Red Blood Cell Distribution Width In Patients Research Articles

Prognostic value of red blood cell distribution width combined with chloride in predicting short- and long-term mortality in critically ill patients with congestive heart failure: Findings from the MIMIC-IV database

BackgroundHypochloremia and red blood cell distribution width (RDW) play important roles in congestive heart failure (CHF) pathophysiology, and they were associated with the prognosis of CHF. However, the prognostic value of chloride combined with RDW in patients with CHF remains unknown. MethodsWe retrospectively analyzed critically ill patients with CHF. The database was derived from the Medical Information Mart for Intensive Care IV v2.0 (MIMIC-IV-v2.0) database. ResultsIn the final analysis, 5376 critically ill patients with CHF were included, and 2428 patients (45.2 %) experienced 5-year mortality. The restricted cubic spline model revealed a positive correlation between RDW and 5-year mortality, whereas chloride showed a U-shaped correlation with 5-year mortality. The median values of RDW and chloride were used to classify patients into four groups: high chloride/low RDW, low chloride/low RDW, high chloride/high RDW, and low chloride/high RDW. We observed the prognostic value of RDW combined with chloride in the Cox proportional hazard model, in predicting 5-year mortality, in-hospital mortality and 1-year mortality. Furthermore, we discovered that patients with chronic kidney disease (CKD) had a higher 5-year mortality risk than patients without CKD. ConclusionWe found the translational potential role of chloride combined with RDW in prioritizing patients at high risk for short- and long-term mortality in a cohort of critically ill patients with CHF. Prospective multicenter investigations are warranted to validate our results.

Relation between red blood cell distribution width and 30-day in-hospital mortality of patients with ventilator-associated pneumonia

BackgroundEpidemiological studies have demonstrated an association between red blood cell distribution width (RDW) and the prognosis of pneumonia-associated diseases. However, prognostic value of RDW in patients with ventilator-associated pneumonia (VAP) has yet to be investigated. This study aimed to explore the association between RDW and in-hospital mortality in VAP patients and explore predictive value of RDW for VAP patients.MethodsThis retrospective cohort study included 1,543 VAP patients from the Medical Information Mart for Intensive Care IV database 2008-2019. The primary outcome was considered to 30-day in-hospital mortality of VAP patients in this study. Non-high RDW level group was defined as <15 %, and high RDW level group as ≥15%. The possible confounding factors were screened by least absolute shrinkage and selection operator regression. Univariate and multivariate COX regression analyses were used for the assessment on the association of RDW and 30-day in-hospital mortality in VAP patients. We also performed subgroup analyses. Furthermore, a comparative analysis of RDW and sequential organ failure assessment (SOFA) score and simplified acute physiology score II (SAPS II) were performed by receiver operating characteristic (ROC) curves.ResultsThe 30-day in-hospital mortality of VAP patients was approximately 19.05%. After adjusting all confounding factors, high RDW was associated with 30-day in-hospital mortality among VAP patients by using non-high RDW as the reference [hazard ratio (HR) =1.29, 95% confidence interval (CI): 1.01-1.63]. Additionally, the relationship was also robust in several populations, such as patients were younger than 60 years, or had not a history of congestive heart failure, or had a history of sepsis, or had not received renal replacement therapy, or had a duration of mechanical ventilation for more than 7 days. The result of ROC indicated that RDW had a better prognostic value in predicting 30-day in-hospital mortality for VAP patients than SOFA score and SAPS II score.ConclusionHigh RDW level is associated with an increased 30-day in-hospital mortality. The RDW is a promising biomarker in predicting 30-day in-hospital mortality for patients admitted to the ICU, regardless of VAP.

Red Blood Cell Distribution Width as a Potential Valuable Survival Predictor in Hepatitis B Virus-related Hepatocellular Carcinoma.

