Red Blood Cell Distribution Width-coefficient Of Variation Research Articles

Relationship between red blood cell-related indices and coronary artery calcification.

Red blood cell (RBC) indices such as RBC count and RBC distribution width (RDW) are associated with heart failure and coronary artery disease, but the relationship between RBC indices and coronary artery calcification (CAC) is unclear. This study aimed to investigate RBC indices' correlation with, and predictive value for, the presence and severity of CAC. In this study, 1257 hospitalized patients who received a coronary computed tomography angiography examination were finally selected. Patients were classified into a control group (without CAC, n = 655) and a calcification group (with CAC, n = 602) according to their CAC score. The calcification group was further divided into a low calcification group, medium calcification group, and high calcification group. In the calcification group, the RBC count was lower, and the RDW-standard deviation (SD) and RDW-coefficient of variation (CV) were higher, than those in the control group (P < .05). In the high calcification group, the RBC count was significantly lower, and the RDW-SD and RDW-CV were significantly higher, than those in the low calcification group (P < .05). Multivariate logistic regression analysis showed that RBC count, RDW-SD, and RDW-CV were independent predictors of CAC presence. Furthermore, multivariate logistic regression analysis also showed that RBC count and RDW-SD were independent predictors of severe CAC. RBC indices were significantly associated with the presence and severity of CAC, indicating that these RBC indices have the potential to be predictors of CAC.

Prevalence and spectrum of haemoglobinopathies in females of reproductive age group- A first tertiary care center experience in Punjab, North India.

Thalassemia and hemoglobinopathies are a group of inherited conditions characterized by abnormalities in the synthesis or structure of hemoglobin (Hb). According to estimates, approximately 7% of the world population is a carrier of Hb disorders, leading to high morbidity and mortality. To reduce the burden of these highly prevalent monogenic disorders, detecting them in the carrier stage is crucial to prevent disease progression. We aimed to estimate the prevalence and spectrum of hemoglobinopathies in females in the reproductive (20-40 years) age group. It was a retrospective observational study carried out for 2.5 years (from January 2018 till June 2020). All the females in the age group of 20-40 years age whose blood samples were received in the department for High-Performance Liquid Chromatography (HPLC) were included. The cases with abnormal HPLC findings were analyzed for hematological parameters including hemoglobin, RBC count, and RBC indices [mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), & red cell distribution width - coefficient of variation (RDW-CV)]. Statistical package for social science (SPSS) statistics 21 version for Microsoft Windows (Chicago, USA) was used for statistical analysis of data. The data were described in terms of range, mean ± standard deviation (SD), frequencies (number of cases), and relative frequencies (percentage) as appropriate. During the study period, 72.2% of the females were affected with β-thalassemia trait, followed by HbD Punjab trait (17.8%), HbQ India trait (2.9%), β-thalassemia major (1.8%), and two cases (1.2%) each of HbS trait, HbD Iran trait, and compound heterozygous of HbD Punjab and β-thalassaemia, whereas HbE trait, compound heterozygous of HbQ and β-thalassemia, compound heterozygous of HbJ-variant and β-thalassemia had one case each (0.6%). Preventive strategies are cost-effective and include population screening, premarital screening, screening of spouses, genetic counseling, and prenatal diagnosis. Educating the carrier females about the potential risk and various screening methods may help in controlling the disease.

Red Cell Distribution Width and Platelet Indices in Women with Pre-eclampsia: A Cross-sectional Study

Introduction: To determine the prognosis and fetomaternal outcome in eclampsia and pre-eclampsia, a simple and costeffective approach is to assess the Red cell Distribution Width (RDW) and platelet count. RDW, Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and platelet markers such as Mean Platelet Volume (MPV) have been the subject of research. Aim: To compare the variation of RDW, NLR, PLR, and platelet indices between women with pre-eclampsia and gestational age-matched healthy controls. Materials and Methods: A cross-sectional study was conducted among 208 pregnant women (104 with pre-eclampsia and 104 controls) at the Department of Obstetrics and Gynaecology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India, from January 2020 to June 2021. RDW, NLR, PLR, and platelet indices were analysed after obtaining detailed history, conducting clinical examinations, and relevant investigations. An Independent t-test was used as a test of significance to identify the mean difference between the two quantitative variables. Results: The RDW among cases was 17.05±4.01, whereas among controls, it was 15.09±1.86. The mean age of subjects among case group was 25.72±4.741 years, while in the control group it was 23.25±3.803 years. There was a significant difference in mean Red cell Distribution Width- Coefficient of Variation (RDW-CV) between the two groups. The MPV among cases was 9.86±1.14, while among controls, it was 8.92±1.40 (p-value=0.001). The PDW among cases was 11.30±2.20, and among controls, it was 12.72±3.50. The mean NLR among cases was 5.92±4.94, whereas among controls, it was 4.59±2.22. There was a significant difference in mean platelet count, MPV, PDW, and NLR between the two groups. Conclusion: According to the findings of the current study, RDW, NLR, and MPV were all shown to be higher in women with pre-eclampsia. Additionally, pre-eclamptic women consistently exhibited decreased PDW and platelet counts.

