Mean Red Blood Cell Distribution Width Research Articles

Differences in RDW Values of COVID-19 Patients with Pneumonia and Without Pneumonia at RSUM and RSUDP NTB

Pneumonia coinfection in COVID-19 patients can be an important risk factor for patient mortality. Red blood cell distribution width (RDW) is a predictor that can determine clinical outcomes in patients with respiratory tract infections and serious illnesses, so researchers want to conduct research to determine the difference in RDW values in COVID-19 patients with and without pneumonia at RSUM and RSUDP NTB. The design of this research is cross sectional. The sampling technique used was consecutive sampling. There were 110 COVID-19 patient data used in this research. Data collection uses medical record notes. The statistical analysis used was the Mann-Whitney test. The average age of patients was 48 years ± 16 years. Most of the subjects were male (53.6%). The most common comorbidity was diabetes mellitus (21.8%). The average RDW values in COVID-19 patients with and without pneumonia were 13.9% and 13.1%. The difference in the mean RDW value in the two groups is 0.8%. This study found that clinically there were differences in the RDW values of COVID-19 patients with pneumonia and without pneumonia at RSUM and RSUDP NTB.

Association of mean RDW values and changes in RDW with in-hospital mortality in ventilator-associated pneumonia (VAP): Evidence from MIMIC-IV database.

Ventilator-associated pneumonia (VAP) is a hospital-acquired infection with high mortality, and remains a challenge for clinical treatment. Red blood cell distribution width (RDW) was associated with worse outcomes in several diseases. The purpose of this study was to investigate the relationship between mean RDW values, changes in RDW (delta RDW), and in-hospital mortality among patients with VAP. In the present study, we enrolled 1266 VAP patients from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. All patients were categorized into low group, medium group, and high group according to tertiles of mean RDW values. The primary outcome was all-cause in-hospital mortality. Univariate logistic regression analysis, multivariate logistic regression analysis, and restricted cubic spline (RCS) curve were performed to determine the association between mean RDW values and in-hospital mortality in VAP. Moreover, RCS curve was plotted to explore the dose-response relationship between delta RDW and in-hospital mortality in VAP. Among the VAP patients included in the study, the in-hospital mortality was 20.85% with 264 non-survivors and 1002 survivors. The non-survivors exhibited significantly higher mean RDW values and delta RDW values compared to survivors. Multivariate logistic regression analysis indicated that mean RDW values were positively associated with in-hospital mortality in VAP after adjusting for relevant covariates. The RCS curve demonstrated a dose-response relationship between mean RDW and the mortality in VAP. Moreover, a linear relationship was observed between delta RDW and in-hospital mortality in VAP. Higher mean RDW values were significantly associated with an increased risk of in-hospital mortality in VAP. Additionally, a linear relationship was found between delta RDW values and in-hospital mortality. These findings suggest that RDW can be used to identify high-risk patients with poorer outcomes in VAP.

Red blood cell distribution width for the prediction of outcomes after cardiac arrest

The red blood cell distribution width (RDW) is a routinely available blood marker that measures the variation of the size/volume of red blood cells. The aim of our study was to investigate the prognostic value of RDW in cardiac arrest patients and to assess whether RDW improves the prognostic value of three cardiac arrest-specific risk scores. Consecutive adult cardiac arrest patients admitted to the ICU of a Swiss university hospital were included. The primary outcome was poor neurological outcome at hospital discharge assessed by Cerebral Performance Category. Of 702 patients admitted to the ICU after cardiac arrest, 400 patients (57.0%) survived, of which 323 (80.8%) had a good neurological outcome. Higher mean RDW values showed an independent association with poor neurological outcomes at hospital discharge (adjusted OR 1.27, 95% CI 1.14 to 1.41; p < 0.001). Adding the maximum RDW value to the OHCA- CAHP- and PROLOGUE cardiac arrest scores improved prognostic performance. Within this cohort of cardiac arrest patients, RDW was an independent outcome predictor and slightly improved three cardiac arrest-specific risk scores. RDW may therefore support clinical decision-making.

