to 2017. Baseline RDW was measured in 6402 first ischemic stroke participants, who were followed for about five years on average. During 62 months of median follow-up, 205 participants (3.20%) reported a recurrence (self-reported). RDW showed a nonlinear relationship with the risk of ischemic stroke recurrence. When RDW was assessed as quartiles (quartile 1, RDW<12.4; quartile 2, 12.4 to 12.8; quartile 3,12.8 to 13.3, quartile4, RDW>13.3), compared with the reference group (quartile 1), the hazard ratios (HRs) of ischemic stroke recurrence were 1.372 (95% confidence interval [CI]=0.671-2.805, P=0.386) in quartile 2, 1.835 (95% CI=1.222-2.755, P=0.003) in quartile 3, and 1.732 (95% CI=1.114-2.561, P<0.001) in quartile 4. The trend test was significant (P<0.001). When quartiles 3 and 4 were combined, the adjusted HR of ischemic stroke recurrence was 1.439 (95% CI=1.330-1.556, P<0.001) compared with the combined quartiles 1 and 2 subgroups. This study demonstrated that elevated RDW levels were positively associated with an increased risk of recurrent ischemic stroke. RDW can provide a new perspective for initial risk assessment and identify high-risk patients early. Further research is required to confirm our results.

Elevated red blood cell distribution width levels predict depression after intracerebral hemorrhage: A 3-month follow-up study.

Inflammation vitally impacts the progression of depression resulting from intracerebral hemorrhage (ICH), while red blood cell distribution width (RDW) marks inflammatory-related diseases. The present study aimed at evaluating how RDW affects depression after ICH. From prospective analyses of patients admitted to our department between January 2017 and September 2022, ICH patients with complete medical records were evaluated. The 17-item Hamilton Depression (HAMD-17) scale was used for measuring the depressive symptoms at 3 months after ICH. Diagnosis of post-ICH depression was conducted for patients based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria. A total of 438 patients were enrolled in the study, out of which 93 (21.23%) patients had PSD at the 3-month follow-up. Accordingly, patients with depression had higher RDW levels (13.70 [IQR: 13.56-13.89] vs.13.45 [IQR: 12.64-13.75], p < 0.001) at admission compared with those without depression. In multivariate analyses, RDW was used for independently predicting the depression after ICH at 3 months (OR: 2.832 [95% CI: 1.748-4.587], p < 0.001). After adjusting the underlying confounding factors, the odds ratio (OR) of depression after ICH was 4.225 (95% CI: 1.686-10.586, p = 0.002) for the highest tertile of RDW relative to the lowest tertile. With an AUC of 0.703 (95% CI: 0.649-0.757), RDW demonstrated a significantly better discriminatory ability relative to CRP and WBC. RDW as an indicator for predicting depression after ICH had an optimal cutoff value of 13.68, and the sensitivity and specificity were 63.4% and 64.6%, respectively. Elevated RDW level predicted post-ICH depression at 3 months, confirming RDW as an effective inflammatory marker for predicting depression after ICH.