Objectives: Red blood cell distribution width (RDW) is a widely used clinical parameter recently deployed in predicting various cancers. This study aimed to evaluate the prognostic value of RDW in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). Methods: We conducted a retrospective study of 745 patients with HBV-related HCC, 253 patients with chronic hepatitis B (CHB), and 256 healthy individuals to compare their hematological parameters and analyze their RDW levels. Potential risk factors for long-term all-cause mortality in patients with HBV-related HCC were predicted using Multivariate Cox regression. A nomogram was generated, and its performance was evaluated. Results: The RDW of patients with HBV-related HCC was significantly higher than that of those with CHB and healthy controls. In the former, splenomegaly, liver cirrhosis, larger tumor diameter, multiple tumor number, portal vein tumor thrombus, and lymphatic or distant metastasis were significantly increased, and the later the Child-Pugh grade and Barcelona clinic liver cancer stage, the higher the RDW. Furthermore, multivariate Cox regression analysis identified RDW as an independent risk factor for predicting long-term all-cause mortality in patients with HBV-related HCC. Finally, we successfully generated a nomogram incorporating RDW and validated its predictive ability. Conclusions: RDW is a potentially valuable hematological marker for predicting the survival and prognosis of patients with HBV-related HCC. The nomogram incorporating RDW can be used as an effective tool to plan the individualized treatment of such patients.

Elevated Red Blood Cell Distribution Width Levels at Admission Predicts Depression After Acute Ischemic Stroke: A 3-Month Follow-Up Study.

PurposeRed blood cell distribution width (RDW) is closely related to inflammatory-related disease markers. The present study aimed to investigate the association between the red blood cell distribution width (RDW) and post-stroke depression (PSD).Patients and MethodsA total of 414 patients with acute ischemic stroke (AIS) admitted to our hospital from June 2018 to July 2021 were consecutively enrolled and received 3 months’ follow-up. According to the 17-item Hamilton Depression Scale (HAMD) assessment, they were divided into PSD group and non-PSD group. Diagnosis of PSD was made in accordance with DSM-IV. RDW was recorded within 24 hours of admission.ResultsAmong the included 414 patients, 95 (22.95%) patients were diagnosed as having PSD at 3 months after stroke. The results showed significantly higher level of RDW in patients with depression (13.69 (IQR13.24–13.88) vs. 13.56 (IQR 12.67–13.77), P<0.001) at admission than patients without depression. After adjustment for potential confounding factors, the odds ratio of PSD was 5.707 (95% CI, 2.717–11.989) for the highest tertile of RDW compared with the lowest tertile. Moreover, based on the receiver operating characteristic (ROC) curve, the optimal cutoff of RDW levels as an indicator for the prediction of PSD was projected as 13.01, which yielded a sensitivity of 83% and a specificity of 41.0%, with an area under the curve (AUC) of 0.643 (95% CI, 0.585–0.701; P = 0.012).ConclusionHigher RDW levels at admission were found to be correlated with PSD 3 months after stroke.

Diagnostic value of red blood cell distribution width in patients with organophosphate poisoning in emergency department of Sina hospital in 2019

Introduction: Organophosphates are pesticides used for agricultural purposes, and their poisoning has critical complications. The purpose of this study was to determine the estimated Red Blood cell distribution width (RDW) prognostic role in patients with organophosphate poisoning in the emergency department. Materials and methods: In this Descriptive-analytical study, patients with acute organophosphate poisoning referred to the emergency department of Sina Hospital in Tabriz from March 2019 to March 2020 were enrolled. The primary outcome of the patients including, organophosphate-induced RDW changes, and the secondary outcome including, organophosphate-induced death were recorded. Results: Eighty two patients with organophosphate poisoning were enrolled in this study. The mean age was 36.21 years. Of 82 patients, insecticidal poisoning, herbicide, fungicides, and acaricide were seen in 62 (76.8%), 16 (19.5%), 1 (1.2%), and 1 (1.2%) patients respectively. There were no statistically significant difference observed between types of pesticides and patients’ outcomes (p&gt; 0.05). There was no statistically significant difference between different organophosphates in terms of pH, HCO3 , PCO2 , WBC, Hb, platelets, RDW, sodium, potassium, PT, PTT, INR, urea, creatinine, and cholinesterase (p&gt; 0.05). Conclusion: Generally, RDW in patients with organophosphates toxicity does not have prognostic value and is not affected by the severity of poisoning.