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.

The Prognostic Consequence of Red Cell Distribution Width in Acute Pancreatitis

INTRODUCTION&#x0D; Acute pancreatitis is commonly a self-limiting disease but, about 25% of patients consequently develop a severe pancreatitis which leads to increase mortality. The available Scoring system is use to predicate severity of the Acute Pancreatitis, which is used for early diagnosis and management. Aim of this study is to assess the association of red blood cell distribution width (RDW) with severity and mortality in patients of acute pancreatitis.&#x0D; MATERIAL AND METHODS&#x0D; This retrospective study was carried out in Department of Surgery of National Medical College and Teaching Hospital. A total of 50 patients with diagnosis as acute pancreatitis over period of March 2020 to February 2022 was included. History and detailed clinical examination was performed as per the working proforma. Blood investigation was done. Data analysis was done using SPSS (Statistical Package for social sciences), version 25.&#x0D; RESULTS&#x0D; Mean age was 39.03 years. 68% cases were female. Acute Biliary was the most common cause. Mean RDW was 12.461, 14.50 and 15.309 in mild, moderate and severe Pancreatitis respectively with a p value of &lt;0.001 showing significant association of RDW and severity of Pancreatitis. Mean RDW in alive was 13.046 and 16.625 in death with a p value of &lt;0.001 showing signifi- cant association between RDW and outcome of acute Pancreatitis.&#x0D; CONCLUSION&#x0D; RDW is a predictor of severity in patients with severe acute pancreatitis.

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.

Elevated red cell distribution width predicts residual dizziness in patients with benign paroxysmal positional vertigo.

ObjectiveThe present study aimed to determine whether residual dizziness (RD) after successful repositioning treatment in benign paroxysmal positional vertigo (BPPV) patients could be predicted by red blood cell distribution width (RDW).Materials and methodsIn this study, a total of 303 BBPV patients hospitalized at the neurology department were investigated. The enrolled patients were divided into two groups after successful repositioning treatment: non-RD group included patients who were completely cured, and RD group included patients with RD. We collected data on all subjects, including general information, blood routine examination, blood biochemical examination, and magnetic resonance imaging tests.ResultsThe mean RDW values of patients in the RD group were significantly higher than that in the non-RD group (13.63 ± 1.8 vs. 12.5 ± 0.8; p < 0.001). In subsequent multivariate analysis, elevated RDW levels were a statistically significant risk factor associated with the occurrence of RD [odds ratio = 2.62, 95% confidence interval (CI) 1.88–3.64, p < 0.001]. The area under the ROC curve was 0.723 in terms of its predictive ability to distinguish patients with RD. A cut-off point of 12.95% of RDW predicted RD with a sensitivity of 75.6% and a specificity of 69.5%. Moreover, the AUC for the ability of the RDW to predict recurrence were 0.692 (95% CI = 0.561–0.831; p < 0.014).ConclusionsElevated RDW level was related to increased risk of RD among BPPV patients, requiring further efforts to clarify the actual underlying pathophysiology.

Red blood cell distribution width in different time-points of peripheral thrombolysis period in acute ischemic stroke is associated with prognosis.

The relationship between red blood cell distribution width (RDW) in peripheral thrombolysis period and prognosis is not fully clarified in those who underwent intravenous thrombolysis (IVT) for acute ischemic stroke (AIS). Our study aimed to clarify this issue. A retrospective analysis of about 510 consecutive thrombolysis cases for AIS from January 2015 to March 2019 in a single-center database was done and followed-up for 3 months. We used univariate and multivariable models to evaluate the relationship between RDW levels at various time-points after IVT and the occurrence risk of hemorrhagic transformation (HT) and recurrent stroke, and used COX regression to assess the hazard ratios of outcomes with RDW levels. Elevated risk of HT was found in higher tertiles of RDW (OR = 10.282, 95% confidence interval (CI) 2.841–39.209, P < 0.001 in Tp tertile G3; OR = 5.650, 95% CI 1.992–16.025, P = 0.001 in T24 tertile G3; OR = 4.308, 95% CI 1.480–12.542, P = 0.007 in T48 tertile G3 and OR = 6.384, 95% CI 2.201–18.515, P = 0.001 in T72 tertile G3, respectively). Occurrence of recurrent stroke was highest in the RDW tertile G3 (HR = 4.580, 95% CI 2.123–9.883, P < 0.001 in Tp tertile G3; HR = 5.731, 95% CI 2.498–13.151, P = 0.001 in T24 tertile G3; HR = 3.019, 95% CI 1.969–4.059, P = 0.031 in T48 tertile G3; HR = 3.318, 95% CI 1.598–6.890, P = 0.001 in T72 tertile G3, respectively). Mean RDW levels ≥13.60 among AIS patients undergoing thrombolysis was associated with higher risk of HT and recurrent stroke.