A Scoring System Based on Laboratory Parameters and Clinical Features to Predict Unfavorable Treatment Outcomes in Multidrug- and Rifampicin-Resistant Tuberculosis Patients.

The growth of antibiotic resistance to Mycobacterium TB represents a major barrier to the goal of "Ending the global TB epidemics". This study aimed to develop and validate a simple clinical scoring system to predict the unfavorable treatment outcomes (UTO) in multidrug- and rifampicin-resistant tuberculosis (MDR/RR-TB) patients. A total of 333 MDR/RR-TB patients were recruited retrospectively. The clinical, radiological and laboratory features were gathered and selected by lasso regression. These variables with area under the receiver operating characteristic curve (AUC)>0.6 were subsequently submitted to multivariate logistic analysis. The binomial logistic model was used for establishing a scoring system based on the nomogram at the training set (N = 241). Then, another independent set was used to validate the scoring system (N = 92). The new scoring system consists of age (8 points), education level (10 points), bronchiectasis (4 points), red blood cell distribution width-coefficient of variation (RDW-CV) (7 points), international normalized ratio (INR) (7 points), albumin to globulin ratio (AGR) (5 points), and C-reactive protein to prealbumin ratio (CPR) (6 points). The scoring system identifying UTO has a discriminatory power of 0.887 (95% CI=0.835-0.939) in the training set, and 0.805 (95% CI=0.714-0.896) in the validation set. In addition, the scoring system is used exclusively to predict the death of MDR/RR-TB and has shown excellent performance in both training and validation sets, with AUC of 0.930 (95% CI=0.872-0.989) and 0.872 (95% CI=0.778-0.967), respectively. This novel scoring system based on seven accessible predictors has exhibited good predictive performance in predicting UTO, especially in predicting death risk.

Development of a complete blood count with differential-based prediction model for in-hospital mortality among patients with acute myocardial infarction in the coronary care unit.

PurposeIn recent years, the complete blood count with differential (CBC w/diff) test has drawn strong interest because of its prognostic value in cardiovascular diseases. We aimed to develop a CBC w/diff-based prediction model for in-hospital mortality among patients with severe acute myocardial infarction (AMI) in the coronary care unit (CCU).Materials and methodsThis single-center retrospective study used data from a public database. The neural network method was applied. The performance of the model was assessed by discrimination and calibration. The discrimination performance of our model was compared to that of seven other classical machine learning models and five well-studied CBC w/diff clinical indicators. Finally, a permutation test was applied to evaluate the importance rank of the predictor variables.ResultsA total of 2,231 patient medical records were included. With a mean area under the curve (AUC) of 0.788 [95% confidence interval (CI), 0.736–0.838], our model outperformed all other models and indices. Furthermore, it performed well in calibration. Finally, the top three predictors were white blood cell count (WBC), red blood cell distribution width-coefficient of variation (RDW-CV), and neutrophil percentage. Surprisingly, after dropping seven variables with poor prediction values, the AUC of our model increased to 0.812 (95% CI, 0.762–0.859) (P < 0.05).ConclusionWe used a neural network method to develop a risk prediction model for in-hospital mortality among patients with AMI in the CCU based on the CBC w/diff test, which performed well and would aid in early clinical decision-making. The top three important predictors were WBC, RDW-CV and neutrophil percentage.

Is red blood cell distribution width a prognostic factor for colorectal cancer? A meta-analysis.

BackgroundRDW might be an easy and cost-effective pre-operative prognostic factor for cancer patients. The aim of the current study was to analyze whether red blood cell distribution width (RDW) was a prognostic factor for colorectal cancer (CRC) patients who underwent radical surgery.MethodsWe conducted the searching strategy in three databases including the PubMed, Embase and Cochrane Library from the inception to May 07, 2022, to find eligible studies. In this meta-analysis, we focused on the prognosis. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for overall survival (OS), disease-free survival (DFS) and cancer-specific survival (CSS).ResultsA total of seven studies involving 7,541 patients were included in this meta-analysis. After pooling up the HRs, red blood cell distribution width-coefficient of variation (RDW-CV) was not an independent prognostic factor of OS (HR = 1.48, I2 = 90%, 95% CI = 0.93 to 2.36, P = 0.10), however, red blood cell distribution width-standard deviation (RDW-SD) was an independent prognostic factor of OS (HR = 1.99, I2 = 0%, 95% CI = 1.59 to 2.49, P < 0.01). As for DFS, we found that RDW-CV (HR = 1.51, I2 = 83%, 95% CI = 0.94 to 2.43, P = 0.09 < 0.10) and RDW-SD (HR = 1.77, I2 = 56%, 95% CI = 0.91 to 3.43, P = 0.09 < 0.10) were both the independent prognostic factors. In terms of CSS, we found that RDW-CV was not an independent prognostic factor (HR = 1.23, I2 = 95%, 95% CI = 0.72 to 2.10, P = 0.46).ConclusionRDW-SD was an independent prognostic factor of OS and DFS, and RDW-CV was an independent prognostic factor of DFS.

