Low Red Cell Distribution Width Research Articles

The Prognostic Value of the Systemic Immune-Inflammation Index (SII) and Red Cell Distribution Width (RDW) in Patients with Cervical Cancer Treated Using Radiotherapy.

There is growing interest in the prognostic value of routinely performed pre-treatment blood test indices, such as the RDW or SII, with the latter combining the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). These indices were shown to be prognostic for survival in some malignancies. The purpose of this study was to evaluate the association between pre-treatment RDW and SII, and OS in patients treated with radiotherapy for primary localised cervical cancer. This retrospective analysis included patients treated with definitive CRT between 2011 and 2017 for histopathologically confirmed FIGO 2018 stage IB2-IVA cervical cancer. Statistical analysis was performed using the Kaplan-Meier method, two-sided log-rank tests, and Cox proportional hazards models, with the AIC serving as a prediction error estimator. The study group included 249 patients with a median age of 57.2 years and a median follow-up of 75.8 months. The majority were diagnosed with squamous cell carcinoma (237; 95.2%) and had FIGO stage III (211; 84.7%). Approximately half of the patients (116; 46.4%) had regional lymph node metastases. Patients with a low RDW (≤13.4%) and low SII (≤986.01) had a significantly longer OS (p = 0.001 and p = 0.002). The RDW remained as an independent prognostic factor in the multivariable model (high vs. low; HR = 2.04; 95% CI: 1.32-3.16; p = 0.001). Including RDW in the model decreased the Akaike Information Criterion from 1028.25 to 1018.15. The RDW is a cheap and widely available index that is simultaneously an independent prognostic factor for survival and could be used to improve pre-treatment prognosis assessments in patients with cervical cancer undergoing CRT. Available data encourage assessing the RDW as a prognostic factor in prospective trials to aid the identification of candidates for treatment escalation.

Prognostic value of red cell distribution width in non-ST elevation myocardial infarction: A cohort study.

Non-ST elevation myocardial infarction (NSTEMI) has a higher risk of long-term mortality than ST-elevation myocardial infarction; thus, identifying such high-risk patients is essential. Red cell distribution width (RDW) recently emerged as a strong predictor of mortality in several cardiovascular diseases, however, it is scarcely known whether RDW has a prognostic value in NSTEMI patients, therefore, this study aims to elucidate this issue. 421 consecutive patients with NSTEMI between January 2020 and June 2022 were prospectively enrolled. Patients were divided into 2 groups by the optimal cutoff value of RDW using time-dependent receiver operating characteristic curves. The optimal cutoff value of RDW for predicting all-cause mortality was 13.4 and the study population was divided into low RDW (≤13.4) and high RDW (>13.4). The primary endpoint of this study was long-term all-cause mortality. The secondary endpoint was the association between RDW and long-term adverse events, including heart failure, gastrointestinal hemorrhage, stroke events, re-infarction rate, cardiovascular mortality, and major adverse cardiovascular events. The association of RDW with the outcome was analyzed by Cox regression analysis. Patients with high RDW tended to be older, had a higher history of previous MI, a higher history of percutaneous coronary intervention, a higher level of neutrophil, high-sensitivity C-reactive protein, a lower level of albumin, and a lower level of ejection fraction (all P < .05). During a median follow-up of 720 days (IQR, 534-913 days), the all-cause mortality was significantly higher in the high RDW group than in the low RDW group (24.8% vs 6.3%, P < .001). In the multivariate Cox proportional hazard analysis, RDW > 13.4 was an independent predictor for long-term all-cause mortality [hazard ratio 3.008; 95% confidence interval 1.005, 9.003, P = .049]. Admission RDW could be used as a new biomarker for predicting long-term mortality in patients with NSTEMI, and high RDW was associated with an increased risk of all-cause mortality.

Hematological parameters as diagnostic biomarkers for patients with rosacea.

