Mean Red Cell Distribution Width Research Articles

Red cell distribution width as a prognostic marker in diabetes; a pilot cross-sectional study

Introduction:Red cell distribution width (RDW) is one of the important factors in anisocytosis which is related to impairment of erythropoiesis and degradation of erythrocytes. Objectives: The aim of this study was to evaluate the use of RDW as a prognostic marker in diabetic patients. Patients and Methods: This cross-sectional study was conducted on 144 individuals who referred to laboratories in Khuzestan. Of all, 69 persons were diabetic patients and 75 were non-diabetic. Results: The mean fasting blood sugar (FBS) and RDW coefficient of variation (RDW-CV), were 85.20 ± 9.12 mg/dL and 13.26 ± 0.69% respectively, in the non-diabetic group, and 238.65 ± 70.54 mg/dL and 13.50 ± 0.74% respectively, in the diabetic group. In this study, a significant difference of mean FBS (P <0.001) and mean RDW (P=0.04) between groups were detected. Conclusion: In our study, a significant relationship between changes in RDW and changes in blood sugar in diabetic patients was detected. Studying RDW in diabetes delineated higher RDW values than in healthy population. Therefore, it can be recommended to apply serum RDW as a prognostic marker for diabetes. However additional studies on this subject are necessary

Red cell distribution width as a prognostic marker in mechanically ventilated children admitted in pediatric critical care unit of tertiary care centre, India

Background: Paediatric population is a vulnerable group necessitating standard care for medically and surgically ill children. Red cell distribution width (RDW) is a simple and low-cost measure that denotes the variability in red blood cell size. Any process that releases reticulocytes in the circulation will result in an increase in RDW. RDW may also be useful as a biomarker of disease severity and clinical outcomes in critically ill patients. Methods: Retrospective cohort study of all patients between 1month-12yrs of age, mechanically ventilated in Paediatric intensive care unit. Those patients with RDW on admission and complete data for PIM3 (Paediatric Index of Mortality 3) were included. Analyses included correlation, logistic regression analysis, and receiver operating characteristic (ROC) curves.Results: Retrospective analysis of data on 93 consecutive critically ill children admitted in PICU was done between Jan 2015- June 2016. We noted statistically significant correlation between mortality and anemia (10.24 g/dL, SD 2.26; 8.78 g/dL, SD 2.60.p = 0.009), LOS on MV (p = 0.008), RDW (p = 0.002), shock (p = 0.004) and ventilator associated Pneumonia (p = 0.024). Mortality increased as length of stay on mechanical ventilation increased (4.13 days, SD 2.125 versus 6.94 days, SD 7.603 p = 0.008). The cut-off of 18.10 was chosen as Mean RDW. Based on AUROC, RDW is independently associated with high risk of mortality.Conclusions: RDW measured within 24 hours of PICU admission was independently associated with length of stay on mechanical ventilation and mortality in a general PICU population. We recommend the need for multicentric, prospective longitudinal studies to determine the optimum utility of RDW to enhance decision making in PICU.

Relationship of Red Cell Distribution Width to Adverse Outcomes in Adults With Congenital Heart Disease (from the Boston Adult Congenital Heart Biobank)

Red cell distribution width (RDW), a measure of variability in red cell size, predicts adverse outcomes in acquired causes of heart failure. We examined the relation of RDW and outcomes in adults with congenital heart disease. We performed a prospective cohort study on 696 ambulatory patients ≥18years old enrolled in the Boston Adult Congenital Heart Disease Biobank between 2012 and 2016 (mean age 38.7 ± 13.5 years; 49.9% women). The combined outcome was all-cause mortality or nonelective cardiovascular hospitalization. Most patients had moderately or severely complex congenital heart disease (42.5% and 38.5%, respectively). Mean RDW was 14.0 ± 1.3%. RDW >15% was present in 81 patients (11.6%). After median 767days of follow-up, 115 patients sustained the primary combined outcome, including 31 who died. Higher RDW predicted both the combined outcome (hazard ratio [HR] for RDW >15% = 4.5, 95% confidence interval [CI] 3.0 to 6.6; HR per + 1SD RDW = 1.8, 95% CI 1.6 to 2.0, both p <0.0001) and death alone (HR for RDW >15% = 7.1, 95% CI 3.5 to 14.4; HR per + 1SD RDW = 1.8, 95% CI 1.6 to 2.0, both p <0.0001). RDW remained an independent predictor of the combined outcome after adjusting for age, cyanosis, congenital heart disease complexity, ventricular systolic function, New York Heart Association functional class, hemoglobin concentration, mean corpuscular volume, high-sensitivity C-reactive protein and estimated glomerular filtration rate (HR per + 1SD RDW = 1.5, 95% CI 1.2 to 1.9, p <0.0001). RDW also remained an independent predictor of mortality alone after adjustment for age plus each variable individually. In conclusion, elevated RDW is an independent predictor of all-cause mortality or nonelective cardiovascular hospitalization in adults with congenital heart disease. This simple clinical biomarker identifies increased risk for adverse events even among patients with preserved functional status.