Red blood cell distribution width as a predictor of cardiovascular outcomes in extensive aortoiliac disease.

Aortoiliac peripheral artery disease may lead to disabling lower limb claudication or to lower limb chronic threatening ischemia, which is associated with increased short and long-term morbi-mortality. The red blood cell distribution width-coefficient of variation (RDW-CV) has been able to predict outcomes in other atherosclerotic diseases, such as myocardial infarction and stroke. The main objective of this study was to assess the predictive ability of perioperative RDW-CV in accurately predicting short and long-term major adverse cardiovascular events (MACE) and all-cause mortality in patients submitted to aortoiliac revascularization due to extensive aortoiliac atherosclerotic disease. From 2013 to 2020, patients who underwent aortoiliac revascularization due to severe aortoiliac disease were included in a prospective cohort. Blood samples were taken preoperatively and the patient's demographics, comorbidities, and postoperative outcomes were assessed. A multivariate Cox regression model was used to adjust for confounding and assess the independent effect of these prognostic factors on the outcomes. The study group included 107 patients. Median follow-up was 57 (95% CI: 34.4-69.6) months. Preoperative RDW-CV was increased in thirty-eight patients (35.5%). Increased RDW-CV was associated with congestive heart failure - adjusted odds ratio of 5.043 (95% CI: 1.436-17.717, P=0.012). It could predict long-term occurrence of MACE (adjusted hazard ratio [aHR] 1.065, 95% CI: 1.014-1.118, P=0.011), all-cause mortality (aHR=1.069, 95% CI: 1.014-1.126, P=0.013), acute heart failure (AHF) (aHR=1.569, 95% CI: 1.179-2.088, P=0.002), and stroke (aHR=1.343, 95% CI: 1.044-1.727, P=0.022). RDW is a widely available and low-cost marker that was able to independently predict long-term AHF, stroke, MACE, and all-cause mortality in patients with extensive aortoiliac disease submitted to revascularization. This biomarker could help assess which patients would likely benefit from stricter follow-up in the long-term.

Thyroid Hormones and Red Cell Indices of HIV Subjects at Enugu

Background: Thyroid hormones act on nearly every cell in the body including red blood cells. Thyroid hormones are also important to proper development and differentiation of all cells of the human body. Human Immunodeficiency Virus (HIV) is a virus that destroys certain cells in the immune system. The aim of this study was to determine free triiodothyronine (FT3), free thyroxine (T4) and red cell indices level of HIV subjects attending clinic at Enugu State University of Science and Technology Teaching Hospital.&#x0D; Study Design: Case control study.&#x0D; Place and Duration of Study: Human Immunodeficiency Virus (HIV) clinic and Haematology Laboratory both of Enugu State University of Science and Technology Teaching Hospital, between August and October 2021.&#x0D; Methodology: Sixty HIV subjects and thirty apparently healthy individuals within the age range of 30 - 60 years were recruited for this study. Free triiodothyronine (FT3), free thyroxine (FT4), hemoglobin (HGB), packed cell volume (PCV), red blood cell count (RBC), mean cell volume (MCV), mean cell hemoglobin (MCH), mean cell hemoglobin concentration (MCHC), red cell distribution width standard deviation (RDW-SD), red cell distribution width coefficient of variation (RDW-CV) were determined in HIV subjects and apparently healthy individuals. &#x0D; Results: There was significant difference in MCV (125.79+/- 7.57 vs 78.89+/- 5.71 fl), MCH (23.17+/- 2.10 vs27.21+/- 3.68 pg), MCHC (25.08+/- 2.74 vs30.09+/- 3.27 g/dl), RDW-SD (61.52+/- 7.55 vs46.23+/- 5.87 fl), RDW-CV (23.06+/- 5.78 vs43.87+/- 1.28 fl) and PCV (39.38+/- 3.06 vs31.75+/- 2.44 %) between patients on antiretroviral therapy (ART) and ART-naïve patients respectively. There was significant difference in T4 (8.29+/- 1.29 vs 6.12 µg/dl), MCV (78.89+/- 5.71 vs 84.47 +/- 3.79 fl), MCH (27.21+/- 3.68 vs 29.20 +/- 2.27 pg), RDW-CV (43.87+/- 1.28 vs 12.51 +/- 1.08 fl) and PCV (31.75+/-2.44vs 37.63+/-2.95 %) on ART-naïve patients and apparently healthy subjects respectively. There was a positive correlation between FT3 and MCH in HIV patients on antiretroviral therapy (ART) (p= 0.016).&#x0D; Conclusion: In people taking antiretroviral therapy, mean cell haemoglobin, mean cell hemoglobin concentration and red cell distribution width coefficient of variation significantly reduced, as well as raised mean cell volume and red cell distribution width standard deviation. This study also observed reduced mean cell haemoglobin, mean cell haemoglobin concentration and mean cell volume in ART- naïve subjects.

Predicting Response of Severe Aplastic Anemia to Rabbit-Antithymocyte Immunoglobulin Based Immunosuppressive Therapy Combined With Eltrombopag.

