Red Blood Cell Distribution Width Levels Research Articles

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, <13.2%; T2, 13.2 - 14.3%; T3, >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 >14.3% (T3) indicated a 43% and 52% increased venture of treatment failure in logistic and GEE analyses, respectively, compared with < 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.

The prognostic roles of red blood cell-associated indicators in patients with resectable gastric cancers.

BackgroundGastric cancer (GC) is one of the leading causes of cancer-related death worldwide. This study was designed to investigate the prognostic values of red blood cell (RBC)-associated indicators, including RBC, hemoglobin (HGB), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and RBC distribution width (RDW) in resectable GC patients.MethodsIn this retrospective study, a total of 104 pathologically confirmed GC patients were recruited. These cases were divided into two groups according to the median values of pretreatment RBC, HGB, HCT, MCV, MCH, MCHC, or RDW. To evaluate the changes in RBC-associated indicators values after treatment, we introduced the concept of post-/pre-treatment ratios (≤1 suggested RBC, HGB, HCT, MCV, MCH, MCHC, or RDW values were not increased after therapy, while >1 represented those in increased levels).ResultsThe lower pretreatment MCHC levels were correlated with worse overall survival (OS), while pretreatment levels of RBC, HGB, HCT, MCV, MCH, or RDW were not. The whole course of treatment (surgery plus adjuvant chemotherapy) significantly decreased the values of MCHC, and increased the values of MCV and RDW, whereas it had no obvious effects on the values of RBC, HGB, HCT, or MCH. Patients with post-/pre-treatment MCV ratio >1 had an increased survival ratio. Meanwhile, post-/pre-treatment RBC, HGB, HCT, MCH, MCHC, or RDW ratios were not correlated with outcomes. Multivariate Cox regression analysis revealed that the American Joint Committee on Cancer (AJCC) stage (III), and lower pretreatment MCHC levels were independent risk factors affecting OS. The receiver operating characteristic (ROC) curve analysis showed that an MCHC value of 341.98 g/L was the optimal cutoff value for prognosis, with a sensitivity of 58.3% and a specificity of 75.0%.ConclusionsPretreatment MCHC levels could become a potential prognostic factor for resectable GC.

Hipoksik iskemik ensefalopatili infantlarda tam kan sayımı parametreleri ve ekokardiyografi bulgularının prognostik değeri

Purpose: The aim of this study was to investigate the prognostic value of complete blood count parameters, presence of pulmonary hypertension (PH) and valve failure in newborns with hypoxic ischemic encephalopathy (HIE). Materials and Methods: 115 term newborns with Sarnat Stage 2 and 3 with HIE and 90 healthy newborns were included in this retrospective study. Echocardiographic examination, red blood cell distribution width (RDW), platelet distribution width (PDW), and C-reactive protein (CRP) values at the first six hours and at 72 hours after the cooling treatment were compared with controls.Results: There was a relationship between presence of mitral regurgitation (MR), aortic regurgitation (AR), and persistent PH and death. The mean RDW, PDW and CRP levels at the first six and after 72 hours were significantly higher in infants with HIE when compared with the control group, and these parameters were significantly increased in the stage 3 group. A significant relationship was found between the increase in RDW and CRP values and the presence of MR, AR and mortality.Conclusion: The degree of PH and presence of valvular insufficiency are important parameters in determining prognosis in HIE. Also, simple blood tests such as RDW and CRP and the echocardiographic evaluation are found to be correlated with hospitalization period and mortality and may be a guide in prognosis.

Platelet and Red Blood Cell Indices in Patients with Panic Disorder: A Receiver Operating Characteristic Analysis.