Rosacea is a chronic inflammatory skin disease. Systemic inflammation plays a vital role in the pathogenesis of rosacea. Many studies have reported hematological parameters as biomarkers for diseases with inflammatory processes. However, the diagnostic value of hematological parameters in rosacea remains a puzzle. This study involved 462 patients with rosacea, including erythematotelangiectatic rosacea (ETR, n = 179), papulopustular rosacea (PPR, n = 250), and phymatous rosacea (PhR, n = 33), and 924 healthy control subjects. Demographic, clinical, and laboratory information was collected and compared between rosacea subtypes. The hematological parameters of the patients and the healthy controls were compared retrospectively. The platelet volume (MPV) and platelet crit (PCT) were significantly upregulated, and the lower red cell distribution width (RDW) was significantly downregulated in rosacea compared to healthy controls, and they were identified as the diagnostic biomarkers for rosacea with area under the curve values of 0.828, 0.742, and 0.787, respectively. Comparing the hematological parameters among the three rosacea subtypes, we found that platelet-to-lymphocyte ratio and platelet-to-neutrophil ratio values in the ETR group were significantly higher than those in the PPR and PhR groups. The correlation between hematological parameters and clinical scores showed that RDW was negatively correlated with the Clinician Erythema Assessment score. However, there was no significant correlation between the Investigator Global Assessment score and hematological parameters. In conclusion, PCT, MPV, and RDW have diagnostic value for rosacea, and RDW is correlated with the severity of rosacea erythema, implying the potential applications of PCT, MPV, and RDW in the diagnosis and monitoring of rosacea.

Genetic and clinical study of myeloperoxidase's association with coronary artery disease.

Unraveling myeloperoxidase's (MPO) correlation with coronary artery disease (CAD) and genetic variations, this study seeks to enhance diagnostic precision and therapeutic strategies. CAD patients were found to be older and more male than controls. Several clinical parameters, including glucose, total bilirubin, alkaline phosphatase, creatinine, and troponin levels, showed significant variations. Moreover, CAD patients had lower red cell distribution width (RDW%) and mean platelet volume (MPV) than controls. Serum MPO levels did not differ significantly between CAD patients and controls, and no correlation was found with other clinical parameters except for glucose, creatinine, and total bilirubin. The data suggest that serum MPO levels are not substantially related to CAD patients, as indicated by lower MPO levels in CAD patients compared to controls. While highlighting the potential of MPV and RDW% as predictors of severe atherosclerosis in CAD. Further research is needed to validate the diagnostic and prognostic value of RDW%, MPV, and MPO levels in CAD. 15092021-9-12. Registered 15 September 2021.

Association between Red Cell Distribution Width and Outcomes of Nonagenarians Admitted to the Intensive Care Unit-A Retrospective Cohort Study.

The red cell distribution width (RDW) measures the heterogeneity of the erythrocyte volume. Different clinical conditions are associated with increased RDW, and high levels (>14.5%) have been described as a predictive marker for unfavorable outcomes and mortality in critically ill patients. However, there is a lack of data on very elderly critically ill patients. Therefore, we aimed to investigate the association of RDW with outcomes in critically ill patients ≥ 90 years. A retrospective analysis was conducted for all consecutive critically ill patients ≥ 90 years who were admitted to the Department of Intensive Care Medicine of the Medical University Centre Hamburg-Eppendorf (Hamburg, Germany) with available RDW on admission. Clinical course and laboratory were analyzed for all patients with eligible RDW. High RDW was defined as (>14.5%). We clinically assessed factors associated with mortality. Univariable and multivariable Cox regression analysis was performed to determine the prognostic impact of RDW on 28-day mortality. During a 12-year period, we identified 863 critically ill patients ≥ 90 years old with valid RDW values and complete clinical data. In total, 32% (n = 275) died within 28 days, and 68% (n = 579) survived for 28 days. Median RDW levels on ICU admission were significantly higher in non-survivors compared with survivors (15.6% vs. 14.8%, p < 0.001). Overall, 38% (n = 327) had low, and 62% (n = 536) had high RDW. The proportion of high RDW (>14.5%) was significantly higher in non-survivors (73% vs. 57%, p < 0.001). Patients with low RDW presented with a lower Charlson Comorbidity Index (p = 0.014), and their severity of illness on admission was lower (SAPS II: 35 vs. 38 points, p < 0.001). In total, 32% (n = 104) in the low and 35% (n = 190) in the high RDW group were mechanically ventilated (p = 0.273). The use of vasopressors (35% vs. 49%, p < 0.001) and renal replacement therapy (1% vs. 5%, p = 0.007) was significantly higher in the high RDW group. Cox regression analysis demonstrated that high RDW was significantly associated with 28-day mortality [crude HR 1.768, 95% CI (1.355-2.305); p < 0.001]. This association remained significant after adjusting for multiple confounders [adjusted HR 1.372, 95% CI (1.045-1.802); p = 0.023]. High RDW was significantly associated with mortality in critically ill patients ≥ 90 years. RDW is a useful simple parameter for risk stratification and may aid guidance for the therapy in very elderly critically ill patients.