Addition of eltrombopag (E-PAG) to intensive immunosuppressive therapy (IST) contributes to restoring hematopoiesis in patients with severe aplastic anemia (SAA). Used at relatively low doses in the East Asian population, the efficacies of E-PAG and the predictors for efficacy are not clear. We conducted a retrospective, multicenter study to analyze the efficacy and the possible predicting factors at 6 months in 58 adult SAA patients with rabbit ATG-based IST and E-PAG. The response rate and complete response rate at 6 months were 76% and 21%, respectively. The baseline reticulocyte percentage [area under a curve (AUC)=0.798, 95% confidence interval (CI) 0.640-0.956, P=0.006], absolute reticulocyte count (ARC) (AUC =0.808, 95%CI 0.647-0.970, P=0.004), red cell distribution width – coefficient of variation (RDW-CV) (AUC=0.722, 95%CI 0.494-0.950, P=0.040), and absolute lymphocyte count (ALC) (AUC=0.706, 95%CI 0.522-0.890, P=0.057) were highly predictive of response at 6 months. The tipping values of reticulocyte percentage, ARC, RDW-CV, and ALC were 0.45%, 7.36×109/L, 11.75%, and 1.06×109/L, respectively. The sensitivity and specificity of reticulocyte percentages were 81.6% and 66.7%; ARC were 86.8% and 66.7%, RDW-CV were 94.7% and 55.6%; ALC were 55.3% and 88.9%. At a median follow-up of 15.5 months, the 2-year cumulative overall survival was 92%. The baseline reticulocyte percentage, ARC, RDW-CV, and ALC were potential factors in predicting a favorable effect of rabbit-ATG based IST plus E-PAG in SAA patients of East Asia (ChiCTR2100045895).Clinical Trial Registrationhttp://www.chictr.org.cn/edit.aspx?pid=125480&htm=4, identifier ChiCTR2100045895.

A Critical Analysis of the Automated Hematology Assessment in Pregnant Women at Low and at High Altitude: Association between Red Blood Cells, Platelet Parameters, and Iron Status.

The objectives of the study were to determine differences in the parameters of red blood cells (RBC), white blood cells (WBC), and platelets at low altitude (LA) and at high altitude (HA) and with the gestation being advanced, and to determine correlations between parameters of RBC and platelets. We also studied the association of RBC and platelets with markers of iron status. In addition, markers of iron status and inflammation were measured and compared at each trimester of gestation in pregnant women at LA and HA. A cross-sectional comparative study was conducted at Lima (150 m above sea level) and Cusco at 3400 m above sea level from May to December 2019. Hematological parameters in pregnant women (233 at LA and 211 at HA) were analyzed using an automated hematology analyzer. Serum ferritin levels, soluble transferrin receptor (sTfR), hepcidin, erythropoietin, testosterone, estradiol, and interleukin-6 (IL6) levels were measured by ELISA. One-way ANOVA supplemented with post hoc test, chi-square test, and Pearson correlation test statistical analyses were performed. p < 0.05 was considered significant. Pregnant woman at HA compared to LA had significantly lower WBC (p < 0.01), associated with higher parameters of the RBC, except for the mean corpuscular volume (MCV) that was no different (p > 0.05). Platelets and mean platelet volume (MPV) were higher (p < 0.01), and platelet distribution width (PDW) was lower at HA than at LA (p < 0.01). A higher value of serum ferritin (p < 0.01), testosterone (p < 0.05), and hepcidin (p < 0.01) was observed at HA, while the concentration of sTfR was lower at HA than at LA (p < 0.01). At LA, neutrophils increased in the third trimester (p < 0.05). RBC parameters decreased with the progress of the gestation, except RDW-CV, which increased. The platelet count decreased and the MPV and PDW were significantly higher in the third trimester. Serum ferritin, hepcidin, and serum testosterone decreased, while sTfR and serum estradiol increased during gestation. At HA, the WBC and red blood cell distribution width- coefficient of variation (RDW-CV), PCT, and serum IL-6 did not change with gestational trimesters. RBC, hemoglobin (Hb), hematocrit (Hct), mean corpuscular hemoglobin concentration (MCHC), and platelet count were lower as gestation advanced. MCV, MPV, and PDW increased in the third trimester. Serum ferritin, testosterone, and hepcidin were lower in the third trimester. Serum estradiol, erythropoietin, and sTfR increased as gestation progressed. Direct or inverse correlations were observed between RBC and platelet parameters and LA and HA. A better number of significant correlations were observed at HA. Hb, Hct, and RDW-CV showed a significant correlation with serum ferritin at LA and HA. Of these parameters, RDW-CV and PDW showed an inversely significant association with ferritin (p < 0.05). In conclusion, a different pattern was observed in hematological markers as well as in iron status markers between pregnant women at LA and HA. In pregnant women a significant correlation between several RBC parameters with platelet marker parameters was also observed. Data suggest that pregnant women at HA have adequate iron status during pregnancy as reflected by higher serum ferritin levels, lower sTfR levels, and higher hepcidin values than pregnant women at LA.