Diagnostic Red Blood Cell Distribution Width As a Prognostic Factor in Acute Myeloid Leukemia

Introduction: A high red blood cell distribution width (RDW) mirrors dysregulated erythrocyte homeostasis and is associated with a higher mortality in several solid cancers and myelodysplastic syndrome (MDS). A high RDW may also identify individuals more likely to develop a MDS or an acute myeloid leukemia (AML). The prognostic relevance of the RDW in patients diagnosed with AML has not been previously evaluated.Methods: We analyzed 294 newly diagnosed AML patients (median age at diagnosis 61, range 14-77 years [y]) that underwent an allogeneic hematopoietic stem cell transplantation (HSCT) at the University Hospital Leipzig in complete remission (CR, 63%), CR with incomplete peripheral recovery (CRi, 18%) or with active disease (19%). The RDW was measured at diagnosis and a cut-off of 20.7% was determined using the R package “OptimalCutpoints” to define patients with a low (87%) or high (13%) diagnostic RDW. Disease risk was assessed according to European LeukemiaNet (ELN) 2017. Median follow up after HSCT was 3.0 y. To verify the results irrespective of the consolidating therapy, a validation set of 392 AML patients (median age at diagnosis 63, range 18-87 years) treated at the University Hospital Dresden was analyzed. Here, 46% of patients received chemotherapy alone and patients that underwent allogeneic HSCT were censored at the time of HSCT.Results: The diagnostic RDW was above the local upper limit of normal (> 15%) in the majority (73%) of AML patients. The RDW as continuous parameter was higher in patients with AML developing from an antecedent myeloid disorder (sAML, after MDS, MPN, or MDS/MPN) than in patients with de novo (P=.01) or treatment-related AML (tAML, after lymphatic or solid neoplasm, P=.02, Figure 1A). A higher RDW was also observed in patients harboring gene mutations previously linked to AML of secondary origin (i.e. mutated JAK2 [P=.03], ASXL1 [P=.004], or spliceosome mutation [P=.03, compromising SF3B1, SRSF2, U2AF1, and ZRSR2, Figure 1B], which was particularly driven by SRSF2 mutations [P=.002]). Adapting an optimal cut, a higher RDW (> 20.7%) was associated with a higher non-relapse mortality (NRM, P=.02), shorter overall survival (OS, P=.009, Figure 1C), but similar relapse incidence (P=.96). In multivariate analyses, the RDW retained its prognostic significance for a higher NRM after adjustment for age at diagnosis. A RDW > 20.7% was also associated with lower hemoglobin levels at diagnosis and a trend for lower incidence of NPM1 mutations (P=.06), which are enriched in de novo AML. In contrast, RDW levels were not associated with chromosomal abnormalities (P=.72) or ELN2017 disease risk (P=.55). Despite known association of a high RDW with a higher cardiovascular/inflammatory risk, neither the comorbidity index at HSCT (HCT-CI, P=.77) nor the incidence of an acute (P=1) or chronic (P=.63) graft-versus-host disease differed according to the diagnostic RDW. Comparably, in the validation set, higher RDW levels were observed in patients with sAML compared to de novo (P=.02) or tAML (P=.02). Introducing the established 20.7% cut into the validation set, patients with high RDW levels again had lower hemoglobin levels at diagnosis (P<.001), less NPM1 mutations (P=.005) and no different ELN2017 disease risk (P=.25). A high RDW in the validation set was associated with a significantly shorter OS (P<.001, Figure 1D) and shorter event-free survival (P=.05).Conclusions: Our study is the first to evaluate the diagnostic RDW in AML patients. Patients with a secondary AML or secondary AML-associated gene mutations had higher diagnostic RDW levels. The presence of a high diagnostic RDW identifies patients with worse outcomes, irrespective of the ELN2017 risk classification and the applied consolidation therapy. This cost-effective and fast to assess parameter may help to personalize AML patient treatment. [Display omitted] DisclosuresVucinic: Gilead: Honoraria, Other: Travel Sponsoring; Novartis: Honoraria; MSD: Honoraria; Abbvie: Honoraria, Other: Travel Sponsoring; Janssen: Honoraria, Other: Travel Sponsoring. Backhaus: Bayer: Other: Current Employment of Family Member. Franke: BMS: Honoraria; Pfizer: Honoraria; Novartis: Honoraria; MSD: Honoraria; Jazz Pharmaceuticals: Honoraria, Other: Travel Sponsoring; Gilead: Honoraria, Other: Travel Sponsoring. Platzbecker: Janssen: Honoraria; Celgene/BMS: Honoraria; AbbVie: Honoraria; Novartis: Honoraria; Takeda: Honoraria; Geron: Honoraria. Schwind: Novartis: Honoraria, Research Funding; Pfizer: Honoraria. Jentzsch: Astellas: Honoraria; Jazz Pharmaceuticals: Honoraria; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees.