Objective Panic disorder (PD) is associated with changes in platelet and red blood cell (RBC) indices. However, the diagnostic or predictive value of these indices is unknown. This study assessed the diagnostic and discriminating value of platelet and RBC indices in patients with PD. Materials and Methods In this cross-sectional study including patients with PD ( n = 98) and healthy controls ( n = 102), we compared the following blood indices: mean platelet volume (MPV), platelet distribution width (PDW), and RBC distribution width (RDW). The receiver operating characteristic (ROC) curve was used to calculate the area under the ROC curve (AUC), sensitivity, specificity, and likelihood ratio for the platelet and RBC indices. Results Statistically significant increase in PDW (17.01 ± 0.91 vs. 14.8 ± 2.06; p < 0.0001) and RDW (16.56 ± 2.32 vs. 15.12 ± 2.43; p < 0.0001) levels were observed in patients with PD. PDW and mean corpuscular hemoglobin concentration had larger AUC (0.89 and 0.74, respectively) and Youden’s index (0.65 and 0.39, respectively), indicating their higher predictive capacity as well as higher sensitivity in discriminating patients with PD from healthy controls. Conclusion PDW can be considered a “good” diagnostic or predictive marker in patients with PD.

Association between red blood cell distribution width and long-term mortality among patients undergoing percutaneous coronary intervention with previous history of cancer

Background: The number of patients suffering from coronary heart disease with cancer is rising. There is scarce evidence concerning the biomarkers related to prognosis among patients undergoing percutaneous coronary intervention (PCI) with cancer. Thus, the aim of this study was to investigate the association between red blood cell distribution width (RDW) and prognosis in this population.Methods: A total of 172 patients undergoing PCI with previous history of cancer were enrolled in this retrospective study. The endpoint was long-term all-cause mortality. According to tertiles of RDW, the patients were classified into three groups: Tertile 1 (RDW <12.8%), Tertile 2 (RDW ≥12.8% and <13.5%) and Tertile 3 (RDW ≥13.5%).Results: During an average follow-up period of 33.3 months, 29 deaths occurred. Compared with Tertile 3, mortality of Tertile 1 and Tertile 2 was significantly lower in the Kaplan–Meier analysis. In multivariate Cox regression analysis, RDW remained an independent risk factor of mortality (HR: 1.938, 95% CI: 1.295–2.655, p < 0.001). The all-cause mortality in Tertile 3 was significantly higher than that in Tertile 1 (HR: 5.766; 95% CI: 1.426–23.310, p = 0.014).Conclusions: An elevated RDW level (≥13.5%) was associated with long-term all-cause mortality among patients undergoing PCI with previous history of cancer.

The Relationship between Red Blood Cell Distribution Width and Incident Diabetes in Chinese Adults: A Cohort Study.

Background Previous studies reported the controvertible association between red blood cell distribution width (RDW) and diabetes. The aim of this study is to explore whether RDW is associated with incident diabetes. Methods We performed this cohort study in 16,971 Chinese adults (9,956 men and 7,015 women, aged 43.3 ± 12.8 years). The level of RDW was measured at baseline (2014). All the participants were further classified into four quartile groups based on baseline RDW. Fasting blood glucose (FBG) and glycated hemoglobin A1c (HbA1c) were measured annually during follow-up (2014-2019). Diabetes was diagnosed if either FBG ≥ 7.0 mmol/L or HbA1c ≥ 6.5%. We used the Cox proportional hazards regression model to evaluate the association between baseline RDW and incident diabetes. Results We identified 2,703 new cases of diabetes during five-year follow-up. The incidence was 15.9%. Comparing with participants in the lowest quartile group (reference group), the adjusted hazard ratios (HR) for the risk of diabetes were 1.31 (95% CI: 1.16, 1.48) for the highest quartile group (p trend < 0.001), after adjustment for potential confounders. Further adjusting baseline FBG and HbA1c did not materially change the association between RDW and incident diabetes. Each unit increase of RDW was associated with a 16% higher risk of incident diabetes (HR = 1.16, 95% CI: 1.06, 1.26) in a fully adjusted model. Sensitivity analysis generated similar results with prospective analyses after excluding aged participants, participants who are overweight and with obesity, participants with elevated blood pressure, participants with decreased eGFR, and those with anemia at baseline. Conclusions High RDW was associated with high risk of developing diabetes in Chinese adults. As RDW is an inexpensive, noninvasive, and convenient indicator, RDW might be considered for inclusion in the risk assessment of high-risk groups of diabetes.