Red cell distribution width as a predictor of impaired exercise capacity in patients with heart failure

Aim To test a hypothesis that increased values of red cell distribution width (RDW) in patients with chronic heart failure (CHF) can be related with low exercise tolerance.Material and methods 102 patients were evaluated who had CHF with mid-range and reduced left ventricular ejection fraction (LV EF) without anemia (72% men, mean age 66±10.2 years). Cardiopulmonary stress test (CPST), echocardiography, 6‑min walk test (6MWT), blood count, and measurements of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and serum iron were performed.Results The average LV EF was 39±8.7 %; the peak oxygen consumption (VO2peak) was 13.7±4.8 ml /kg /min; and the median NT-pro-BNP was 595.3 pg /ml (Q1-3 1443-2401). RDW variables, including the RDW coefficient of variation (RDW-CV) and RDW standard deviation (RDW-SD), were not significantly related with serum iron or hemoglobin concentrations. A one-factor linear regression analysis showed a significant correlation of VO2peak with RDW-SD (р=0.039). A multivariate linear regression analysis with adjustments for LV EF, hemoglobin concentration, and age did not reveal any significant correlation of VO2peak with RDW variables. The distance covered in the 6MWT was significantly associated with RDW-CV both in the one-factor analysis and with adjustments for LV EF, hemoglobin and serum iron concentrations, and age.Conclusion This study showed that high RDW values in CHF patients without anemia predicted low exercise tolerance regardless of the age, LV systolic function, and hemoglobin and serum iron concentrations. A 16% increase in RDW-CV significantly decreased the likelihood of covering a distance longer than 360 m during 6 min.

Association Between Red Blood Cell Indices and Preoperative Deep Vein Thrombosis in Patients Undergoing Total Joint Arthroplasty: A Retrospective Study.

To investigate the association of red blood cell (RBC), hemoglobin (Hb), red cell distribution width-coefficient of variation (RDW-CV), and red cell distribution width-standard deviation (RDW-SD) with preoperative deep vein thrombosis (DVT) in patients undergoing total joint arthroplasty (TJA). A total of 2059 TJA patients were enrolled. We used the ratios of RBC, Hb, RDW-CV, and RDW-SD to DVT before TJA to create the receiver operator characteristic (ROC) curve, thereby calculating the cut-off values and the area under the curve (AUC). The patients were categorized into groups based on cut-off value, and risk factors for DVT before TJA were subsequently analyzed. We included the variates that were statistically significant in the univariate analysis in the multivariate binary logistic regression analysis. Preoperative DVT occurred in 107 cases (5.20%). Based on the ROC curve, we found that the AUC for RBC, Hb, RDW-CV, and RDW-SD were 0.658, 0.646, 0.568, and 0.586, respectively. Multivariate binary regression analysis revealed that the risk of preoperative DVT in TJA patients with RBC≤3.92*109 /L, Hb≤118g/L, RDW-CV≥13.2%, and RDW-SD≥44.6fL increased 3.02 (P < 0.001, 95% confidence interval (CI) [2.0-4.54]), 2.15 (P < 0.001, 95% CI [1.42-3.24]), 1.54 (P = 0.038, 95% CI [1.03-2.3]), and 1.98 times (P = 0.001, 95% CI [1.32-2.98]), respectively. The risk of preoperative DVT in patients with corticosteroid use increased approximately 2.6 times (P = 0.002, 95% CI [1.22-5.81]). We found that decreased RBC and Hb, increased RDW-CV and RDW-SD, and corticosteroid use were independent risk factors for preoperative DVT in patients undergoing TJA.

Positive Relationship of RDW with NT-proBNP and cTnI in Acute Myocardial Infarction Patients.

The goal of the study was to investigate the relationship of several parameters of complete blood count (CBC) with N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI) in a cohort of acute myocardial infarction (AMI) patients. One hundred and one AMI patients were analyzed in this retrospective study. CBC, serum NT-proBNP, and cTnI levels were detected at the time of admission and on the day before or the day of discharge. The correlation between CBC with NT-proBNP and cTnI was analyzed. In this study, we found that red cell distribution width (RDW), red cell distribution width - coefficient of variation (RDW-CV), monocyte/lymphocyte ratio (MLR), neutrophil/lymphocyte ratio (NLR), NT-proBNP, and cTnI were significantly higher in AMI patients on the day of admission than the day before or the day of discharge. RDW and RDW-CV were significantly related with serum NT-proBNP and cTnI levels both at the time of admission and the day before or the day of discharge. RDW and RDW-CV were changed dramatically and synchronized with serum NT-proBNP and cTnI levels after the recovery. These results suggested that RDW and RDW-CV could be used as simple and convenient indicators to assess the condition of AMI patients.