Evaluation of Erythrocyte Indices in Newborn According to Gestational Age

Background: The normal hematological values in newborns differ significantly from those of infants, older children and adults. In our observation, the values of the newborn babies vary according to the gestational age. At birth the hemoglobin, hematocrit, mean corpuscular volume and mean corpuscular hemoglobin of term newborns are significantly higher than those of older infants and children, and in preterm newborns the differences are even more pronounced. The objective of this study is to evaluate the erythrocyte indices in preterm and term newborns at birth.Methodology: This cross sectional study was conducted in the department of Neonatology in BSMMU from May 2014 to April 2015. A total of 86 newborns; 48 term and 38 preterm were included in the study. Newborns were divided into two groups- term group and preterm group. Erythrocyte indices: hemoglobin (Hb), hematocrit (Hct), red blood cell (RBC) count, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC) and red cell distribution width (RDW) were estimated from cord blood immediately after birth.Results: Mean hemoglobin level in term group was 15.65±1.04g/dl and preterm group was 15.21±0.93g/dl; this difference was statistically significant (p&lt;0.05). Mean hematocrit value was significantly higher in term group (47.27%) than preterm group (46.10%) (p&lt; 0.05). Mean MCH in term group was 34.49 pg and preterm group was 35.83 pg; this difference was statistically significant (p&lt;0.05). Mean RBC count in term group was 4.47 million/cmm and preterm group was 4.35 million/cmm. Mean MCV was higher in preterm group (107.70 fl) than term group (104.58 fl): Mean MCHC was higher in preterm group (33.34g/dl) than term group (33.0g/dl); Mean RDW in term group was 18.18% and in preterm group was 18.58%. These differences were not statistically significant (p&gt;0.05).Conclusion: This study concluded that erythrocyte indices of all newborns are not same; these differ according to gestational age.Bangladesh J Child Health 2018; VOL 42 (2) :58-61

Predictive value of red cell distribution width on left atrial thrombus or left atrial spontaneous echo contrast in patients with non-valvular atrial fibrillation.

ObjectiveTo evaluate the predictive value of red cell distribution width (RDW) on left atrial thrombus (LAT) or left atrial spontaneous echo contrast (LASEC) in patients with non-valvular atrial fibrillation (AF).MethodsWe reviewed 692 patients who were diagnosed as non-valvular AF and underwent transesophageal echocardiography (TEE) in Guangdong Cardiovascular Institute from April 2014 to December 2015. The baseline clinical characteristics, laboratory test of blood routine, electrocardiograph measurements were analyzed.ResultsEighty-four patients were examined with LAT/LASEC under TEE. The mean RDW level was significantly higher in LAT/LASEC patients compared with the non-LAT/LASEC patients (13.59% ± 1.07% vs. 14.34% ± 1.34%; P < 0.001). Receiver–operating characteristic curve analysis was performed and indicated the best RDW cut point was 13.16%. Furthermore, multivariate logistic regression analysis indicated that RDW level > 13.16% could be an independent risk factor for LAT/LASEC in patients with AF.ConclusionElevated RDW level is associated with the presence of LAT/LASEC and could be with moderate predictive value for LAT/LASEC in patients with non-valvular AF.