Does the severity of atopic dermatitis change with allergic sensitization? Is it real or a myth?

Atopic dermatitis (AD) is a chronic inflammatory skin disease that can occur at any age. This study aimed to evaluate the impact of food allergy on disease severity as well as clinical/laboratory findings in children with AD. Clinical and laboratory data of AD patients evaluated for food allergy between January 2021 and December 2022 were examined retrospectively. Of the 52 patients evaluated, 32 (61.5%) were males, with a median age of 6 months (2-118 months). Among them, 26 (50%) had food allergies (FA) and five (9.6%) had inhalant allergen sensitivity. No significant difference in AD severity was observed between patients with and without FA. However, the FA group showed higher serum lactate dehydrogenase (LDH) levels (343.3 ± 81.5 U/L vs 297.7 ± 77.4 U/L; P = 0.011) and lower red cell distribution width (RDW). Inhalant allergen sensitivity was associated with higher AD severity. While guidelines recommend investigating food allergies in moderate to severe AD, this study found no significant difference in the relationship between AD severity and the presence of FA. However, inhalant allergen sensitivity was linked to increased AD severity. Therefore, a comprehensive patient history should include an evaluation of food allergies in children with AD, regardless of disease severity. Elimination and provocation tests related to suspected food items should be performed, and allergenic foods should be removed from the diet if they are found to contribute to the allergy.

Prognostic Role of Red Cell Distribution Width (RDW) in Patients with Diffuse Large B-cell Lymphoma.

Several A number of prognostic blood markers related tofor Diffuse Large B-Cell Lymphoma (DLBCL) have been identified, most of which are costly and not easily availableaccessible. Although the relationship between the prognostic role of RDW and some cancers has been well established, the role it of RDW plays in DLBCL patients is unclear still questionable and requires more investigations. All patients diagnosed with DLBCL who had referred to Imam Reza Hospital, during were included in this retrospective cohort study. Based onRegarding their RDW, the subjects were divided into two groups of normal (RDW ≤14.6%) and elevated RDW (RDW > 14.6%) RDW, and the outcomes were investigated. One hundred fifty patients with DLBCL were included in this study. The results showed a significant relationship between the RDW values of the DLBCL patients and stage frequency distribution, relapse, mortality, and complete remission (P value<0.05). It was also found out that elevated RDW > 14.6% was associated with the risk of relapse (OR=2.50, P value<0.05), mortality (OR=3.59, P value<0.01), and lack of complete remission (OR=0.115, P value< 0.01). The results of the survival analysis indicated that the subjects with higher RDWs had a lower median survival rate than those with low RDWs. In addition, the mortality risk for the individuals with RDW > 14.6% was 2.44 times that of those with RDW≤14.6% (HR=2.44, P value<0.05). The results of this study well indicated that as an independent prognostic factor, RDW was associated with the stage of DLBCL patients, failure to achieve complete remission, disease relapse, and patient mortality. However, further studies are would be needed to realize determine the role of RDW in DLBCL patients.

Red cell distribution width as a predictor of mortality after hip fracture: a systematic review and meta-analysis.

This review examined the association between red cell distribution width (RDW) and mortality after hip fracture. PubMed, CENTRAL, Scopus, Web of Science, and Embase were searched up to 10th January 2023 for studies comparing mortality after hip fracture based on RDW. All cut-offs of RDW were accepted. Crude and adjusted mortality ratios were pooled separately. Nine studies with 5,274 patients were eligible. Meta-analysis of eight studies reporting crude mortality rates showed that patients with high RDW had a significantly higher risk of mortality than those with low RDW (RR: 2.81 95% CI: 2.05, 3.86 I2=82%). The results did not change in significance on subgroup analyses based on study location, sample size, the cut-off of RDW, and follow-up. Four studies reported adjusted mortality rates. Analysis of the same showed that high RDW was an independent predictor of mortality in hip fracture patients (HR: 3.14 95% CI: 1.38, 7.14 I2=95%). Within the limitations of the review, RDW was found to be an indicator of mortality in hip fracture patients. High RDW was significantly associated with increased mortality despite different cut-offs among studies. Further research is needed to generate more rigorous evidence.