MO1038: Haematologic Factors Associated with Favourable Long-Term Outcomes in Paediatric Patients with Chronic Kidney Disease on Maintenance Haemodialysis

Abstract BACKGROUND AND AIMS In children with chronic kidney disease (CKD), anaemia is defined as haemoglobin (Hb) &amp;lt;11–13.0 g/dL, depending on the patient's age and gender. Previous exploratory machine learning in a subpopulation of CKD-5 patients suggested an increased mortality risk with Hb &amp;lt; 10.5 g/dL and increased red blood cell distribution width (RDW) &amp;gt;15%. The objective was to evaluate such associations in a traditional time-to-event analysis in a larger population. METHOD Retrospective analysis of a cohort of patients &amp;lt; 30 years of age who started chronic haemodialysis (HD) in childhood (≤19 years) and received thrice-weekly HD (2004–2016) in outpatient DaVita centres. Survival at 5 years while remaining on HD was investigated by non-parametric analysis (Kaplan–Meier) stratified by terciles of mean individual Hb and RDW, respectively. A sensitivity analysis was carried out for different subpopulations (&amp;lt;6y/6y–12y/&amp;gt;12y at the initiation of HD). RESULTS A total of 493 patients were included with Hb and RDW terciles of &amp;lt; 10.7/10.7–11.5/&amp;gt;11.5 g/dL and &amp;lt; 14.6/14.6–15.7/&amp;gt;15.7%, respectively. Age at initiation of HD was &amp;lt; 6 years: n = 66, 6–12 years: n = 173, &amp;gt;12 years: n = 1254. Both Hb and RDW terciles showed strong associations with survival distributions (P &amp;lt; .001 for both, log-rank test). Estimated 5-year survival [95%confidence interval (95%CI)] by Hb terciles was 85.1% (81.1–89.3%) (Hb &amp;lt; 10.7 g/dL) versus 94.9% (92.5–97.4%) (&amp;gt;10.7–11.5 g/dL) and 93.8% (90.8–97.0%) (&amp;gt;11.5 g/dL) and for RDW 98.6% (97.1–100%) (&amp;lt;14.6%) versus 94.1% (91.3–96.9%) (14.6–15.7%) and 84.2% (80.1–88.6%) (&amp;gt;15.7%). Sensitivity analyses confirmed significant associations in patients &amp;gt; 12 years (P &amp;lt; .001 for both Hb/RDW) and for RDW in 6–12 years patients (P = .03 versus P = .14 for Hb). CONCLUSION This analysis confirmed strong associations between haematologic factors and survival in our population. Clinical utility of RDW in HD management and its physiological interpretation such as the importance of specific anaemia forms, or treatment-induced RDW increase in patients requiring more intense treatment remains to be investigated, with potential impacts on existing guidelines for prescribing iron and epoetin therapy. Further studies will also include the time variation trajectories of Hb and RDW.