Association between elevated red blood cell distribution width and long-term mortality in acute pulmonary embolism

Background/aim: The prognostic value of the red cell distribution width (RDW) as a cost-effective and noninvasive test in acute pulmonary embolism (PE) is still unknown. We aimed to investigate the prognostic value of the admission RDW level in the long-term survival of PE patients. Materials and methods: In this registry-based, prospective cohort study, a total of 378 patients (mean age: 60.4 ± 17.11 years, 47.4% female) who presented with acute PE were enrolled. All the clinical data for each patient were obtained from our institutional PE registry. The follow-up was performed at a median time of 17 months. The primary endpoint was death at follow-up. Results: The mean RDW in study patients was 14.67 ± 2.13. The all-cause mortality rate during the follow-up was 15.6% (n = 59). After adjustment for potential confounders, the relationship between RDW and long-term mortality showed a trend of a significant level (hazard ratio: 1.109; 95% CI, 0.998−1.232; P = 0.053). We divided patients into 3 groups based on the European Society of Cardiology’s classification. As we moved from the low risk to the higher risk categories, the mean RDW increased significantly (P = 0.037). Conclusion: It seems there may be an independent association between RDW at presentation and PE mortality within 17 months.

Combined Assessment of the Red Cell Distribution Width and B-type Natriuretic Peptide: A More Useful Prognostic Marker of Cardiovascular Mortality in Heart Failure Patients.

Objective An increased red cell distribution width (RDW) has been reported to be associated with adverse outcomes in patients with heart failure (HF). This study aimed to evaluate the prognostic power of the combined measurement of RDW and B-type natriuretic peptide (BNP) concentrations in patients with HF. Methods and Results We retrospectively studied 116 patients (mean age, 63.7±14.3 years) who were admitted for the treatment of HF. Data including demographic information, vital signs, and laboratory and echocardiographic measurements at admission were collected from medical records. The observational period was defined as the number of days from hospitalization, and the study endpoint was defined as cardiovascular death. The mean RDW and BNP concentration at admission were 14.5±2.0% and 626±593 pg/mL, respectively. During a median observation period of 1,046 days, 22 patients died of cardiovascular disease. A univariate Cox proportional hazard analysis revealed that both RDW [hazard ratio (HR) 1.252, p = 0.0391] and BNP (HR 1.001, p = 0.0445) were significant prognostic indices for cardiovascular death. A receiver operating characteristic curve analysis revealed that the optimal cut-off RDW and BNP values for cardiovascular death were 14.9% and 686 pg/mL, respectively. The Kaplan-Meier survival curve revealed that the survival rate of patients with both RDW ≥ 14.9% and BNP ≥ 686 pg/mL showed the poorest prognosis in comparison to the patients in the other groups. Conclusion The combined assessment of the RDW and BNP concentrations may be useful for predicting mortality in patients with HF.

The Impact of Red Cell Distribution Width on the Development of Contrast-Induced Nephropathy in Patients with Stable Coronary Artery Disease who Underwent Coronary Angiography.

Objectives:Contrast-induced nephropathy (CIN) accounts for 10% of all causes of hospital-acquired renal failure. The pathophysiological cellular mechanism of the CIN development remains unclear and seems to be multifactorial. Herein, we aimed to determine the role of red cell distribution width (RDW) in the development of CIN after elective percutaneous intervention in patients with stable coronary artery disease, which in our opinion has not been researched enough.Methods:Between October 2009 and October 2011, a total of 211 patients with stable coronary artery disease who had undergone a coronary intervention procedure were evaluated prospectively. The patients were classified according to the development of CIN, and both groups were compared statistically according to clinical, laboratory, and demographic features, including the serum RDW level.Results:In 18.8% of the patients, CIN was observed. The mean age was 64±10.5, and 59% of the study group was male. An advanced age, male gender, hypertension, the serum total protein level, high density lipoprotein, and albumin levels were correlated with the development of CIN. The mean RDW level was 13.7±1.4%, and the mean creatinine level was 1.0±0.2 mg/dL. There was not any correlation between RDW and the presence of CIN (CIN[−]=13.8±1.5, CIN[+]=13.6±1.0, p>0.05), and also a multivariate regression analysis proved this non-correlation (OR : 0.92, 95% confidence interval [CI]=0.62–1.34; p: 0.67 ). There was only a correlation between hypertension and male gender with CIN that was proved with a multivariate regression analysis (OR=5.74, 95% CI: 1.96–16.79, p<0.01 vs OR=5.34, 95% CI=1.22–23.3, p: 0.02, respectively).Conclusion:Our outcomes indicate that the RDW has a limited use as a CIN predictor in patients with stable coronary artery disease.