Red cell distribution width is inversely associated with body mass index in late adolescents.

There are no studies that investigated the association between red blood cell (RBC) and platelet (PLT) indices in relation to obesity in a cohort of exclusively late adolescents. Hence, we aimed to explore this potential relationship. A cohort of adolescents (n=156) aged between 16-19 years was included. Iron homeostasis parameters [i.e. RBC, hemoglobin (HGB), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) and red cell distribution width (RDW)] and platelet indices [i.e., PLT, mean platelet volume (MPV), plateletcrit (PCT) and platelet distribution width (PDW)] were determined on the automatic hematology analyzer. Their indexes (i.e. MCV/RBC, MCH/RBC, RDW/MCV, MPV/PLT and PDW/PCT) were calculated. Univariate binary regression analysis showed negative associations between body mass index (BMI) and RDW, PDW, and PDW/PCT, respectively, and positive associations between BMI and MPV and PCT, respectively. However, only RDW kept the independent negative association with BMI in multivariate binary regression analysis [Odds Ratio (95% Confidence Interval)=0.734 (0.548-0.983); p=0.038]. Lower RDW values are the independent predictor of higher BMI in the adolescent population. As a low-cost and simply measured parameter, RDW could be a useful diagnostic biomarker in young populations with overweight/obesity.

Long-term prognostic scores may underestimate the risk of death in patients with heart failure with reduced ejection fraction in whom red cell distribution width is elevated.

Risk prediction in patients with heart failure with reduced ejection fraction (HFrEF) is one of the key challenges for clinicians. Novel biomarkers aggregating several important pathophysiological pathways may modify the diagnostic discrimination of validated scores. The red cell distribution width (RDW) is a cheap and easily available measure of anisocytosis, and was shown to have a strong independent prognostic power in short- and medium‑term prognosis in HFrEF. Our aim was to assess the prognostic power of RDW in optimally treated chronic HFrEF, and to investigate whether different RDW may impact the prognostic accuracy of validated long‑term scores in HFrEF. The study included 551 patients at a median (interquartile range [IQR]) age of 54 (47-59) years, of whom 86.6% were men. The patients represented the median New York Heart Association class III (IQR, II-III), and ischemic etiology occurred in 56.6% of the cases. In all patients, RDW as a coefficient of variation was calculated, along with Meta‑Analysis Global Group in Chronic Heart Failure Score (MAGGIC‑HF) and Seattle Heart Failure Survival Model (SHFSM). The patients were followed for 5 years and all‑cause mortality was assessed. We recorded 166 (30.1%) and 225 (40.8%) deaths at 3 and 5 years, respectively. Scores based on MAGGIC‑HF and SHFSM algorithms for the respective prediction of 3- and 5‑year mortality were calculated for each patient and compared with the observed mortality. There was a significant underestimation of mortality in the patients with RDW above 15.4% (reference values, 11.5%-14.5%), while in those with lower RDW SHFSM overestimated the actual risk. The excess mortality in the higher RDW group was confirmed by the Hosmer-Lemeshow statistic. The RDW has a strong prognostic value in chronic HFrEF, independently of the risk assessed by the MAGGIC‑HF or the SHFSM score.