Assessment of the Severity of CAD Regarding Number of Vessels Involved

Background: Coronary artery disease (CAD) is characterized by atherosclerotic plaque accumulation in the epicardial arteries. The dynamic nature of the CAD process results in various clinical presentations. Red blood cell distribution width (RDW) is a practical, widely available marker for assessing the severity of coronary artery disease and helps in the risk stratification of patients with CAD. This study aimed to analyze the severity of CAD regarding the number of vessels involved. Material Methods: This descriptive cross-sectional study included 124 purposively selected patients who underwent elective CAG in the Department of Cardiology, Chittagong Medical College Hospital, Chattogram, from January 2020 to June 2021. SPSS 23.0 software was used for processing and analysis at the end of the data collection period. Results: The age of the patients ranged from 32-75 years with a mean (±SD) age of 53.4 (±9.9) years. The majority of the patients (83.1%) were male with a male-to-female ratio of 4.9:1. On coronary angiography, the majority of the patients (51/124, 41.1%) had triple vessel disease, followed by double vessel disease in 23 (28.5%) patients, single-vessel disease in 31 (25.0%). In 19 (15.4%) patients no significant lesion was observed in any of the vessels. Gensini score ranged between 1 and 176 in the study with a median score of 56.77. The majority of the patients (69.4%) in the present study had a Gensini score ≥30 indicating severe stenosis. A positive correlation between RDW and coronary artery disease severity in terms of Gensini score (r=0.393). With the increase of RDW, the Gensini score increases. It was found statistically significant (p=&lt;0.001) by Pearson’s correlation test. There was a positive correlation between RDW and CAD severity regarding the number of vessels involved (rho =0.5). With the increase of RDW, the number of involved vessels increases. It was found statistically significant (p=&lt;0.001) by Spearman’s correlation test. The Median (IQR) value of RDW was 13.5 (13.0-14.0) in patients with mild stenosis compared to 14.5 (13.9-15.0) in patients with severe stenosis. This difference was statistically significant (p&lt;0.001). The median (IQR) value of RDW was the lowest in patients without any significant stenosis in any of the coronary arteries [13.1% (12.7%-13.5%)] and was the highest in patients with triple vessel diseases [14.5% (14.1%-15.0%)]. Conclusion: This study demonstrated that RDW level was an independent predictor for CAD and the severity of coronary stenosis. So, it can be concluded that RDW is an inexpensive routine laboratory test that might help identify high-risk patients before planning for a more invasive treatment strategy.

Examining the Prevalence of Iron-deficiency Anemia in Children with Cyanotic Congenital Heart Disease Admitted to the Pediatric Heart Department of Imam Reza Hospital in Mashhad between 2011 and 2019: A Cross-sectional Observational Study

Introduction: This study was performed to investigate the frequency of iron-deficiency anemia and some related factors in children with cyanotic congenital heart disease between 2011 and 2019 in Mashhad City, Iran. Method: This cross-sectional observational study was conducted with a consensus method on children under 14 years of age. The samples were diagnosed with cyanotic congenital heart disease in the pediatric heart department of Imam Reza Hospital in Mashhad and had an oxygen saturation of less than 94%. The information from the patients' files was recorded in the questionnaire. The studied children were divided into five age groups to evaluate iron-deficiency anemia. The mean and lower limit of normal erythrocyte indices were determined, and the patients with anemia were identified based on mean corpuscular hemoglobin (MCH), mean corpuscular volume (MCV), and red blood cell distribution width (RDW). The data were statistically analyzed in SPSS23 software using Chi-square and Mann-Whitney statistical tests. A significance level of 0.05 was considered. Results: Among 250 examined patients, 90 cases were included in the study (54 boys and 36 girls). Angiography was the reason for half of these patients' referral to the hospital. The highest frequency was related to patients with tetralogy of Fallot (40%). The frequency rates of iron-deficiency anemia based on MCV and MCH erythrocyte indices were 10% and 17.8%, respectively. Moreover, 64.4% of patients had increased RDW levels. Cyanosis attacks were reported positive in 85.4% of the studied population. Of note, the frequency of cyanosis attacks was not significantly different in the two gender groups (P&lt;0.494). Conclusion: Considering the high prevalence of iron-deficiency anemia, especially in children with congenital heart disease, the treatment of this disorder is necessary for all such children and should not be neglected

The role of red blood cell distribution width in predicting coronary artery lesions in pediatric patients with kawasaki disease.