COMPARATIVE STUDY OF CORD BLOOD HEMATOLOGICAL PROFILE OF NEONATES BORN TO MOTHERS WITH AND WITHOUT PREGNANCY-INDUCED HYPERTENSION: A PROSPECTIVE CASE–CONTROL STUDY

Background: The neonates born to mothers with pregnancy-induced hypertension (PIH) are prone to have abnormalities in their umbilical cord blood hematology. However, the exact pattern of the derangements and their clinical correlations has not been defined. Objectives : The purpose of this study is to compare the hematological profile of cord blood of neonates born to mothers with and without PIH (gestational hypertension, pre-eclampsia, and eclampsia), and to evaluate short-term clinical outcomes in the two groups. Methods: A prospective case–control study was done on cord blood of 155 neonates born to mothers with PIH (cases) and compared with that of 155 neonates born to normotensive mothers (controls). 2 ml cord blood was collected at birth and was analyzed for - hemoglobin (Hb), various red cell indices including nucleated red blood cell (NRBC), reticulocyte count, total leukocyte count (TLC), differential leukocyte count, absolute neutrophil count (ANC), absolute lymphocyte count (ALC), platelet count, and cord blood smear examination. The cases and controls were followed up during their hospital stay for the clinical outcome. Results: The mean red cell distribution width, NRBC, and reticulocyte count in cases were 14.64±2.14%, 11.18±2.33/100 white blood cells (WBCs) and 5.18±0.49% as compared with 11.84±0.78%, 4.32±1.32/100 WBCs, and 3.83±3.59% in controls (p 1 (1.64), with a significant increase in mortality as compared to controls. Conclusions: PIH increased the RR of sepsis (although not significantly) and mortality rate in the neonate, which can be related to cord blood hematological profile findings of leukopenia, absolute neutropenia, and thrombocytopenia, and increased NRBC count.

Diagnostic Significance of Haemogram Parameters and RBC Indices in Haemoglobin E Trait

Background: Hemoglobin E disease are the most common structural haemoglobinopathies, reaching its highest frequency in South East Asia and also prevalent in Bangladesh. There are very few data for effective screening of HB E trait. The aim of the study was to analyze hematological profile and RBC indices as a marker of screening for Hb E trait.Methodology: A cross sectional observational study was conducted among 150 subjects at Dhaka Shishu (Children) Hospital from December 2008 to November 2009. On the basis of Hb electrophoresis, all subjects were divided into three groups. Group I comprised of 50 subjects with Hb E trait, group II comprised 51 subjects with ß thalassemia trait and Group III comprised of 49 normal subjects. Result of RBC indices and blood count were compared between Hb E trait and normal study population.Results: In group I the mean age was 29.53 years and the age range was 2-47 years. In group II the mean age was 30.31 years and the range was 1-55 years. In group III the mean age was 21.81 years and the range was 1-52 years. The present study revealed the mean±SD haemoglobin level (g/dl) in group I (E trait) and group III (normal subjects) were 11.76±1.91 and 10.77±1.4 respectively. Statistically no significant difference was found between these 2 groups (P&gt;.05). The mean corpuscular volume (MCV) in mean±SD in group I and group III were 72.89±12.24 fl and 77.35±10.27 fl respectively. No statistical significance was found as P&gt;0.05. The mean corpuscular haemoglobin (MCH) and mean corpuscular haemoglobin concentration (MCHC) in group I were 24.84±2.71pg &amp; 32.97±2.27 g/dl and in group III were 28.28±2.71 pg &amp; 32.97±2.38 g/dl respectively. There were no significant difference between group I and III regarding MCH and MCHC.The mean RBC count in E trait and normal subject group were 5.01±71 million/cmm and 4.61±0.65 million/cmm respectively. There was no significant difference was found P&gt;0.05. Mean red cell distribution width (RDW) in group I and III were 14.32 ±2.34 and 14.83±1.28 without any statistical difference (P&gt;0.05)Conclusion: In our study there were no diagnostic significance of Blood count and RBC Indices for detection of Hb E trait. More study should be conducted to find out reliable marker of screening for Hb E carrier.Anwer Khan Modern Medical College Journal Vol. 8, No. 2: Jul 2017, P 94-99