Baseline neutrophil/lymphocyte ratio (NLR) and red blood cell distribution width (RDW) correlate with advanced stages in cutaneous squamous cell carcinoma.

The neutrophil/lymphocyte ratio (NLR) and red blood cell distribution width (RDW) at diagnosis have been shown to correlate with advanced disease and to be prognostic factors in many tumors. However, their role as a prognostic factor for cutaneous squamous cell carcinoma (cSCC) has not yet been studied. Therefore, the aim of our study was to evaluate the correlation of NLR and RDW with stages of disease in patients with cSCC in order to define whether or not higher values of these two markers correlate with a more aggressive disease. We retrospectively analyzed the NLR and RDW in a total of 51 newly diagnosed cSCC patients. NLR and RDW were calculated using data obtained from the complete blood count (CBC). Median NLR among patients with the non-advanced disease (insitu and stage I) was 2.2, whereas median NLR for patients with advanced disease was 4.87. Median RDW among patients with early stage disease was 13.7%, while median RDW in patients with advanced disease was 15.81%. Statistical analysis showed positive associations of advanced cSCC stages with NLR or RDW higher than 3.07 or 14.5%, respectively. Therefore, our analysis demonstrated how both NLR and RDW represent cheap and easily available factors that could be used as markers for advanced cSCC. They could help to identify patients with advanced stages disease that requires a strict follow-up.

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.

Preoperatively elevated RDW-SD and RDW-CV predict favorable survival in intrahepatic cholangiocarcinoma patients after curative resection

BackgroundRecent studies suggest red blood cell distribution width (RDW) was a prognostic factor in various types of cancer patients, although the results are controversial. The objective of this study was to investigate the significance of RDW in patients with intrahepatic cholangiocarcinoma (ICC) after radical resection.MethodThe relationship between the preoperative serum RDW value and clinic pathological characteristics was analyzed in 157 ICC patients between January 2012 and June 2018 who underwent curative resection. X-tile software was used to determine 40.2 fl, 12.6% as the optimal cut-off value for RDW-SD and RDW-CV respectively. 153 patients were classified into the low RDW-SD (≤ 40.2, n = 53) group and the high RDW-SD (> 40.2, n = 104) group, low RDW-CV (≤ 12.6, n = 94) group and the high RDW-CV (> 12.6, n = 63). Based on the RDW-SD combined with RDW-CV (SCC), classified into SCC = 0, 1 and 2 group. Kaplan–Meier survival analysis and Cox proportional hazard models were used to examine the effect of RDW on survival.ResultsKaplan–Meier curve analysis showed that Patients with RDW-SD > 40.2 were significantly associated with better OS (P = 0.004, median OS: 68.0 months versus 17.0 months). Patients with RDW-CV > 12.6 were significantly associated with better OS (p = 0.030, median OS: not reach versus 22.0 months). Compared with a SCC = 0 or SCC = 1, SCC = 2 was significantly associated with better OS (p < 0.001, median OS: not reach versus 33.0 months versus 16, respectively). In the multivariate analysis, RDW-SD > 40.2 fl (HR = 0.446, 95% CI: 0.262–0.760, p = 0.003), RDW-CV > 12.6% (HR = 0.425, 95%CI: 0.230–0.783, p = 0.006), SCC = 2 (HR = 0.270, 95%CI: 0.133–0.549, p < 0.001) were associated with favorable OS. The multivariate analysis showed RDW-SD, RDW-CV and SCC level were not independent prognostic factors for DFS.ConclusionsPreoperative low levels of RDW are associated with poor survival in ICC after curative resection. This provides a new way for predicting the prognosis of ICC patients and more targeted intervention measures.

Red blood cell distribution width is associated with adverse cardiovascular events after septal myectomy.