Recent studies have shown that red blood cell distribution width (RDW) has emerged as a novel predictor of cardiovascular diseases. We aim to investigate the association between RDW and the risk of coronary artery lesions (CALs) in pediatric patients with Kawasaki disease (KD). KD patients were classified as the CALs group (patients with CALs) and non-CALs group (patients without CALs). Differences among the groups were analyzed by Mann-Whitney U-test and Chi-square analysis. The independent risk factors of CALs were identified by multivariate logistic regression analysis, followed by receiver operating characteristic (ROC) curve analysis to calculate the optimal cut-off value. The red blood cell distribution width (RDW) and C-reactive protein were significantly higher in the CALs group than those in the non-CALs group (p < 0.01). Multivariate logistic regression analysis revealed that RDW (OR = 5.2, 95% CI, 4.064 to 6.654) was independent risk factors of CALs in KD patients (p < 0.01). The subgroup analysis also confirmed that the high level of RDW was an independent risk factor for the development of CALs in patients with complete and incomplete KD. The ROC analysis showed the optimal cut-off value of RDW for predicting CALs was >13.86%, with a sensitivity of 75.79% and specificity of 92.81% (AUC = 0.869, 95% CI = 0.844-0.892; p < 0.0001). RDW is an independent predictor with high sensitivity and specificity to predict CALs in KD patients. The elevation in RDW level (>13.86%) may be used as novel biomarkers for early predicting CALs in KD patients during the acute phase.

Disease severity and prognostic nutritional index (PNI), C-reactive protein (CRP), and red blood cell distribution width (RDW) in acute pancreatitis

Objective: Acute pancreatitis is a common emergency. Morbidity control requires early detection of disease severity. Material and Methods: A total of 131 AP patients were analyzed retrospectively. Patients were divided into two groups mild AP (MAP: Ranson score &lt;3) and severe AP (SAP: Ranson score ≥3), according to Ranson’s criteria. Demographic data, hospitalization duration, PNI, CRP, and RDW levels were compared. Any p-value below 0.05 (p&lt;0.05) was accepted as statistically significant. Results: Study included 67 (51.15%) males and 64 (48.85%) females. The age average was 59.74 (19-90) years. 95 (72.52%) patients had MAP, and 36 (27.48%) patients had SAP. Mean hospitalization time, PNI, and CRP differed significantly between the two groups (p=0.010, p&lt;0.05, p&lt;0.05, respectively). The RDW (p=0.380) level difference was insignificant. For SAP prediction; the sensitivity, specificity, and cut-off value according to Ranson code cut-off point for PNI were determined as 80.0% (95% CI:54.8-85.8), %72.2 (95% CI:70.5-87.5) and ≤45.6 (gr/L) + (mm3), respectively, and 94.7% (95% CI:57.8-87.9), %75.0 (95% CI:88.1-98.3) and &gt;105,1 mg/L, respectively for CRP. Conclusion: PNI and CRP values (but not RDW values) were compatible with the disease severity determined by the Ranson criteria.

Association between red blood cell distribution width and left ventricular hypertrophy in pediatric essential hypertension.

Left ventricular hypertrophy (LVH) is one of the most common types of target organ damage in hypertension. The red blood cell distribution width (RDW) is closely related to many cardiovascular diseases, including hypertension. The aim of this study was to analyze the relationship between the RDW level and LVH in pediatric essential hypertension. A total of 429 untreated children and adolescents with essential hypertension were recruited and divided into an LVH group (n = 114) and non-LVH group (n = 315) according to left ventricular mass index (LVMI) and relative wall thickness (RWT) by color Doppler ultrasound. Spearman correlation analysis was used to determine the relationship between RDW and LVMI, RWT. The effect of RDW on LVH was determined using a multivariate logistic regression analysis. To assess the predictive value of RDW on LVH, the receiver operating characteristic (ROC) curve was used. The level of RDW in children with hypertension in the LVH group was significantly higher than that in the non-LVH group (13.0 [12.0, 13.0] vs. 12.4 [12.0, 13.0] %, P = 0.001). The incidence of low and high quantiles of LVH was 21.0% and 32.0%, respectively. Spearman correlation analysis showed that RDW was positively correlated with C-reactive protein (CRP), LVMI, RWT, and red blood cell (RBC) count (P all < 0.05), and negatively correlated with hemoglobin (HGB) level, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) (P all < 0.05). After adjusting for various confounding factors, a multivariate logistic regression model revealed that RDW was an independent risk factor for LVH (OR = 1.946, 95% CI: 1.324-2.861, P = 0.001). The area under the ROC curve of RDW predicting centripetal hypertrophy was 0.700 (95% CI: 0.541-0.859, P < 0.05) in pediatric essential hypertension. Increased RDW levels are an independent risk factor for LVH in pediatric essential hypertension, and RDW may be a predictor of LVH in untreated pediatric essential hypertension.