Red cell distribution width: a novel predictive biomarker for stroke risk after transient ischaemic attack

Objective Predicting the prognosis of transient ischaemic attack (TIA) is difficult for many frontline clinicians. The purpose of this study was to determine whether subsequent stroke in TIA patients can be predicted via red blood cell distribution width (RDW). Material and methods A total of 360 consecutive patients with new-onset TIA in our stroke centre, were enrolled over the period studied. The patients were divided into three groups: 103 TIA patients, 206 ischaemic stroke (IS) patients and 51 patients with haemorrhagic stroke (HS) within 7 days after TIA. Complete blood count, biochemical parameters and brain imaging were performed on all patients. Results The mean RDW values of patients with IS and HS after TIA were significantly higher than patients with TIA (13.35 ± 1.59 vs 12.84 ± 1.19, 13.32 ± 1.08 vs 12.84 ± 1.19, respectively, all p ≤ .001). In a multivariate model, RDW was independently associated with stroke after TIA (IS: odds ratio (OR) = 2.52, 95% confidence interval (CI) = 1.46–3.35, p = .002; HS: OR = 1.511, 95% CI = 1.101–2.074, p = .011). Compared to ABCD2 scores, the diagnostic power of RDW in the differentiation of patients with IS after TIA was better (area under curve (AUC): 0.731 vs 0.613, p = .015). When an RDW cut-off value of 13.95% was accepted for differentiating patients with IS from TIA, the sensitivity and specificity were 73.7% and 74.3%, respectively. However, the AUC for the ability of the RDW to predict HS was 0.653 (95% CI = 0.589–0.716; p < .001). Conclusions The early determination of RDW is a promising, rapid, easy and inexpensive biomarker to predict the subsequent stroke in TIA patients, especially for IS. KEY MESSAGES The most important result of our study is to show that (1) the higher RDW, the earlier the stroke onset and (2) RDW ≥13.95% has a 2.52-fold risk of ischaemic stroke in TIA patients, and RDW ≥12.85% has a 1.51-fold risk of haemorrhagic stroke. As an economic and accessible hematological marker, baseline RDW may serve as a useful biomarker for risk stratification in TIA patients.

Determination of Red Blood Cell Distribution Width in Patients with Primary Cutaneous Vasculitis Compared to Systemic Vasculitis

Introduction: Red blood cell distribution width (RDW) has been considered as an inflammatory marker in various disorders. Evaluation of RDW value can also be used as a novel and additional marker for differentiating systemic vasculitis from primary cutaneous vasculitis. Objective: To compare RDW value between patients with cutaneous vasculitis with systemic vasculitis, thereafter to find out it's role as an effective indicator to distinguish both forms of vasculitis. Materials and Methods: This cross sectional observational study was conduct between from July 2016 to December 2017. Total of 48 patients were divided into primary cutaneous vasculitis and systemic vasculitis. Blood was collected in EDTA tube to measure RDW value. Patient’s disease activity also scored and plotted according to Birmingham vasculitis activity score. Statistical analysis was performed by using SPSS. Results: Significantly high mean RDW were found in patients with systemic vasculitis compared to primary cutaneous vasculitis (15.09±0.92 vs. 13.48±1.1, p = 0.000). BVAS was significantly greater (13.93±5.10 vs. 4.87±2.69, p = &lt; 0.001) in systemic vasculitis as well as in patients with high RDW group (11.73±5.71 vs. 5.37±3.96, p = &lt; 0.001). Optimal RDW cut off point for differentiating systemic vasculitis from cutaneous vasculitis was 14.2 with 81.3% sensitivity and 81.2% specificity. Conclusion: Present study revealed importance of RDW monitoring along with disease activity in patients with any form of vasculitis. Systemic vasculitis had higher level of RDW. So RDW can be considered as a marker to discriminate systemic vasculitis from primary cutaneous vasculitis. Medicine Today 2021 Vol.33(2): 84-89

Pretreatment red blood cell distribution width as an efficient predictor of survival in older patients undergoing hip fracture surgery.