BackgroundRed blood cell distribution width (RDW) is associated with increased morbidity and mortality in several cardiovascular diseases. However, the prognostic significance of RDW in patients with hypertrophic obstructive cardiomyopathy (HOCM) who underwent septal myectomy remains unclear as no studies have been conducted on this topic. This study aimed to assess the prognostic significance of RDW in these patients.MethodsA total of 867 adults with HOCM who underwent septal myectomy at Fuwai Hospital from 2011 to 2017 were retrospectively studied. All patients were assessed comprehensively, including their medical history, echocardiograms, and blood test results.ResultsThe median age of patients was 47.9 [interquartile range (IQR), 37.0–56.0] years and 61.5% of patients were men. During a median follow-up period of 32 (IQR, 17–53) months, 26 patients died and 23 had a cardiovascular death during follow-up. Compared to patients in the lowest RDW quartile, those in the highest quartile had a significantly lower 5-year survival free from all-cause and cardiovascular death (95.9% vs. 87.6%, P<0.001; 95.9% vs. 89.9%, P<0.001). Compared with lower RDW, higher RDW was significantly associated with all-cause and cardiovascular death after adjustment for age, sex, body mass index, and relevant clinical risk factors [per RDW standard deviation (SD) hazard ratio (HR) increase =1.76, 95% confidence interval (CI): 1.54–2.05, P<0.001; per RDW SD HR =1.91, 95% CI: 1.63–2.22, P for trend <0.001].ConclusionsHigher RDW is independently associated with all-cause and cardiovascular death in patients with HOCM after septal myectomy. Therefore, this readily available biomarker could be considered as an additive biomarker for risk stratification in these patients.

Red blood cell distribution width and mortality of spontaneous intracerebral hemorrhage patients

ObjectivesTwo studies have found an association between hematoma expansion and red blood cell distribution width (RDW) in the diagnosis of spontaneous intracerebral hemorrhage (SIH); however, its association with SIH mortality has been not reported. Thus, the objectives of this study were to determine whether RDW in patients with SIH could be associated with mortality and could be used as mortality biomarker. Patients and MethodsObservational and prospective study of patients with severe supratentorial SIH (Glasgow Coma Scale < 9) from Intensive Care Units of 6 Spanish hospitals. RDW was recorded at days 1, 4 and 8 of SIH. Thirty-day mortality was considered the end-point study. ResultsNon-surviving patients (n = 54) compared to surviving patients (n = 63) had higher RDW (p ≤ 0.001) at days 1, 4 and 8 of SIH. The area under curve (95 % confidence interval) to predict 30-day mortality by RDW at days 1, 4, and 8 of SIH was 0.87 (0.79−0.92; p < 0.001), 0.74 (0.64−0.83; p < 0.001) and 0.79 (0.68−0.87; p < 0.001) respectively. In the regression analysis an association between RDW and 30-day mortality was found controlling for early evacuation of SIH, midline shift, ICH score and glycemia (Odds ratio = 1.159; 95 % CI = 1.046−1.284; p = 0.005). ConclusionsThe higher RDW during the first week of SIH in non-surviving than in surviving patients, and the potential role of RDW at any time during the first week as mortality biomarker are the main novelties of our study.

P1162RED BLOOD CELL DISTRIBUTION WIDTH AND PERITONEAL DIALYSIS-ASSOCIATED PERITONITIS PROGNOSIS

Abstract Background and Aims The red blood cell distribution width (RDW) is a parameter of the heterogeneity of circulating erythrocyte size. Recent researches have pointed out a link among RDW, chronic kidney disease and inflammation. We sought to investigate the prognostic value of baseline RDW in patients with peritoneal dialysis-associated peritonitis (PDAP), which remains unknown. Method Our study included 337 peritonitis episodes experienced by 202 patients who were undergoing continuous ambulatory peritoneal dialysis (CAPD) at a single center from 2013 to 2018. Episodes were categorized according to the tertiles of baseline RDW levels (T1, &amp;lt;13.2%; T2, 13.2 - 14.3%; T3, &amp;gt;14.3%). Routine logistic regression, generalized estimating equation and restricted cubic spline were used to estimate the association between RDW and treatment failure, which was defined as relapse or recurrent episodes, catheter removal, or death during peritonitis therapy. The predictive performance of multivariate models including RDW and other potential predictors were also evaluated. Results After adjusting for other potential predictors, RDW exhibited an incremental relationship with the risk of treatment failure. The baseline RDW of &amp;gt;14.3% (T3) indicated a 43% and 52% increased venture of treatment failure in logistic and GEE analyses, respectively, compared with &amp;lt; 13.2% (T1). As a continuous variable, the fitting curve based on restricted cubic spiline showed that the relationship was nolinearly but positively correlated. The multivariate model A (combined RDW with age, duration on PD, albumin and ferritin) showed an area under the curve (AUC) of 0.671 (95% CI, 0.592 to 0.749) for the prediction of treatment failure. In sensitive analyses, the predictive performances for other unfavourable outcomes were also reliable (AUC for catheter removal, 0.72, 0.62 to 0.81; for relapse or recurrence, 0.61, 0.48 to 0.74). Conclusion Higher levels of baseline RDW was significantly associated with greater rates of treatment failure among peritonitis episodes independent of other potential predictors.