Red Blood Cell Distribution Width as a Predictive Biomarker for Postoperative Infections in Children Who Underwent Cardiac Surgery: A Single-Center Retrospective Study.

Background It has been investigated that red blood cell distribution width (RDW) is associated with the clinical outcomes of patients following surgeries and is used as a prognostic biomarker for postsurgical complications. In this study, we aimed to assess the value of RDW as a predictor of postoperative complications in children after cardiac surgeries. Methods Three hundred fifty-five pediatric patients who underwent cardiac surgery between 2017 and 2018 were enrolled, and preoperative and postoperative RDW values were determined. Data collected included demographics; incidence of postsurgical complications, including sepsis, surgical site infections (SSIs), urinary tract infections (UTIs), and ventilator-associated pneumonia (VAP); length of hospital and pediatric cardiac intensive care unit (PCICU) stay; and ventilator duration. Results Among children who underwent cardiac surgery, 29 (8.2%) of the cases developed bloodstream infections (BSIs), while urinary tract infections (UTIs) were observed in 32 (9.0%) of the cases, and ventilator-associated pneumonia (VAP) was observed in 36 of the cases (10.1%). Of all cases, surgical site infections (SSIs) were reported in 13 patients (3.7%). Significantly higher postoperative RDW levels were observed on days three (p-value=0.028), five (p-value=0.041), and seven (p-value=0.042) in cases of BSI. For UTI cases, only preoperative RDW levels (p<0.001) and postoperative day three RDW levels (p<0.049) were significantly higher than their counterparts. VAP cases had significantly higher RDW levels pre-operatively (p-value=0.002), which was also observed in postoperative RDW levels on days three (p-value=0.033), five (p-value=0.031), and seven (p-value=0.021) in comparison to their analogs (p-values<0.05). Furthermore, a significant relationship was found between preoperative RDW and length of intensive care unit (ICU) stay (95% CI 0.685-3.221, p-value=0.003, R2=0.104) and duration of mechanical ventilation (95% CI 0.549-1.938, p-value=0.001, R2=0.102). Conclusion RDW is a significant factor in predicting complications in pediatric patients' post-cardiac surgeries, including BSI, UTI, and VAP, which would consequently anticipate patients' clinical state after cardiac procedures.

Is there any relationship between red blood cell distribution width and prognosis of brain death?

Accumulating evidence has demonstrated that RDW (red blood cell distribution width) may independently predict clinically important outcomes in many populations. However, the role of RDW has not been elucidated in brain death. We conducted this study with the aim of evaluating the predictive value of RDW in brain death. A retrospective study of seventy-seven of brain death cases during 36 months were evaluated at university hospitals, affiliated in Tehran, Iran. Demographical data include age, sex, BMI and cause of brain death, also laboratory results (red blood cell distribution, mean corpuscular volume, hemoglobin) collected by checklists from patient records. Having the three RDW measurements (days of hospital admission, day of brain death, and day of cardiac arrest) required. Time interval from hospital admission until brain death was 5.27±4.07. The mean age of brain death cases was 32.65±16.53. The mean RDW values on days of hospital admission, the day of brain death, and the day of cardiac arrest were 14.53±1.98, 15.12±1.93 and 15.18±2.07, respectively. Results of the repeated-measures ANOVA test reveal that RDW level was constantly higher in the traumatic patient group compared to the non-traumatic ones (P=0.008). The frequency of brain death was high in patients with high RDW values. RDW might be a prognostic biomarker for brain death. More prospective studies with large sample size and long follow-up period should be carried out to determine the prognostic significance of RDW and brain death in future.