We aimed to determine whether pretreatment red blood cell distribution width (RDW) is an efficient predictor of 30-day mortality in older patients undergoing hip fracture surgery. In this prospective cohort study, 203 patients with hip fractures were eligible and followed up for at least 30days. All the patients underwent medical examinations. RDW was measured using an automated hematology analyzer. To evaluate the prognostic significance of RDW, Cox proportional hazard model and Kaplan-Meier analyses were performed. Of the 203 patients (114 men, 89 women), 28 (13.79%) died within 30days. The mean RDW was significantly higher in the deceased group than in the survival group (14.54%±1.09% vs 13.26%±0.57%; P<.001). Multivariate Cox regression analysis showed that elevated RDW (hazard ratio=2.73, 95% confidence interval=2.06-3.62, P<.001) was the key predictor of 30-day mortality in older patients undergoing hip fracture surgery. Survival analysis showed that patients with a high RDW had a significantly higher 30-day mortality rate (log-rank test, P<.05). Similar results were observed in the male and female subgroups. RDW might be an effective predictor of 30-day mortality in older patients undergoing hip fracture surgery.

Correlation of Albumin Serum Levels as Inflammation Marker with Red Blood Cell Distribution Width Value in Regular Hemodialysis Patients at H. Adam Malik General Hospital Medan

Background: One of the modalities of renal replacement therapy in chronic kidney disease (CKD) is hemodialysis (HD). The role of inflammation in HD patients by uremic toxins and dialysis can be assessed by the marker of serum albumin. This inflammation also causes dysregulation of the hormone erythropoietin which results in increased variability or heterogeneity of red blood cell distribution width (RDW). Previous studies have revealed an association between RDW and albumin levels in regular HD patients which leads to increased patient morbidity and mortality. This study aims to determine the relationship between albumin serum levels and RDW as a marker of inflammation in regular HD patients. Method: This was a cross sectional study design, conducted in June to August 2020 at the HD unit of Haji Adam Malik General Hospital in Medan. Twenty subjects were included. Data were analyzed using Pearson correlation test and T-test to find the correlation between albumin serum levels and RDW, and other variables. Results: Of the 20 subjects taken based on consecutive sampling, the majority was male, 13 people (65%), mean age was 50.30 ± 12.57 years with the most comorbid type 2 diabetes mellitus for 14 people (70%). The mean serum albumin level was 3.2 ± 0.65 mg/dl. The mean RDW value was 15.93 ± 1.87%. This study showed that there was a significant relationship between serum albumin levels and RDW values ​​(r = - 0.687; p = 0.001). RDW values ​​were also significantly associated with hemoglobin levels (r = 0.497; p = 0.026) and creatinine (r= 0.519; p= 0.019). Conclusion: Albumin, hemoglobin, and creatinine levels were significantly associated with RDW values ​​in regular HD patients. Keywords: inflammation, albumin, regular hemodialysis, RDW.

The role of serum red blood cell distribution width level in predicting the short term mortality of community-acguired pneumonia, acute attack chronic pulmonary disease, and acute pulmonary thromboembolism

Background: There is a growing concern in inflammatory parameters that are commonly used in routine practice and can be measured cost-effectively for predicting mortality community-acquired pneumonia (CAP), acute-attack chronic obstructive pulmonary disease (COPD), and acute pulmonary thromboembolism (PTE). Red blood cell distribution width (RDW) is a significant parameter indicating the heterogeneity of the size of red blood cells (RBCs). The present study was designed to compare RDW levels among patients that were hospitalized due to CAP, acute PTE, and acute-attack COPD, all of which are characterized by persistent inflammation, and to investigate the role of RDW in predicting 30-day mortality.&#x0D; Materials and Methods: The RDW levels measured on admission in all three groups were evaluated retrospectively.&#x0D; Results:The 554 patients comprised 320 (57.76%) men and 234 (42.24%) women with a mean age of 67.074±14.73 years. The patients comprised 92 (16.6%) CAP, 265 (47.8%) acute PTE, and 197 (35.6%) acute-attack COPD patients. Mean RDW was 14.42%±2.73% (range, 3.77-28%) while it was 14.88%±3.30% in the CAP group, 13.21%±2.77% in the COPD group, and 15.15%±2.12% in the PTE group. In the COPD, CAP, and PTE groups, RDW levels were significantly higher in patients with 30-day mortality compared to those without mortality (p=0.008, p=0.020, and p

Impact of Red Cell and Platelet Distribution Width in Patients of Medical Intensive Care Unit.