PS-C06-9: THE PREDICTIVE VALUE OF RED CELL DISTRIBUTION WIDTH IN VENOUS THROMBOEMBOLISM AND RELATED MORTALITY

Background: Red cell distribution width (RDW) is a measure of red blood cell size variation and heterogeneity. Recent meta-analyses demonstrated this measurement could be strong predictor in coronary artery disease, chronic heart failure, and atrial fibrillation. Nevertheless, there is no meta-analysis evaluating the role of RDW in prediction of the occurrence of venous thromboembolism (VTE), the third most common cardiovascular disease, and related mortality. Objective: To investigate the association of RDW and VTE including deep vein thrombosis (DVT) and pulmonary embolism (PE) and related mortality. Methods: Major medical databases were systematically searched for observational studies which assessed the association of RDW and VTE published until May 2022. The databases were searched with predefined protocol without language restriction based on PRISMA guidelines. The analysis was performed in RevMan 5.3 to provide pooled measures for Risk Ratio (RR) and weighted mean difference (WMD). Results: Twenty-three studies were enrolled including 6,737 cases and 58,831 controls. Higher RDW was indicated as independent predictors for VTE compared to lower RDW (RR = 1.82, p &lt; 0.00001), comprising DVT and PE (RR = 1.6, p &lt; 0.00001, and RR = 2.05, p = 0.002, respectively). There was also an association between higher RDW and risk of mortality after PE episode with RR = 1.4 (p = 0.0004), involving short- (30-day) and long-term (&gt; 1 year) mortality (RR = 1.79, p = 0.04, and RR = 1.15,p = 0.03, respectively). Compared to lower RDW, higher RDW also revealed a significant association with unprovoked VTE (RR = 2.18, p = 0.02). VTE-group had a higher mean of RDW compared to control with WMD = 1.13% (p &lt; 0.00001), consisting of PE-group (WMD = 0.99%, p &lt; 0.00001) and DVT-group (WMD = 1.07%, p &lt; 0.00001). Among PE patients, The PE-related mortality group also had a higher mean of RDW in comparison to the survivor group with WMD = 1.97%, (p &lt; 0.00001). Conclusions: Higher RDW value was associated with the occurrence of VTE, including DVT, PE, unprovoked VTE, and PE-related mortality. Therefore, the use of the potential role of RDW should be emphasized since it is low-cost and simple to obtain, even in a low-resource setting.

Role of the haematological phenotype as a predictive biomarker of retinopathy of prematurity development

AbstractPurpose: To evaluate haematological parameters as possible biomarkers of the development of retinopathy of prematurity (ROP).Methods: Multicenter, observational, and prospective study of preterm infants (PTI) from eight NICU, born in Portugal with gestational age (GA) &lt; 32 weeks or birth weight (BW) &lt;1500 g. ROP staging performed according to the International Classification of ROP (ICROP). Sociodemographic, clinical and laboratory data were collected from the first week of life. Complete blood count (CBC) was determined according to standardized methods. According to the maximum stage of ROP, PTI were divided into four groups: without ROP, ROP stage 1 (ROP‐1), ROP stage 2 (ROP‐2) and ROP stage 3 (ROP‐3). Statistical analysis was performed with the SPSS program with significant value for p &lt; 0.05.Results: 455 PTI were included, GA average of 29.5 ± 2.3 weeks, BW average of 1165.7 ± 313.9 grams and 50.5% were female. In this study 37.8% of the PTI developed ROP: 20% had ROP‐1, 9.4% ROP‐2 and 8.4% ROP‐3. 4.6% of PTI received treatment: laser was performed in 12 PTI (2.6%), anti‐VEGF in 7 PTI (1.5%), anti‐VEGF and laser in 1 PTI (0.2%), and anti‐VEGF, laser, and surgery in 1 PTI (0.2%). ROP‐3 was significantly associated with lower GA (p = &lt;0.001), BW (p &lt; 0.001), erythrocytes (p &lt; 0.001), haemoglobin (p &lt; 0.001), haematocrit (p &lt; 0.001), lymphocyte (p = 0.047) and lymphocyte to monocyte ratio (LMR) (p = 0.018) compared with the other groups. Neutrophils (p = 0.039) and neutrophil to lymphocyte ratio (NLR) (p &lt; 0.001) were higher in ROP‐3. For PTI who did not develop ROP were observed, in relation with the other groups: higher mean corpuscular haemoglobin concentration (MCHC) (p &lt; 0.001), platelets (p = 0.029) and plateletcrit (PCT) (p = 0.007) and lower red cell distribution width (RDW) (p = 0.015) and erythroblast (p &lt; 0.001).Conclusions: This study shows that the increase in neutrophils, NLR, and RDW and the decrease in lymphocytes, LMR, erythrocytes, and platelets may constitute early and low‐cost predictive biomarkers of ROP development.