Abstract 10330: Intermittent Fasting Interacts with Red Cell Distribution Width to Differentially Improve Cardiometabolic Health

Introduction: Intermittent fasting reduces weight and cardiometabolic risk factors. In the WONDERFUL Trial (NCT02770313), intermittent fasting reduced homeostatic model assessment of insulin resistance (HOMA-IR) and the Metabolic Syndrome Score (MSS), with insulin having the largest decline. The red cell distribution width (RDW) measures the dispersion of red blood cell size, is strongly predictive of mortality and major adverse events, and may be a biomarker of general health. This post hoc study of subjects from the WONDERFUL Trial examined the interactive effect of intermittent fasting and baseline RDW on changes in insulin, glucose, HOMA-IR, and MSS. Methods: Subjects aged 21-70 years who had pre-diabetes, diabetes, or ≥1 other metabolic syndrome factor and modestly elevated LDL-C were enrolled if they were not taking anti-diabetic or statin medications and were free of chronic diseases (N=71; n=38 intermittent fasting, n=33 controls). Subjects were randomized to 24-hour water-only fasting (twice-weekly for 4 weeks followed by once-weekly for 22 weeks) or ad libitum eating (control) for 26 weeks. Results: Age averaged 49.1±11.1 years and 64.8% were female. Change scores stratified by RDW size distribution (RDW-SD) are shown in the Table. Results were similar when the RDW coefficient of variation (RDW-CV) was used. Intermittent fasting did not change RDW-SD (1.27±9.6 fL vs. control: -0.37±1.76 fL, p=0.34) or RDW-CV (-0.15%±0.55% vs. control: -0.11%±0.45%, p=0.76) over the 26-week trial. Conclusions: Compared to controls, intermittent fasting significantly decreased insulin more in subjects with higher baseline RDW than those with RDW ≤median. This differential effect may also apply to changes in HOMA-IR, glucose, and MSS. These findings should be validated and expanded in larger studies since RDW may identify people who would derive the most cardiometabolic benefit from engaging in intermittent fasting.

Red blood cell distribution width-standard deviation but not red blood cell distribution width-coefficient of variation as a potential index for the diagnosis of iron-deficiency anemia in mid-pregnancy women.

The aim of this study was to compare the diagnostic values of red blood cell distribution width-coefficient of variation (RDW-CV) and red blood cell distribution width-standard deviation (RDW-SD) in mid-pregnancy women with iron deficiency anemia (IDA). To obtain the results, 115 mid-pregnancy women with IDA, defined as the IDA group, and 142 healthy mid-pregnancy women, selected as the control group, were enrolled in this study. Hematological parameters and ferritin concentrations in the serum were analyzed. The efficiency of RDW-CV and RDW-SD to distinguish IDA from mid-pregnancy women was evaluated using receiver operating characteristic (ROC) curves. The RDW-SD value in the IDA group was significantly higher than that in the control group (p < 0.05), while the RDW-CV value did not differ between them (p = 0.84). Significantly negative correlations were found between RDW-CV (r = −0.297, p = 0.001), RDW-SD (r = −0.404, p = 0.000), and serum ferritin in the IDA group but not in the control group. For the diagnosis of IDA, RDW-CV and RDW-SD produced areas under the ROC curves of 0.58 and 0.84. To conclude, our results suggest that RDW-SD, but not RDW-CV, can be used as a diagnostic index of IDA for mid-pregnancy women.

Predictors of Efficacy in Chinese Patients with Severe Aplastic Anemia Treated with Eltrombopag and Intensive Immunosupressive Therapy