Introduction The red blood cell distribution width (RDW) is a measurement of variations in the size of red blood cells. As the width increases, the rate of mortality also increases, although the reason for it is still not known. On the other hand, platelet distribution width (PDW) is also useful in predicting morbidity and mortality in sepsis and other critically ill patients. In our study, we planned to study the impact of both RDW and PDW and evaluate their prognostic importance with outcome in patients admitted in medicine intensive care unit (MICU). Material and Method In these cross-sectional observational studies, 1,300 patients were included who were admitted in MICU. Critically ill patients were defined on the basis of qSOFA score greater than 2. PDW and RDW were obtained from Coulter report of complete blood count. Parameters included in Acute Physiology and Chronic Health Evaluation (APACHE) IV scores were taken and APACHE IV score was calculated. Correlation of RDW and PDW with outcomes such as length of ICU stay, use of mechanical ventilator, and discharge/death was done. Result The mean RDW (%) for the entire study population was 15.17 ± 3.01. The RDW (%) was significantly on the higher side in patients who succumbed to the disease as compared with the patients who were discharged. The correlation between the length of ICU stay (days) and RDW (%) was moderately positive and was significant (rho = 0.37, p ≤ 0.001). The correlation between the length of ICU stay (days) and PDW (%) was moderately positive and was significant (rho = 0.5, p ≤ 0.001). Conclusion RDW and PDW were found as significant indicators for period of stay in ICU, requirement for mechanical ventilation, and mortality rate in patients admitted to ICUs. As these are simple, easy to conduct, universally available tests, they can be regularly incorporated in patients admitted in ICUs.

The Relationship Between the Severity of Coronary Artery Disease and Erythrocyte Morphology Parameters Measured by New-Generation Hematology Analyzer.

There is a possible relation between red blood cell distribution width (RDW) and various clinical conditions. These conditions can render RDW disadvantageous in its relation with cardiovascular disease. There may be a relation between the severity of acute coronary syndrome (ACS) and the percentage of hypochromia (hypo%), percentage of hyperchromia (hyper%), percentage of macrocytosis (MAC%), and percentage of microcytosis (MIC%) values measured using new-generation hematological devices. We aimed to examine the relation between the SYNTAX score and the hypo%, hyper%, MAC%, and MIC% values in patients admitted with ACS. A group of 55 patients who underwent coronary angiography with diagnosis of ACS (STEMI and NSTEMI) and a control group of 48 patients with normal coronary arteries were included in the study. Venous blood samples were collected in the morning after a fasting of at least 8 h and analyzed using standard laboratory methods. Hemogram parameters were studied using Alinity HQ (Abbott, USA) a completely automated hemogram autoanalyzer. Biochemical parameters were studied using Architect c16000 (Abbott, USA) a completely automated biochemistry autoanalyzer. Significant difference was observed in erythrocyte morphology-related tests (mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, RDW, hypo%, hyper%, MIC%, and MAC%) between the groups. Correlation analysis showed a positive correlation between the SYNTAX score and MAC% (r = 0.315, p = 0.019). Multivariate logistic regression analysis was performed for MAC% to identify the independent predictors of the SYNTAX score (β = 0.315, p = 0.019). Changes in MAC% test can be measured in emergencies with new-generation hematological devices and used as independent predictors of the presence of severe coronary artery disease.

Red blood cell distribution width as a novel prognostic marker after myocardial revascularization or cardiac valve surgery