Prediction of Resistance to Hydroxyurea Therapy in Patients with Polycythemia Vera: A Machine Learning Study (PV-AIM)

Introduction: Polycythemia vera (PV) is a chronic myeloproliferative neoplasm characterized by erythrocytosis. Thromboembolic events (TEs) are a common complication in patients (pts) with PV but can be reduced by controlling hematocrit (HCT) levels (<45%) with phlebotomy and/or hydroxyurea (HU), a first-line treatment (tx) for PV. However, in some pts HU can fail due to resistance and alternative tx options are needed, such as ruxolitinib. Machine learning was utilized to analyze real-world evidence (RWE) and identify clinical and/or laboratory variables that may be predictive of developing resistance to HU (HU-RES) tx. Methods: PV-AIM (PV advanced integrated models for prevention of TEs) is an analytical, retrospective cohort study of pts with PV that utilizes data from the US Optum database. Pts were eligible for the current analysis if they had a diagnosis of PV, were ≥18 years old, had received only HU tx for 9 months (mo), had 6 mo pre-index (first HU tx) history (laboratory data and observations) and 12 mo post-index follow-up. An ensemble machine learning classification model, Random Forest (RF), was developed to predict HU-RES in the 6-9 mo window post-index, based on the 2010 European LeukemiaNet (ELN) consensus definition for HU-RES (criteria 1, 2 and 4), and evaluated by ROC-AUC (Receiver Operating Characteristic-Area Under the Curve). The 10 variables having the greatest impact on HU-RES prediction were identified using RF variable importance; those pairs of variables that showed greatest synergy (more significant association with HU-RES than expected) in predicting HU-RES were examined and a novel heatmap-based method was developed to visualize the risk landscape of each pairwise combination. Results: Of 82,960 pts with PV identified in the Optum database (median record length 8.4 years), 2,453 pts were eligible for inclusion and 1,304 of these were assigned as HU-RES (n=733) or HU non-resistant (n=571) and were used to develop the model. The composite ROC-AUC was 0.71, illustrating the model's accuracy for predicting HU-RES at 6-9 mo post-index. Of the variables analyzed, the 10 most predictive for HU-RES (in rank order of importance) were: red blood cell count (RBC), hematocrit (HCT), red cell distribution width (RDW), age at index, hemoglobin (HGB), annualized phlebotomy count (APC), absolute neutrophil count (ANC), white blood cell count (WBC), weight, and time between diagnosis and treatment. These variables had higher values in the HU-RES pts except for 'age at index', which was lower in HU-RES pts. For these 10 variables, 45 pairwise combinations were generated to examine variable interaction. The HCT-APC pairwise combination had the strongest association with HU-RES (p=1.74E-22) at thresholds HCT 44% and APC 0.7; notably, APC was a key variable for the next 5 out of 10 most significant pairwise associations (in combination with RBC, ANC, WBC, RDW, and weight, respectively; p=7.16E-17 to 4.26E-22). Some combinations were synergistic; the most significant was RDW-HGB (synergy score: 4001) [Table] with optimal thresholds for this combination of RDW 17% and HGB 15.5 g/dL (p=4.67E-15) [Figure]. Comparisons of pts in the 'high RDW’ (≥17%; n=559) and 'low RDW’ (<17%; n=745) groups saw significant differences between these groups in WBC, ANC, RBC, lymphocytes, neutrophils, and HGB (p≤2.72E-09 for all), and neutrophil lymphocyte ratio (p=2.75E-37). Notably, a 1.36-fold greater proportion of HU-RES pts were in the 'high RDW’ than the 'low RDW’ group (p=2.74E-09). Conclusions: Failure of HU tx may put pts at risk of TEs; however, this analysis has shown that common clinical and laboratory variables can be utilized to predict the likelihood of pts developing resistance to HU before starting tx. Pre-index HCT and APC were strongly associated with HU-RES and a synergistic association between RDW and HGB provided thresholds indicative of HU-RES, which potentially could be applied in the clinic. This analysis highlights the clinical value of pt history to help identify pts at risk of HU-RES and potentially empowers physicians to proactively schedule laboratory analyses pre-HU tx to identify pts at risk, and then closer, focused monitoring of at-risk pts to take timely clinical decisions for a switch to appropriate second-line therapy. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