Early Screening of Hemoglobinopathy in Indonesia Using Erythrocyte Indices

BACKGROUND: The mutation spectrums of hemoglobinopathy are different among populations that yield a different result of erythrocyte indices. Calculation of erythrocyte indices with some formula has been reported to differentiate between hemoglobinopathy and non-hemoglobinopathy, but its cut-off should be recalculated specific for each population to gain a better sensitivity and specificity. We aimed to evaluate red blood cell count (RBC), Mentzer index, red cell distribution width (RDW), RDW index (RDWI), Shine and Lal index (S&amp;L) and Green and King index (G&amp;K) to screen hemoglobinopathy in Indonesia.METHODS: A retrospective cross-sectional study was performed on 202 subjects. The diagnosis of hemoglobinopathy was determined based on the results of complete blood count (CBC) data, high-performance liquid chromatography (HPLC) and Hemoglobin H (HbH) inclusion body. The ferritin concentration was checked to determine the status of iron. The erythrocytes indices were analyzed and calculated to predict hemoglobinopathy. RESULTS: A total 202 subjects who met the criteria were involved in this study. Fifty percent showed pure hemoglobinopathy and 4% showed a combination of thalassemia and hemoglobinopathy. The hemoglobin concentration and RBC were significantly higher, and the mean corpuscular volume (MCV) and RDW were significantly lower in hemoglobinopathy compared to iron deficiency. The difference was not significant if the hemoglobinopathy was combined with iron deficiency. By this study's cut-off, the G&amp;K and RDWI showed the highest accuracy, sensitivity, and specificity.CONCLUSION: The new cut-off of erythrocyte index and its calculation to screen hemoglobinopathy in Indonesia showed a higher sensitivity and specificity, especially for G&amp;K and RDWI with cut-off 73 and 228, respectively. The presence of iron deficiency in hemoglobinopathy could decrease the sensitivity.KEYWORDS: hemoglobinopathy, RBC, Mentzer index, RDW, RDWI, S&amp;L, G&amp;K

Can red cell distribution width be used as a predictor of acute cholecystitis?

Acute cholecystitis is a common disease requiring accurate markers for diagnosis and proper treatment. The aim of this study was to investigate the role of red cell distribution width (RDW) in acute cholecystitis. 299 were included in the study. The subjects were divided into 2 groups; group 1 (n: 46) acute cholecystitis group and group 2 (n: 253) chronic cholecystitis group. The patients were compared with respect to demographic characteristics, white blood cell count, C-reactive protein, and red cell distribution width. A statistically significant difference was observed between groups with respect to gender, white blood cell count, C-reactive protein, and red cell distribution width level (p<0.05). The mean red cell distribution width level of group 1 and 2 was 14.19±2.02% and 15.03±2.51%, respectively. Red cell distribution width level can be used as a predictor of acute cholecystitis. Multicenter prospective studies should be performed to elucidate the exact role of RDW level in acute cholecystitis.

Increased red cell distribution width levels in children with seasonal allergic conjunctivitis.

Seasonal allergic conjunctivitis (SAC) is an inflammatory disease of the conjunctiva. Red cell distribution width (RDW) is a widely accepted inflammatory marker. We aimed to investigate whether RDW level is associated with the development of SAC in pediatric population. The present study consisted of 90 subjects (45 children with SAC and 45 age- and sex-matched healthy children). The demographic findings, complete blood count parameters including RDW and laboratory parameters, were evaluated. The mean RDW levels were significantly higher in children with SAC compared to the control group (14.02±0.82 vs. 13.26±0.64%, respectively, p<0.001). In receiver operating characteristic analysis, the area under the curve for RDW for predicting SAC was 0.786, and a RDW value of 13.45 or higher predicted SAC with a sensitivity of 75.6% and specificity of 65%. Our study suggests that elevated RDW levels are significantly associated with SAC in pediatric population, which may imply a possible role of increased inflammatory status and oxidative stress in the pathogenesis of SAC.

Red cell distribution width and uric acid in patients with obstructive sleep apnea.