Neutrophil-to-lymphocyte ratio and red blood cell distribution width as predictors of microalbuminuria in type 2 diabetes.

Background and aimChronic inflammation has an important role in the development and progression of type 2 diabetes through immunologic inflammatory mechanisms. Simple new inexpensive inflammatory markers may contribute to the detection of microalbuminuria. Aim of our study is to evaluate the predictive value of neutrophil‐to‐lymphocyte ratio (NLR), mean platelet volume (MPV), and red blood cell distribution width (RDW) for microalbuminuria in type 2 diabetic patients for possible application as prognostic factors for the prediction of microalbuminuria and the progression of disease in patients with diabetes.MethodsA total of 168 patients with type 2 diabetes mellitus were classified into gender‐ and BMI‐matched three groups according to hemoglobin A1c and microalbuminuria: Group A: 53 patients with controlled diabetes, Group B: 57 patients with uncontrolled diabetes, both without microalbuminuria, and Group C: 58 patients with uncontrolled diabetes with microalbuminuria. Levels of NLR, MPV, and RDW between the study groups were examined and compared.ResultsA significant difference in NLR was found between Group C and groups A and B (P < .001, P = .005, respectively). A statistically significant difference in RDW was found between groups B and C (P = .014). Receiver operating characteristic curve analysis of inflammatory markers and microalbuminuria prediction showed an area under curve (AUC) of 0.675 for NLR (CI 0.58‐0.76, P < .001) and 0.614 for RDW (CI 0.52‐0.70, P = .013). NLR value of 2.54 has 39.7% sensitivity, 78.8% specificity, and 45% positive predictive value (PPV). RDW value of 14.44 has 37.9% sensitivity, 76% specificity, and 41.5% PPV.ConclusionsNeutrophil‐to‐lymphocyte ratio and RDW have PPV for microalbuminuria in diabetic patients.

Red blood cell distribution width is associated with mortality after acute ischemic stroke: a cohort study and systematic review.

Whether red blood cell distribution width (RDW) is associated with the prognosis of acute ischemic stroke is inconclusive according to recent studies. We performed a cohort study and meta-analysis to explore the association between RDW and functional outcome. Patients with ischemic stroke admitted to the Department of Neurology within 24 hours of stroke onset between January 1, 2015 to December 31, 2018 were enrolled. Blood was sampled within 24 hours after admission. We searched PubMed, Embase, Web of Science databases up to Nov 2019 to identify studies investigating the association between RDW values and prognosis following stroke. Outcomes included 3-month death and poor functional outcome [defined by modified Rankin Scale (mRS) score ≥3]. We included 1,558 patients in cohort study. RDW was independently associated with 3-month death [odds ratio (OR), 1.19; 95% confidence interval (CI), 1.03, 1.37], but not associated with 3-month poor outcome (OR 1.05, 95% CI, 0.95, 1.16), after adjustment for confounders. A dose-dependent relationship between RDW levels and 3-month death was revealed in the restricted cubic spline plot. Seven observational studies with 4,407 patients were identified for systematic review. When combining our study and previous studies, the association was significant for RDW predicting death (5 studies with 3,366 patients, OR 1.25, 95% CI, 1.15, 1.35), as well as for poor outcome (4 studies with 3,483 patients, OR 1.23, 95% CI, 1.05, 1.44). RDW was an independent predictor of 3-month functional outcome, and a trend of dose-dependent relationship between RDW and 3-month death was detected.

Red Cell Distribution Width as a Prognostic Factor in Patients with Hepatocellular Carcinoma.