The Prognostic Value of Systemic Immune-Inflammation Index (SII) and Red Cell Distribution Width (RDW) in Cervical Cancer Patients Treated with Radiotherapy

<h3>Purpose/Objective(s)</h3> To assess the association of pre-treatment systemic immune-inflammation index (SII) and red cell distribution width (RDW) with overall survival (OS) in patients treated for primary localized cervical cancer with radiotherapy. <h3>Materials/Methods</h3> The study cohort includes retrospectively collected data of 249 consecutive cervical cancer patients treated with radical intent between 2011 and 2017. The database was based on medical history of the patients and survival data from National Cancer Registry. The statistical analysis included Kaplan-Meier method, log-rank testing and Cox proportional hazards regression model. The cut-off values for log-rank testing were based on available literature data. <h3>Results</h3> The median age of the patients was 57.2 (IQR 49.2-64.5). The patients undergone a combination of external beam radiotherapy (100%), brachytherapy (98%) and concurrent chemotherapy (90%). The 5-year OS was 69.9% and 60.2% patients were alive at the time of the analysis. The results of the Cox model are presented in Table 1. Both SII and RDW were associated with survival in univariate analysis and remained independent prognostic factors in stepwise selection multivariate analysis. The OS was significantly higher in low SII (≤1000 and >1000; p=0.006) and low RDW (≤14.5% and >14.5%; p=0.002) groups. The 5-year OS was 73.5% and 60.2% for SII, and 74.3%, and 52.7% for RDW respectively. <h3>Conclusion</h3> SII and RDW are significantly associated with overall survival and could be used to improve the accuracy of pre-treatment prognostic assessment, in patients treated with radiotherapy for cervical cancer. Table: Univariate and multivariate Cox Regression analysis of HR for OS in patients with cervical cancer

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.

Red blood cell distribution width is associated with increased interactions of blood cells with vascular wall

The mechanism underlying the association between elevated red cell distribution width (RDW) and poor prognosis in variety of diseases is unknown although many researchers consider RDW a marker of inflammation. We hypothesized that RDW directly affects intravascular hemodynamics, interactions between circulating cells and vessel wall, inducing local changes predisposing to atherothrombosis. We applied different human and animal models to verify our hypothesis. Carotid plaques harvested from patients with high RDW had increased expression of genes and proteins associated with accelerated atherosclerosis as compared to subjects with low RDW. In microfluidic channels samples of blood from high RDW subjects showed flow pattern facilitating direct interaction with vessel wall. Flow pattern was also dependent on RDW value in mouse carotid arteries analyzed with Magnetic Resonance Imaging. In different mouse models of elevated RDW accelerated development of atherosclerotic lesions in aortas was observed. Therefore, comprehensive biological, fluid physics and optics studies showed that variation of red blood cells size measured by RDW results in increased interactions between vascular wall and circulating morphotic elements which contribute to vascular pathology.

Red Cell Distribution Width and Its Association with Neonatal Bacteremia: A Case-Control Study

Background: Bacteremia is a major cause of prolonged hospital stay and mortality in neonates and its early diagnosis remains a challenge to pediatricians. Red cell distribution width (RDW) is a component of a complete blood count test which is accessible and inexpensive and has been reported to be a possible diagnostic marker for neonatal bacteremia. This study determined the association of RDW with neonatal bacteremia in term and preterm neonates. Methodology: This is a retrospective case-control study of 26 bacteremic neonates as cases and 104 non-bacteremic neonates, either symptomatic or with risk factors for bacteremia, as controls. Included newborns were seen between January 1, 2010 to September 30, 2021. Laboratory data obtained were CBC, C-reactive protein and blood culture. Results: RDW values between bacteremic and non-bacteremic neonates were not significantly different. There was an association between RDW and neonatal bacteremia at an RDW level of &gt; 16.1, where the likelihood of bacteremia was three times higher compared with lower RDW values. Significantly lower levels of hemoglobin, hematocrit, RBC count, WBC count, platelet count, MCH and MCHC, and a higher CRP level were seen among bacteremic neonates compared to those who were not. The median RDW for both term and preterm neonates was close to 16, with a narrow inter-quartile range at 1 and 2 for controls and cases, respectively. The range (minimum to maximum) of RDW values of bacteremic preterm neonates was more variable than those of term neonates. Using RDW to detect bacteremia, it had an equivocal discriminatory power or AUC of 0.6056. We found insufficient evidence to demonstrate a correlation between RDW and other CBC parameters, except for MCHC. For MCHC, the results suggest a very weak and indirect correlation. Conclusion: RDW was not significantly different between bacteremic and non-bacteremic neonates, but there was a suggested association between RDW and bacteremia at an RDW level of &gt; 16.1, at which level there was a 3-fold risk for bacteremia.