The red blood cell distribution width (RDW) measures the variability in the size of circulating erythrocytes. Previous studies suggested a powerful correlation between RDW obtained from a standard complete blood count and cardiovascular diseases in both primary and secondary cardiovascular prevention. The current study aimed to evaluate the prognostic role of RDW in patients undergoing cardiac rehabilitation after myocardial revascularization and/or cardiac valve surgery. The study included 1.031 patients with available RDW levels, prospectively followed for a mean of 4.5 ± 3.5 years. The mean age was 68 ± 12 years, the mean RDW was 14.7 ± 1.8%; 492 patients (48%) underwent cardiac rehabilitation after myocardial revascularization, 371 (36%) after cardiac valve surgery, 102 (10%) after valve-plus-coronary artery by-pass graft surgery, 66 (6%) for other indications. Kaplan–Meier analysis and Cox hazard analysis were used to associate RDW with mortality. Kaplan–Meier analysis demonstrated worse survival curves free from overall (log-rank p < 0.0001) and cardiovascular (log-rank p < 0.0001) mortality in the highest RDW tertile. Cox analysis showed RDW levels correlated significantly with the probability of overall (HR 1.26; 95% CI 1.19–1.32; p < 0.001) and cardiovascular (HR 1.31; 95% CI 1.23–1.40; p < 0.001) mortality. After multiple adjustments for cardiovascular risk factors, hemoglobin, hematocrit, C-reactive protein, microalbuminuria, atrial fibrillation, glomerular filtration rate,left ventricular ejection fraction and number of exercise training sessions attended, the increased risk of overall (HR 1.10; 95% CI 1.01–1.27; p = 0.039) and cardiovascular (HR 1.13; 95% CI 1.01–1.34; p = 0.036)mortality with increasing RDW values remained significant. The RDW represents an independent predictor of overall and cardiovascular mortality in secondary cardiovascular prevention patients undergoing cardiac rehabilitation.

Red cell distribution width as a predictor for bronchopulmonary dysplasia in premature infants

Bronchopulmonary dysplasia (BPD) is the most common morbidity complicating preterm birth. Red blood cell distribution width (RDW), a measure of the variation of red blood cell size, could reflect oxidative stress and chronic inflammation in many diseases such as cardiovascular, pulmonary, and other diseases. The objectives of the present study were to evaluate perinatal factors affecting RDW and to validate whether RDW could be a potential biomarker for BPD. A total of 176 preterm infants born at < 30 weeks were included in this study. They were categorized into BPD (n = 85) and non-BPD (n = 91) infants. RDW at birth and 14 days and 28 days of life (DOL 14, DOL 28) were measured. Clinical data were obtained from all subjects at Fukushima Medical University (Fukushima, Japan). The mean RDW at birth, DOL 14 and DOL 28 were 16.1%, 18.6%, 20.1%, respectively. Small for gestational age (SGA), chorioamnionitis (CAM), hypertensive disorders of pregnancy (HDP), gestational age and birth weight were significantly associated with RDW at birth. SGA, BPD and red blood cell (RBC) transfusion before DOL 14 were associated with RDW at DOL 14. BPD and RBC transfusion before DOL 14 were associated with RDW at DOL 28. Compared with non-BPD infants, mean RDW at DOL 14 (21.1% vs. 17.6%, P < 0.001) and DOL 28 (22.2% vs. 18.2%, P < 0.001) were significantly higher in BPD infants. Multivariate analysis revealed that RDW at DOL 28 was significantly higher in BPD infants (P = 0.001, odds ratio 1.63; 95% CI 1.22–2.19). Receiver operating characteristic analysis for RDW at DOL 28 in infants with and without BPD yielded an area under the curve of 0.87 (95% CI 0.78–0.91, P < 0.001). RDW at DOL 28 with mild BPD (18.1% vs. 21.3%, P < 0.001), moderate BPD (18.1% vs. 21.2%, P < 0.001), and severe BPD (18.1% vs. 24.0%, P < 0.001) were significantly higher than those with non-BPD, respectively. Furthermore, there are significant differences of RDW at DOL 28 among mild, moderate, and severe BPD. In summary, we conclude that RDW at DOL 28 could serve as a biomarker for predicting BPD and its severity. The mechanism by which RDW at DOL 28 is associated with the pathogenesis of BPD needs further elucidation.

Risk Factors for Acute Coronary Syndrome in Upper Gastrointestinal Bleeding Patients.