The red blood cell distribution width (RDW) was reported to be related to the severity of liver diseases, but its clinical significance in patients with hepatocellular carcinoma (HCC) remains unclear. The aim of this study was to explore the clinical significance of RDW in HCC patients. For the retrospective study, 422 HCC patients were enrolled in this study. Hematological parameters and liver biochemical indexes were analyzed. Child-Pugh grade and Barcelona Clinic Liver Cancer (BCLC) stages of the HCC patients were calculated. The diagnostic accuracy was evaluated according to the area under the receiver operating characteristic (ROC) curve. The medical records of HCC patients who were admitted to The Second Affiliated Hospital of Nanjing University of Chinese Medicine from January 2006 to August 2015 were retro-spectively reviewed. Subgroup analysis showed that RDW level of HCC patients with tumor size more than 10 cm were higher than those of HCC patients with tumor size smaller than 3 cm, 3 - 5 cm, and 5 - 10 cm (14.77 ± 2.35%, 15.27 ± 2.65%, 15.32 ± 2.40% vs. 15.97 ± 2.39%, p < 0.001). RDW level significantly increased with worsening Child-Pugh grade and BCLC stages. In addition, RDW level were negatively correlated with red blood cell (RBC) counts, hematocrit (HCT), lymphocyte (LY) counts, hemoglobin (Hb), blood platelet (PLT) counts, and positively correlated with aspartate-aminotransferase (AST), and total bile acid (TBA). ROC curve analysis showed that RDW level was 14.15% was the optimal prognostic cutoff point to determine the survival rate of HCC patients. In the univariate analysis followed by multivariate analysis, RDW level below 14.15% together with better Child-Pugh grade, better BCLC stages, and smaller tumor size were prognostic indicators for HCC patients. This indicated HCC patients with RDW level below 14.15% [hazard ratio of 0.530 (95% confidence interval, 0.395 - 0.710; p < 0.001)] had the lower mortality. RDW level was positively associated with tumor size. The prognosis was better for HCC patients with RDW levels below14.15% together with better Child-Pugh grade, better BCLC stages, and smaller tumor lesions. It suggested RDW level might be an easily obtainable and inexpensive prognostic indicator for HCC patients.

May hemocytometer parameters be a biomarker in distinguishing between adrenal adenomas and carcinomas and in prognosis of adrenocortical carcinomas?

SUMMARYRecently, studies have reported that inflammatory response and elevated platelet counts are associated with several cancers. In the present study, we aimed to evaluate hemocytometer parameters in differentiating adrenal adenoma and carcinoma, and the prognostic utility of hemocytometer parameters in adrenocortical carcinoma (ACC). We included 30 patients with nonfunctional adrenal adenoma and 13 patients with ACC having undergone surgery between 2005 and 2017 and followed up postoperatively at our centre. The neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), red blood cell distribution width (RDW), mean platelet volume (MPV) and plateletcrit (PCT) were evaluated preoperatively in all patients included in the study. There was a significant difference between the adrenal adenoma and ACC groups in terms of neutrophil and lymphocyte counts, NLR and PLR. There was no significant difference between the two groups in terms of platelet count and MPV, but PCT levels were significantly lower in ACC group. There was no statistically significant difference between recurrent and/or metastasis positive patients and negative ones according to NLR, PLR, RDW and MPV. There was a statistically significant difference in RDW levels and tumor diameter between the groups. Our study is the first to evaluate hemocytometer parameters in differentiating adrenal adenomas and carcinomas, and also in the prognosis of ACC. The present study suggested that the hemocytometer parameters may be a marker in the differential diagnosis of adrenal adenomas and carcinomas. However, our study also showed that these parameters had no prognostic value in ACC.

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.

The Relationship Between Hematological Parameters and Mortality in Cardiovascular Patients With Postcardiac Arrest Syndrome.