Prognostic significance of red cell distribution width in bladder cancer.

BackgroundBladder cancer is one of the most common cancers worldwide. It ranks ninth among all cancers and fourth among cancers in male patients. Recent studies reported that red blood cell (RBC) distribution width (RDW) was a potential predictor in some cancers. This study explored the significance of RDW in patients with bladder cancer after radical cystectomy.MethodsThis study involved 169 patients who underwent radical cystectomy between March 2009 and October 2018. The overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS) were analyzed using the Kaplan-Meier method. Univariate and multivariate Cox analyses were used to evaluate the prognostic significance of RDW.ResultsThe patients with bladder cancer were divided into two subgroups according to the RDW value (0.1395). A high RDW value significantly correlated with higher mortality, a decrease in hemoglobin, an increase in C-reactive protein, a decrease in RBC count, and T stage (P<0.05). Statistically significant differences in OS, CSS, and DFS were found between high- and low-RDW groups. Hence, a high RDW value was presumed to be a risk factor for poor prognosis in patients with bladder cancer after radical cystectomy (P<0.001).ConclusionsPatients with a high RDW value had a poor prognosis. Therefore, RDW is a reliable predictor for the prognosis of patients with bladder cancer who underwent radical cystectomy.

Red blood cell distribution width and peritoneal dialysis-associated peritonitis prognosis

Objective Red blood cell distribution width (RDW) is a parameter of the heterogeneity of circulating erythrocyte size. Recent researches have pointed out a link among RDW, chronic kidney disease, and inflammation. We sought to investigate the prognostic value of baseline RDW in patients with peritoneal dialysis-associated peritonitis (PDAP). Methods Our study included 337 peritonitis episodes experienced by 202 patients who were undergoing continuous ambulatory peritoneal dialysis (CAPD) at a single center from 2013 to 2018. Episodes were categorized according to the tertiles of baseline RDW levels (T1, <13.2%; T2, 13.2−14.3%; T3, >14.3%). Routine logistic regression and generalized estimating equation (GEE) were used to estimate the association between RDW and treatment failure, which was defined as relapse/recurrent episodes, catheter removal, or death during therapy. Results After adjusting for other potential predictors, RDW exhibited an incremental relationship with the risk of treatment failure. The baseline RDW of T3 indicated a 43% and 52% increased venture of treatment failure in logistic and GEE analyses, respectively, compared with T1. As a continuous variable, the fitting curve based on restricted cubic spiline showed that the relationship was nonlinearly but positively correlated. The multivariate model A (combined RDW with baseline age, albumin, serum ferritin, and duration on CAPD) showed an area under the curve of 0.671 (95% confidence interval, 0.5920.749) for the prediction of treatment failure. Conclusions A Higher baseline level of RDW was significantly associated with a greater rate of treatment failure among PDAP episodes independent of other potential predictors.

Red Blood Cell Distribution Width Predicts Pulmonary Hypertension Secondary to Chronic Obstructive Pulmonary Disease.