Obstructive sleep apnea (OSA), characterized by recurrent partial or complete pharyngeal closure, resulting in apnea or hypopnea, is closely associated with cardiovascular disorders (CVDs). Elevated red cell distribution width (RDW) and serum uric acid (SUA) levels have also been associated with CVDs and the consequent mortality. The aim of this study is to determine SUA levels and RDW in patients with OSA which is major a risk factor for CVDs. This was a retrospective study involving 600 subjects evaluated by polysomnography. Patients were grouped according to the apnea-hypopnea index (AHI), expressed as control group or as mild OSA, moderate OSA, and severe OSA groups. The mean RDW and the mean SUA were significantly higher in the severe OSA group than in all other groups (P < .015 and P < .003, respectively, for all). RDW was negatively correlated with minimum SpO2 (r = -.142, P < .01) and positively correlated with mean oxygen desaturation time (r = .113, P < .05). SUA was negatively correlated with minimum SpO2 (r = -.229, P < .01). The RDW was significantly higher in the OSA patients with CVDs than in those with OSA only (P < .05), although there was no significant difference between the OSA patients with and without CVDs in terms of the SUA in any of the groups (P > .05). Elevated levels of SUA and RDW were associated with OSA severity, as defined by AHI. In addition, RDW was significantly higher in severe OSA with CVDs.

Effect of Continuous Positive Airway Pressure Treatment on Hemograms of Patients with Severe Obstructive Sleep Apnea in the Lack of Comorbidities

In this study, we aimed to evaluate the effect of CPAP treatment on hemograms of patients with severe OSA in the lack of comorbidities which might affect the real values of hematological parameters. This retrospective cohort study patients selected from those whose polysomnography reports were compatible with severe OSAS and who underwent PAP titration in our sleep medicine department. 49 patients were enrolled to the study. The baseline hemograms of the participants were collected from one of the patients' visits before they started to use CPAP devices. The control hemograms were evaluated from one of the control visits in the first six months of treatment. We examined the red cell distribution width (RDW), mean platelet volume (MPV), hemotocrit (Hct) and platelet (Plt) count from the hemograms. The mean age was 58.2 years ± 11.3 years, 38.8% were female and 61.2% were male. 69.4% were non-smokers and 30.6% were ex-smokers. The mean body mass index (BMI) was 31.6 ± 5.8 while the mean apnea hypopnea index (AHI) was 50.2 ± 29. The mean duration of CPAP therapy was 4.8 months ± 3.3 months. The mean RDW, MPV, Hct and Plt count values before CPAP treatment were in normal ranges of laboratory tests. All of the values reduced after CPAP therapy but only the decrease in MPV was statistically significant. The reduced values supported that CPAP treatment helped to control hypercoagulability and prevented from cardiovascular disorders in OSAS. Hemogram may be a cheap and easily found laboratory test for monitoring the response to CPAP therapy.

Red Cell Distribution Width Is Associated with All-Cause and Cardiovascular Mortality in Patients with Diabetes.

Background and Methods Red cell distribution width (RDW) has emerged as a prognostic marker in patients with cardiovascular diseases. We investigated mortality in patients with diabetes included in the National Health and Nutrition Examination Survey, in relation to baseline RDW. RDW was divided into 4 quartiles (Q1: ≤12.4%, Q2: 12.5%–12.9%, Q3: 13.0%–13.7%, and Q4: >13.7%). Results A total of 3,061 patients were included: mean age 61 ± 14 years, 50% male, 39% White. Mean RDW was 13.2% ± 1.4%. Compared with first quartile (Q1) of RDW, patients in Q4 were more likely to be older, female, and African-American, have had history of stroke, myocardial infarction, and heart failure, and have chronic kidney disease. After a median follow-up of 6 years, 628 patient died (29% of cardiovascular disease). Compared with Q1, patients in Q4 were at increased risk for all-cause mortality (HR 3.44 [2.74–4.32], P < .001) and cardiovascular mortality (HR 3.34 [2.16–5.17], P < .001). After adjusting for 17 covariates, RDW in Q4 remained significantly associated with all-cause mortality (HR 2.39 [1.30–4.38], P = 0.005) and cardiovascular mortality (HR 1.99 [1.17–3.37], P = 0.011). Conclusion RDW is a powerful and an independent marker for prediction of all-cause mortality and cardiovascular mortality in patients with diabetes.