Prospective trials showed the clinical efficacy of eltrombopag in refractory/relapsed aplastic anemia (AA), with up to 40% hematologic improvement [1]. Moreover, eltrombopag was combined with frontline immunosupressive therapy (IST) consisited of antithymocyte immunoglobulin (ATG) and cyclosporin (CsA), with an overall response rate exceeding 80% [2]. The metabolism of eltrodopag is different in disparate population. Currently, the recommended dose is 75 mg/d for East Asian populations [2], Pretreatment clinical and laboratory characteristics predicting eltrombopag response are still unclear in severe AA (SAA) patients of real-world in East Asian.From May 2014 to December 2020, 59 adult SAA patients were treated with IST (r-ATG, 3.5mg/kg/d × 5d and CsA 3-5 mg/kg/d) in conjunction with eltrodopag at the dose of 75 mg/d from day 1 until 6 months. We used Receiver Operating Characteristic (ROC) curve to predict the factors of the efficacy of eltrombopag.Median follow-up was 13 months (6 month to 29 months). Overall 45 patients (76%) responded to eltrombopag, including 16 patients (27%) who achieved complete response (CR) and 29 patients (49%) who achieved partial response (PR), whist 14 patients were non-remission (NR) according to the criteria of the European Group for Blood and Marrow Transplantation (EBMT) [3].The severity (P=0.032), infection (P=0.039) and lymphocyte count (P=0.021), as well as reticulocyte percentage (P=0.002) were different significantly between groups before the treatment (Table 1). Yet, the median age (38 years and 50.5 years) and median time from diagnosis to treatment (16 d and 27.5 d) are comparable. There was no significant difference in the count of platelet and T cell subsets of peripheral blood.ROC curve was used as one model to predict factors linked to the effects of eltrodopag in 6 months. The lymphocyte count (P=0.042, AUC=0.721, 95%CI 0.537-0.904), the percentage of reticulocyte (P=0.007, AUC=0.793, 95%CI 0.631-0.955), and red cell distribution width - coefficient of variation (RDW-CV) (P=0.042, AUC=0.721, 95%CI 0.493-0.948) were positively correlated with the efficacy of eltrombopag (Table 2, Figure 1).DiscussionIt has been reported that moderate diseaseand lymphoid marrow infiltration were related with the response to eltrombopag in older AA patients [4]. Scheinberg et al. has showed that predictive factors related to IST of 6th month were including the age, lymphocyte count and reticulocyte count [5]. We found that the lymphocyte count, the percentage of reticulocytes and RDW-CV were related with response. The increase of RDW-CV is related to production of reticulocyte. A higher lymphocyte count, the percentage of reticulocytes and RDW-CV may indicate better residual marrow function. Lymphocyte count is also associated with abnormal immunity. Hematopoietic recovery of SAA depends on IST involving elimination of autoreactive T cells that target progenitor cells in the bone marrow, and sufficient residual stem cells to support blood cell production after IST. IST combined with eltrombopag could eradicate autoreactive T cells and promote hematopoiesis simultaneously, thereby, the relevant indicators for predicting efficacy also reflect this related status.This study was limited by its retrospective nature, small cohorts, an absence of randomization a treatment comparator, and IST was based on r-ATG and CsA. In preliminar conclusion, the pretreatment lymphocyte count, the percentage of reticulocytes and RDW-CV together serve as a simple predictor of response following IST combined with eltrombopag for Chinese patients with SAA.Reference[1] Olnes MJ, et al. Eltrombopag and improved hematopoiesis in refractory aplastic anemia. N Engl J Med. 2012;367(3):11-19.[2] Townsley DM, et al. Eltrombopag Added to Standard Immunosuppression for Aplastic Anemia [J]. N Engl J Med, 2017, 376 (16): 1540-1550.[3] de Latour, RP, et al. Results of the EBMT SAAWP Phase III Prospective Randomized Multicenter RACE Study of Horse ATG and Ciclosporin with or without Eltrombopag in naive SAA patients. EBMT 2020 abstract O018.[4] Fattizzo B, et al. Clinical and morphological predictors of outcome in older aplastic anemia patients treated with eltrombopag. Haematologica. 2019 Nov;104(11): e494-e496.[5] Scheinberg P,et al. Predicting response to immunosuppressive therapy and survival in severe aplastic anaemia. Br J Haematol. 2009 Jan;144(2):206-16. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

The Coefficient of Variation of Red Blood Cell Distribution Width Combined with Cancer Antigen 125 Predicts Postoperative Overall Survival in Endometrial Cancer.

PurposeThis study assessed the prognostic value of red blood cell distribution width (RDW) and cancer antigen 125 (CA125) in predicting the prognosis of endometrial cancer (EC) patients.Patients and MethodsIn this study, we included 525 patients with EC between January 2013 and January 2019. Demographic and clinical indicators were collected, and the receiver operating characteristics curve (ROC) and cutoff values were calculated between the early and advanced stages of EC. Independent risk factors associated with EC prognosis were assessed using Cox regression analyses and the Kaplan–Meier method.ResultsCompared to women in the early stage of EC, women with advanced stage had significantly elevated RDW coefficient of variation (RDW-CV) and CA125 levels and lower mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) (both P < 0.05). Consequently, RDW-CV and CA125 were found to be independent risk factors for EC by using ROC curve and multivariate logistic regression analysis. The survival analysis curve was used to assess the diagnostic value of RDW-CV, CA125, and their combination in the prognosis of EC. The results showed that patients with high expression of RDW-CV and CA125 had worse overall survival than those with low expression. Moreover, multivariate Cox regression analysis indicated that RDW-CV+CA125=2 was an independent prognostic factor.ConclusionThese findings suggest that CA125 combined with RDW-CV has a good prognostic value for EC. Thus, the RDW-CV+CA125 score is a promising prognostic marker for the clinical decision-making process regarding EC outcomes.

Efficacy of circulating microRNA-130b and blood routine parameters in the early diagnosis of gastric cancer.