Background Upper gastrointestinal bleeding (UGIB) is a common critical disease with a certain fatality rate. Acute coronary syndrome (ACS), another critical ill condition, is a regular occurrence in the UGIB. We identified risk factors for ACS in UGIB. Methods 676 patients diagnosed with UGIB were enrolled retrospectively. We assessed the occurrence of ACS in UGIB patients and identified the risk factors for ACS by logistic regression analysis and random forest analysis. Results After propensity score matching (PSM), the ACS group (n = 69) and non-ACS group (n = 276) were analyzed. Logistic regression analysis showed that syncope (P = 0.001), coronary heart disease history (P = 0.001), Glasgow Blatchford score (P ≤ 0.001), Rockall risk score (P = 0.004), red blood cell distribution width (RDW) (P ≤ 0.001), total bilirubin (TBil) (P = 0.046), fibrinogen (P ≤ 0.001), and hemoglobin (P = 0.001) had important roles in ACS patients. With Mean Decrease Gini (MDG) sequencing, fibrinogen, RDW, and hemoglobin were ranked the top three risk factors associated with ACS. In ROC analysis, fibrinogen (AUC = 0.841, 95% CI: 0.779-0.903) and RDW (AUC = 0.826, 95% CI: 0.769-0.883) obtained good discrimination performance. According to sensitivity > 80%, the pAUC of fibrinogen and RDW were 0.077 and 0.101, respectively, and there was no significant difference (P = 0.326). However, according to specificity > 80%, the pAUC of fibrinogen was higher than that of RDW (0.126 vs. 0.088, P = 0.018). Conclusion Fibrinogen and RDW were important risk factors for ACS in UGIB. Additionally, combination with coronary heart disease, syncope, hemoglobin, and TBil played important roles in the occurrence of ACS. Meanwhile, it was also noted that Rockall score and Glasgow Blatchford score should be performed to predict the risk.

Red Cell Distribution Width, Unlike Neutrophil Lymphocyte Ratio Is Unable to Accurately Gauge Enhanced Systemic Inflammation Associated With Panoramic Imaged Carotid Plaque.

We have previously shown that panoramic X-rays (PXs) demonstrating calcified carotid artery atheromas (CCAA) are associated with increased systemic inflammation demonstrating increased neutrophil lymphocyte ratios (NLRs), a validated risk indicator of fatal myocardial infarctions arising from coronary artery atherosclerosis. Using this same cohort of patients (with minor adjustments because of missing data), we sought to determine if a like association existed between PXs evidencing CCAA and elevated red blood cell distribution width (RDW) given conflicting data as its reliability relative to NLR as a biologic marker of system inflammation. We hypothesized that CCAAs on PXs would simultaneously be associated with both increased NLR and RDW. Investigators implemented a cross-sectional study design. Study sample consisted of patient medical records and PXs of white men ≥ 55 years. Two groups (N = 50 each) were constituted, one with atheromas (CCAA+) and without atheromas (CCAA-). The predictor variable was CCAA+and outcome variables were NLR and RDW. Bootstrapping analysis was employed to analyze the differences in mean NLRs and RDWs between groups since the data was not normally distributed. Statistical significance determined to be ≤ 0.05 for all tests. The Medical Center's Institutional Review Board approved the research protocol. A study group of 50 CCAA+men (mean age 71; range 58-89 years) demonstrated a mean NLR of 2.98 ± 1.38 and an RDW of 13.21 ± 0.85. A control group of 50 CCAA- males (mean age 70 range; 55-91 years) evidenced a mean NLR of 2.38 ± 0.77 and an RDW of 13.16 ± 0.77. Bootstrapping comparison of NLR values evidenced significant (P = 0.008) difference (95% confidence interval of difference of mean: - 0.4272, 0.4384; observed effect size: 0.579) between groups; however, there was no significant difference in RDW values between the groups. Furthermore, logistic regression modeling demonstrated that for a one unit increase in NLR the odds of being CCAA+ (vs. CCAA-) increases by a factor of 1.659. The existence of CCAA seen on PXs of elderly white men is associated with significantly (P = 0.008) elevated NLR values but is not associated with increases in RDW.