Elevated Red Cell Distribution Width as a Prognostic Marker in Severe Sepsis: A Prospective Observational Study.

Introduction:Sepsis is a dysregulated host response to infection resulting in potentially life-threatening organ dysfunction. Elevation in red cell distribution width (RDW), a simple routinely done investigation, could be a prognostic marker in these patients.Methods:Between January 2014 and June 2015, 200 patients with severe sepsis at admission were prospectively evaluated for association between RDW at admission and 30-day mortality. Besides the groups of raised and normal RDW, study population was further analyzed after categorizing into three RDW groups as follows: ≤14.5%, 14.6–17.3%, and >17.3% as well. To find out factors associated independently with 30-day mortality, we applied multivariate logistic regression analysis.Results:Among 200 patients, 115 (57.5%) were males. Mean age of the study subjects was 51.32 ± 16.98 years. Mean RDW at admission was 17.40 ± 3.21%, ranging from 12.6% to 33.3%. Mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score of study population at admission was 22.49 ± 5.72. One hundred and fourteen (57%) patients had 30-day mortality. Even though RDW showed a hierarchical association with 30-day mortality among three RDW groups, it was not found to be an independent predictor of 30-day mortality. APACHE II score, serum albumin, partial pressure of arterial oxygen/fraction of inspired oxygen ratio, and serum fibrinogen level at admission were observed to be independent predictors of 30-day mortality.Conclusions:In severe sepsis patients, RDW though showed a graded relationship with 30-day mortality was not found to be an independent predictor of 30-day mortality.

Anisocytosis Predicts Worse Survival in Secondary Polycythemia

▪Background: Red cell overproduction in certain lung and heart conditions causing hypoxia is a well-known entity. This mechanism is thought to be compensatory to the chronic hypoxia. But how this red cell overproduction and other red cell variables affect the morbidity and mortality of these secondary or reactive erythrocytosis patients has not been studied. Our goal is to see the effect of red cell parameters and other routinely obtained laboratory values in the clinical outcomes of secondary erythrocytosis patients in our ethnically diverse and large urban population.Methods: Patients ≥ 18 years of age seen at our center from 1998 to 2015 with a diagnosis of polycythemia or erythrocytosis, either primary or secondary, with follow up of at least one year, were included. This was done with the help of Clinical Looking Glass software after obtaining Institutional Review Board approval. Secondary erythrocytosis was confirmed by evaluating each medical record in detail. After confirming diagnosis, further evaluation and data collection were obtained including demographic variables, the following lab values at diagnosis and the mean values since diagnosis: Hemoglobin (Hb), Mean Corpuscular Volume( MCV), Red Cell Distribution Width ( RDW), White Blood Cell counts ( WBC), platelet counts and albumin level. All analyses were conducted using STATA statistical software. Kaplan-Meier curves were constructed to compare survival by various subgroups. Hazard ratios were calculated using multivariate Cox regression models to adjust for co-variates to compare mortality risk and identify potential independent predictors of mortality.Results: 190 patients with secondary erythrocytosis and 69 patients with Primary Polycythemia Vera were included in the study. Our population with secondary erythrocytosis consisted of 48 % Hispanic, 27 % Caucasian and 25% African American subjects. The main causes of secondary erythrocytosis were Lung and cardiac diseases, namely Chronic Obstructive Pulmonary Disease (COPD) in 29% and Obstructive Sleep Apnea (OSA) in 15%. Figure 1 depicts the various causes of secondary erythrocytosis. We found significant higher survival in patients with secondary erythrocytosis compared to Primary Polycythemia Vera (p value: 0.05) as shown in Figure 2a. Amongst the various laboratory parameters, the strongest interaction with the disease status was of mean RDW with secondary erythrocytosis. Subjects with high mean RDW had significantly worse survival in the secondary erythrocytosis group with a p value of 1.02*10-6. Another intriguing finding was that higher hemoglobin levels, both at diagnosis and mean values, were not associated with worse survival in these patients. When we further evaluated secondary erythrocytosis patients with high RDW (> 16.1) to normal RDW, there was a very significantly worse survival in patients with high RDW (p-value = 7*10-5). Also, when we compared secondary erythrocytosis with high RDW and Primary Polycythemia patients, there was no difference in survival (Figures 2b and c).Conclusions: This is a novel study in a minority rich population regarding the different common lab parameters in secondary erythrocytosis. RDW is a ubiquitously reported lab value. RDW is a measure of the range of variation of red blood cell volume that is reported as part of a standard complete blood count. Anisocytosis is when RBCs are of unequal sizes, thus equivalent to high RDW. Increased RDW has been linked to worse survival in various lung and heart diseases in the past. Our study proves this concept in the patients with reactive erythrocytosis often found in advanced lung and heart disease patients. Furthermore, our study gives a very strong possible explanation for this finding; that disordered overproduction of red blood cells under the stress of chronic hypoxia leads to higher RDW. The degree of hypoxia and resulting dyserythropoiesis might not be very obvious to the treating clinician and observing the trend of RDW could be very helpful in these situations. We conclude that high RDW in patients with secondary erythrocytosis should be taken very seriously and all attempts should be made to treat the underlying condition causing high hemoglobin. [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Importance of Mean Red Cell Distribution Width in Hypertensive Patients.