Purpose This study aims at investigating the predictive value of red blood cell distribution width (RDW) in pulmonary hypertension (PH) secondary to chronic obstructive pulmonary disease (COPD). Methods 213 eligible in-hospital COPD patients were reviewed between May 2016 and May 2018, including 39 cases with PH and 174 without PH. Clinical data including demographic characteristics, comorbidities, and results of ultrasound scans, imaging examinations, and laboratory tests were recorded. Results Increased RDW level was observed in COPD patients with PH compared with COPD patients without PH, with 15.10 ± 1.72% versus 13.70 ± 1.03%, respectively (p < 0.001). RDW shared positive relationships with brain natriuretic peptide (BNP) (p=0.001, r = 0.513), pulmonary artery (PA) systolic pressure (p=0.014, r = 0.390), and PA-to-ascending aorta (A) ratio (PA : A) (p=0.001, r = 0.502). Multivariate analysis indicated that RDW, BNP, and PA : A > 1 were the independent risk factors of PH secondary to COPD (p < 0.05). The AUC of the RDW in patients with PH was 0.749 ± 0.054 (p < 0.001). The optimal cutoff value of RDW for predicting PH was 14.65, with a sensitivity and a specificity value of 69.2% and 82.8%, respectively. Conclusion RDW is significantly increased in COPD patients with PH and thus may be a useful biomarker for PH secondary to COPD.

Red blood cell distribution width is a simple and novel biomarker for survival in light-chain amyloidosis.

Red blood cell distribution width (RDW) has been used for the differential diagnosis of anemia, but high RDW may also be associated with several human disorders. We evaluated the prognostic relevance of RDW in patients with light-chain (AL) amyloidosis. We retrospectively analyzed all patients with AL amyloidosis who were newly diagnosed at the Japanese Red Cross Medical Center between December 2011 and June 2018. RDW was evaluated in 94 patients; 48% (n = 45) of patients had a high RDW (≥ 13.8%) and 52% (n = 49) had a low RDW (< 13.8%). Overall survival (OS) was significantly lower in patients with a high RDW (P < 0.001). On multivariate analysis, increased RDW was an independent predictor for OS. Even in patients without cardiac amyloidosis, the OS was significantly lower in the high-RDW group (P = 0.0064). The survival rate of high-RDW patients without cardiac involvement was as poor as that of patients with cardiac involvement. In addition, in patients with revised Mayo stage I or a normal level of N-terminal pro-B-type natriuretic peptide, high RDW was negatively correlated with OS (P = 0.0086, 0.025). RDW is a simple and strong predictor of early death, and is a prognostic biomarker in patients with AL amyloidosis without cardiac involvement.

High Red Cell Distribution Width is an Adverse Predictive and Prognostic Factor in Patients With Diffuse Large B-Cell Lymphoma Treated With Chemoimmunotherapy

IntroductionThe red blood cell distribution width (RDW) is an easy-to-obtain laboratory value that has emerged as a potential prognostic factor in solid and hematologic malignancies. Patients and MethodsWe evaluated 121 patients with de novo diffuse large B-cell lymphoma (DLBCL) treated with standard chemoimmunotherapy at our institution between 2010 and 2012. We categorized patients with high RDW (> 14.6%) and normal RDW (11.6%-14.6%). We fitted multivariate regression models for complete response (CR) and overall survival (OS). ResultsPatients with high RDW were less likely to achieve CR to chemoimmunotherapy than patients with normal RDW (48% vs. 83%; P < .001). The 5-year OS rate for patients with high RDW was lower than in patients with normal RDW (51% vs. 79%; P = .001). In multivariate regression models, high RDW was independently associated with lower odds of achieving CR (odds ratio, 0.32; 95% confidence interval [CI], 0.12-0.83; P = .02) and with higher risk of death from any cause (hazard ratio [HR], 2.04; 95% CI, 1.03-4.02; P = .04) than normal RDW in patients with DLBCL treated with chemoimmunotherapy. High RDW remained an independent adverse factor for OS after adjustment for the International Prognostic Index and the National Comprehensive Cancer Network-International Prognostic Index scores with HR 2.20 (95% CI, 1.12-4.31; P = .02) and HR 2.67 (95% CI 1.28-5.59; P = .009), respectively. ConclusionHigh RDW appears to be an adverse predictive and prognostic factor in patients with de novo DLBCL treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone).

The potential value of red blood cell distribution width in patients with invasive hydatidiform mole.