Patients with gastric cancer (GC) have a poor prognosis, which is mainly due to the low rate of early diagnosis. The present study aimed to evaluate whether circulating microRNA-130b (miR-130b) and blood routine parameters [neutrophil count (N#), lymphocyte count (L#), monocyte count (M#), neutrophil percentage (N%), lymphocyte percentage (L%), monocyte percentage (M%), hemoglobin (Hb) level, hematocrit (Hct), red blood cell distribution width (RDW), platelet count, platelet distribution width (PDW), mean platelet volume (MPV), MPV to platelet count ratio (MPV/PC), monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR)] are useful biomarkers for GC, early stage GC (EGC) and precancerous lesion (Pre) detection, and to identify more effective diagnostic models by combining circulating blood markers. Circulating levels of M#, M%, RDW-coefficient of variation (RDW-CV), MPV, PDW, MLR and NLR were significantly higher, and the levels of Hb and L% were significantly lower in patients with GC and Pre compared with those in healthy controls (NCs) (all P<0.05). The N#, N% and PLR in patients with GC were significantly higher and the Hct was significantly lower than those in the NCs (all P<0.05). The values of MPV/PC were significantly higher in the Pre cohort compared with those in the NCs. The area under the curve (AUC) of the receiver operating characteristic curve of potential biomarkers for GC was 0.634–0.887 individually, and this increased to 0.978 in the combination model of miR-130b-PDW-MLR-Hb. Additionally, the values for RDW-CV, PLR, NLR, N# and N% were positively correlated with cancer stage, while the values for MPV, L#, L%, Hb and Hct were negatively correlated with cancer stage. Furthermore, the circulating levels of miRNA-130b, and the values for NLR, RDW-CV, PDW, M%, red blood cell count, Hct, Hb and MLR differed between the EGC and NC groups. The AUC values of these biomarkers were 0.6491–0.911 individually in the diagnosis of EGC, and these increased to 0.960 in combination. In addition, the AUC values for miR-130b, RDW-CV, MPV/PC ratio, MLR, NLR, PDW, L%, M%, M# and Hb in the diagnosis of Pre were 0.638–0.811 individually. The dual-model of miR-130b-PDW manifested the largest AUC of 0.896 in the diagnosis of Pre, and the sensitivity and accuracy were increased when miR-130b and PDW were combined. All these results suggested that circulating miR-130b and blood routine parameters might be potential biomarkers, and combinations of measurements of these biomarkers may improve the GC, EGC and Pre diagnostic accuracy.

Could fibrinogen to albumin ratio be a predictive marker for recurrent pregnancy loss.

Recurrent pregnancy loss (RPL) is usually defined by two or more consecutive clinical miscarriages, which causes psychological trauma for couples. In this study, we aimed to investigate the predictive role of fibrinogen to albumin ratio (FAR) in patients with RPL. Pregnant women in their first trimester of pregnancy were included in the study and divided into two groups as RPL patients (n: 44) and patients with no previous recurrent miscarriage (n: 60) as control group. Demographical parameters and routine blood parameters (fibrinogen, D-dimer, FAR, neutrophil to lymphocyte ratio [NLR], platelet count, main platelet volume [MPV], and red cell distribution width [RDW] values) were compared between the RPL group and the control group. The groups were determined to be statistically different in regard to gravidity and parity (P<.001). The difference between the groups was statistically different in regard to fibrinogen (mg/dL), albumin (g/dL), FAR (%), NLR (%), RDW-coefficient of variation (%), RDW-standard deviation (fl), and platelet counts (10-3 /μL). However, MPV (fl) and D-dimer (μg/L) levels were similar in both groups. The receiver operating characteristic curve analysis revealed that the NLR levels were 84.1% sensitive and 75% specific with a cut-off value of 4.27 and the FAR levels were 79.5% sensitive and 88.3% specific with a cut-off value of 105.69 for predicting RPL. Our results indicate that the FAR and NLR levels seem to be effective parameters for predicting RPL with high sensitivity and specificity.

Effect of Phoxilium on prognostic predictors in patients undergoing continuous venovenous hemodiafiltration.

BackgroundPhosphorus-containing dialysis solution is used to prevent hypophosphatemia in patients undergoing continuous venovenous hemodiafiltration (CVVHDF). This study evaluated the effect of phosphorus-containing dialysis solution on mortality in patients undergoing CVVHDF based on changes in phosphorus and red cell distribution width-coefficient of variation (RDW-CV) levels.MethodsWe included 272 patients with acute kidney injury (AKI) who underwent CVVHDF at the medical intensive care unit from 2017 to 2019 and classified them according to Phoxilium (Baxter Healthcare Ltd.), as a phosphorus-containing dialysis solution, use within 48 hours after CVVHDF initiation. Clinical data were collected at baseline and 48 hours after CVVHDF initiation. The primary outcome was all-cause mortality during the follow-up period.ResultsThe non-Phoxilium (NP) group had higher phosphorus and lower RDW-CV levels than the Phoxilium (P) group (phosphorus, 7.3 ± 4.3 vs. 5.0 ± 2.8 mg/dL; RDW-CV, 14.6 ± 1.9 vs. 15.7 ± 2.6%; all p < 0.001). In the multivariable Cox proportional hazard regression of the NP group, an increase in phosphorus and RDW-CV at 48 hours of CVVHDF was associated with mortality (delta phosphorus: median, >0 mg/dL vs. <–2.0 mg/dL; hazard ratio [HR], 8.62; 95% confidence interval [CI], 2.10–35.32; p = 0.003/delta RDW-CV: median, >0% vs. <–0.2%; HR, 4.34; 95% CI, 1.49–13.18; p = 0.008). Meanwhile, in the P group, an increase in delta RDW-CV was associated with mortality (delta RDW-CV: >0% vs. >–0.2% and <0%; HR, 2.65; 95% CI, 1.12–6.24; p = 0.03), while an increase in delta phosphorus was not.ConclusionIn patients with AKI undergoing CVVHDF, the risk factors for all-cause mortality differed according to the initial phosphorus levels and use of Phoxilium.