PurposeRed cell distribution width (RDW), expressed in femtoliters (fl), is a measure of the variation in the size of circulating erythrocytes and is often expressed as a direct measurement of the width of the distribution. We aim to observe the mean value of red cell distribution width (RDW) in hypertensive patients. Increased RDW can be used as a tool for early diagnosis, as an inflammatory marker, and a mortality indicator in hypertensive patients due to its close relation to inflammation.Materials and methodologyHypertensive patients who had the condition for more than one year duration, diagnosed according to the Joint National Committee (JNC 7) criteria were subjected to complete blood count and RDW measurement. One hundred patients, aged between 12 years and 65 years were enrolled from the outpatient department of medicine at the Military Hospital Rawalpindi.ResultsThe mean age (± SD) of the patients was 51.48 ± 10.08 years. Out of 100 patients 69% were males whereas 31% were females. The overall frequency of hypertension more than five years was 55% subjects whereas 45% individuals had duration of hypertension less than five years. Mean RDW in females was found to be 49.35±8.42 fl while mean RDW in males was 44.78±7.11 fl. An independent sample t-test was applied to assess if there was any significant difference between age and gender. No significant difference between age and gender was found (p<0.05). The Mann-Whitney test was used to assess any association of RDW with gender. RDW values in females was found to be statistically significantly higher than in males (U=603, p=0.01). Linear regression showed that mean RDW value increased with increasing age (P <0.001).ConclusionsA significant number of patients with hypertension have increased levels of RDW. Therefore, it is recommended that serum RDW should be checked regularly in patients with hypertension.

Red cell distribution width in predicting 30-day mortality in patients with pulmonary embolism

PurposeThe aim of the study was to investigate red cell distribution width (RDW) in predicting 30-day mortality in patients with pulmonary embolism (PE). MethodsA single-center, retrospective study design was used between January 1, 2014, and February 1, 2016. The primary end point was 30-day mortality after admission. The RDW predicting value was assessed by receiver operating characteristic curves and area under the curve. ResultsA total of 309 patients with PE were included. The 30-day mortality was 14.9% (46/309). The mean RDW level was 13.9%±0.6% (range, 10.7%-21.9%) at admission. The 30-day mortality was higher in the high-RDW-level group compared with the normal-RDW-level group (12.5% vs 23.5%, χ2=5.140, P=.023), with an odds ratio of 2.164 (95% confidence interval [CI], 1.019-4.450). Logistic regression showed that presence of shock, RDW level, and simplified pulmonary embolism severity index (sPESI) were independent risk factors for 30-day mortality in patients with PE. After adjustment by these risk factors, the adjusted odds ratio was 1.439 (95% CI, 1.024-2.116). The area under the curve for RDW predicting the 30-day mortality was 0.6646 (95% CI, 0.5585-0.7518). The cutoff was 16%. The Youden index for RDW and sPESI was 0.400 and 0.453, respectively. When adding RDW into sPESI, the modified sPESI showed highest prediction accuracy, with Youden index 0.499. ConclusionsOur results suggested that the RDW is a simple and useful indicator in predicting 30-day mortality in patients with PE. However, this conclusion showed be confirmed by prospective study with large sample.