BackgroundRed blood cell distribution width (RDW) has attracted increasing attention in cancer. The aim of this study was to assess the changes of RDW in patients with invasive hydatidiform mole and analyze the relationship between RDW and invasive hydatidiform mole.MethodsA retrospective analysis was performed on 102 patients diagnosed as invasive hydatidiform mole in the First Affiliated Hospital of Guangxi Medical University from January 2009 to March 2018. A total of 120 healthy subjects were used as a control group. The Mann‐Whitney U test was used for comparison between the invasive hydatidiform mole and control groups. Comparison of RDW with other blood parameters was performed using Spearman's. The area under the ROC curve (AUC) and 95% confidence interval (95% CI) were also determined.ResultsThe RDW, platelet‐lymphocyte ratio (PLR), neutrophil‐lymphocyte ratio (NLR), and absolute lymphocyte count were significantly elevated in the invasive hydatidiform mole group compared with control group. The hemoglobin (Hb) concentration, mean red blood cell volume (MCV) and platelet count (PLT) were significantly lower in invasive hydatidiform mole group than control group. Grade III and above invasive hydatidiform mole patients had higher levels of RDW than grade I and II patients. Correlation analysis showed that RDW was negatively correlated with Hb, MCV, NLR, and neutrophil count, but positively correlated with PDW and different stages of invasive hydatidiform mole. The ROC curve showed that the AUC of the RDW was 0.660 (95% CI 0.581‐0.740; P < 0.01).ConclusionThis study reveals the potential value of RDW in invasive hydatidiform mole.

Assessment of Red Blood Cell Distribution Width and Multiple Myeloma in a Guangxi Population: a Retrospective Study.

Red blood cell distribution width (RDW) has been reported as a marker for inflammation and tumors. The present study aims to investigate the use of RDW in patients with multiple myeloma (MM). Seventy-three patients with newly diagnosed symptomatic multiple myeloma (SMM), 39 patients with relapsed multiple myeloma (RMM), and 91 healthy individuals were recruited into this study. The demographic and laboratory parameters were reviewed retrospectively, and the correlation between RDW and other parameters among groups were evaluated by Spearman's correlation analysis. The sensitivity and specificity of RDW were determined by receiver operating characteristic (ROC) curve analysis. The RDW values in both SMM and RMM were significantly higher than in the healthy individuals (p < 0.001). In SMM patients with International Staging System (ISS) Stages II and III, the level of RDW was higher than in the patients with ISS Stage I; however, there was no significant difference between each ISS stage in RMM patients. The RDW strongly correlated with platelet distribution width (PDW), cystatin C, serum beta2-microglobulin (Sβ2M), hemoglobin (HGB), hematocrit (HCT), albumin (Alb), and calcium (p < 0.05) in SMM patients, and RDW in RMM patients had a positive or negative correlation with PDW, Sβ2M, globulin, HGB, absolute neutrophil count, platelet count, HCT, and Alb (p < 0.05). The ROC curve analysis showed that RDW > 13.5 had 94.5% sensitivity and 63.7% specificity for SMM, and 92.3% sensitivity and 63.7% specificity for RMM. Elevated RDW in MM patients was associated with the stage of the disease.

Inflammation markers are associated with frailty in elderly patients with coronary heart disease.

The neutrophil-to-lymphocyte ratio (NLR) and red blood cell distribution width (RDW) are important indicators of adverse outcomes and have predictive value for many diseases; however, the relationships between frailty, and the NLR and RDW in patients with coronary heart disease (CHD) have not been determined. In this cross-sectional study, we investigated the association between frailty, and the NLR and RDW in elderly CHD patients ≥ 60 years of age. Frailty was defined according to frailty phenotype. Of 345 patients enrolled in the study, 22.6%, 58.3%, and 19.1% were characterized as robust, pre-frail, and frail, respectively. A significant positive correlation was observed between frailty and the NLR (r = 0.169) and RDW (r = 0.196). After adjusting for confounders, linear regression analyses showed that participants in the 4th quartile of the NLR or RDW were more likely to have a higher frailty phenotype score. Based on multivariable logistic regression, patients in the 4th quartile of the NLR and RDW, the fully-adjusted odds ratios for incident frailty were 2.894 (p = 0.011) and 2.494 (p = 0.040), respectively. Our findings indicate that frailty is associated with the NLR and RDW in elderly patients with CHD.