Higher red cell distribution width and poorer hospitalization-related outcomes in elderly patients.

Red cell distribution width (RDW), an index for variation of red blood cell (RBC) size, has been proposed as a potential marker for poorer outcomes in several aging-related diseases and conditions. We tested whether greater variability of RBC size, presented as a higher RDW value, predicts poor prognoses among hospitalized patients over 60 years old. We retrospectively collected data from older hospitalized patients aged ≥60 years between January 2013 to December 2017 at Sutter Health, a large integrated health system in Northern California. The RDW was measured during hospital admission and categorized with 1% intervals (≤13.9, 14.0-14.9, 15.0-15.9, 16.0-16.9, 17.0-17.9 and ≥18.0%). The primary outcome was the rate of in-hospital mortality and secondary outcomes included 30-day re-admission rate and length of hospital stay (in days). A total of 167,292 admissions from 94,617 patients were included. The overall in-hospital mortality rate was 6.3%. As the RDW value increased, the rate of in-hospital mortality gradually increased from 2.7% for the lowest RDW category to 12.2% in the highest category (p-trend <0.001). The overall 30-day re-admission rate after discharge was 12.5% and the rate of 30-day re-admission also increased with increasing RDW categories (7.4% in the lowest group vs. 15.8% in the highest group, p-trend <0.001). Patients with the highest RDW values at admission stayed 1.5-2.0 times longer in the hospital than patients with lower RDW values who were admitted for the same causes. Greater variability of RBC size is significantly associated with worse prognosis in hospitalized elderly patients, indicating higher mortality, greater risk of early re-admission, and longer hospital stay days. Risk stratification strategies for hospitalized elderly should include RDW value.

Red Cell Distribution Width Is Independently Associated with Mortality in Sepsis

Background: Mortality in sepsis remains high. Studies on small cohorts have shown that red cell distribution width (RDW) is associated with mortality. The aim of this study was to validate these findings in a large multicenter cohort. Methods: We conducted this retrospective analysis of the multicenter eICU Collaborative Research Database in 16,423 septic patients. We split the cohort in patients with low (≤15%; n = 7,129) and high (>15%; n = 9,294) RDW. Univariable and multivariable multilevel logistic regressions were used to fit regression models for the binary primary outcome of hospital mortality and the secondary outcome intensive care unit (ICU) mortality with hospital unit as random effect. Optimal cutoffs were calculated using the Youden index. Results: Patients with high RDW were more often older than 65 years (57% vs. 50%; p < 0.001) and had higher Acute Physiology and Chronic Health Evaluation (APACHE) IV scores (69 vs. 60 pts.; p < 0.001). Both hospital (adjusted odds ratios [aOR] 1.18; 95% CI: 1.16–1.20; p < 0.001) and ICU mortality (aOR 1.16; 95% CI: 1.14–1.18; p < 0.001) were associated with RDW as a continuous variable. Patients with high RDW had a higher hospital mortality (20 vs. 9%; aOR 2.63; 95% CI: 2.38–2.90; p < 0.001). This finding persisted after multivariable adjustment (aOR 2.14; 95% CI: 1.93–2.37; p < 0.001) in a multilevel logistic regression analysis. The optimal RDW cutoff for the prediction of hospital mortality was 16%. Conclusion: We found an association of RDW with mortality in septic patients and propose an optimal cutoff value for risk stratification. In a combined model with lactate, RDW shows equivalent diagnostic performance to Sequential Organ Failure Assessment (SOFA) score and APACHE IV score.