Background: Post-cardiac arrest syndrome is the insufficiency of cardiac and cerebral functions caused by ischemia after sudden cardiac arrest. We aimed to determine the hematological parameters associated with mortality in the intensive care follow-up of patients with post-cardiac arrest syndrome.Methods: The hematological parameters of 285 cardiovascular patients who were admitted to the emergency department of Harran University Medical Faculty between 2013 and 2018 and followed up in the intensive care unit with post-cardiac arrest syndrome were examined. A total of 85 patients were included in the study. These parameters were recorded as the time of arrival to the emergency department (0 hour) and hematological parameters at the 24th and 48th hours of intensive care follow-up.Results: In the mortality group, albumin (P:0.030), hemoglobin (Hg) (P: 0.049), and hematocrit (HCT) (P: 0.020) values ​​in the blood parameters, at the time of admission to the emergency department, were significantly lower than those in the survival group. Red blood cell distribution width (RDW) (P: 0.009) and urea (P <0.001) values ​​at the time of arrival were higher than the survival group. In the 24th and 48th hours, mean hemoglobin (MCHC) (P <0.05) values ​​were lower and RDW (P <0.05) values ​​were higher in the mortality group compared to the survival group.Conclusions: In this retrospective validation, low albumin, Hg, HCT, MCHC, and high RDW and urea levels may increase mortality in cardiovascular patients who develop post-cardiac arrest syndrome within the first 48 hours. Correcting these values ​​early may reduce mortality.

Red blood cell distribution width for predicting significant liver inflammation in patients with autoimmune hepatitis.

Red blood cell distribution width (RDW) was reported to be associated with the severity of liver diseases. We aimed to investigate the association between RDW and severity of liver inflammation in autoimmune hepatitis (AIH). Ninety-two consecutive AIH patients who underwent liver biopsy during 2016-2017 were included. Liver histology was evaluated using the Scheuer scoring system. Logistic regression analysis was used to analyze the risk factors for significant inflammation. The diagnostic accuracy was evaluated by the area under the receiver operating characteristic curve. The RDW level was higher in AIH patients with significant inflammation (14.6%, interquartile range: 13.2-16.3%) than in patients with mild inflammation (13.2%, interquartile range: 12.6-13.8%). The RDW level was correlated positively with the grades of liver inflammation (r=0.356, P < 0.001). The area under the receiver operating characteristic curve of RDW in predicting significant inflammation was 0.739 (95% confidential interval: 0.634-0.843, P < 0.001), with 67.80% sensitivity and 75.76% specificity. The diagnostic performance of RDW for significant inflammation was better than alanine aminotransferase (P = 0.003) and immunoglobulin G (P = 0.049). RDW (odds ratio = 1.702, P = 0.001) was identified as an independent predictor for significant inflammation by logistic multivariable analysis. The RDW level was correlated positively with the severity of liver inflammation in AIH patients. RDW can be a promising indicator for predicting significant liver inflammation in AIH.

Can we assess the advancements of gallbladder cancer using red blood cell distribution width?

Gallbladder cancer (GBC) is a rare biliary malignancy. The relationship between red blood cell distribution width (RDW) and cancer prognosis has been confirmed by many studies, however, the relationship between RDW and gallbladder cancer is rarely reported. Therefore, we aimed to assess the correlation between RDW and the advancements of GBC in this study.A retrospective study was performed on 108 GBC patients and 119 age and gender-matched individuals who were admitted to the First Affiliated Hospital of Guangxi Medical University from January 2012 to December 2018.The GBC patients had significantly higher RDW(%) levels compared to the healthy controls group (15.7 ± 2.4 vs 13.5 ± 0.6; P = .000). In addition, GBC patients with stage III+IV had higher levels of RDW(%) than stage I+II (16.1 ± 2.5 vs 14.9 ± 2.0, P = .011). Correlation analysis showed that RDW had positive correlations with TNM stage (correlation coefficient = 0.302, P = .002). The cut-off value of RDW was observed to be 14.5% in patients with GBC (area under the curve = 0.757, 95% confidence interval = 0.677–0.838, P = .000). Univariate logistic regression and multivariate logistic regression analysis showed that RDW was an independent risk factor for GBC lymph node metastasis.Our results suggest that elevated levels of RDW are independently associated with GBC patients and may serve as potential markers for the advancements of GBC.

Association between Red Blood Cell Distribution Width and Hemorrhagic Transformation in Acute Ischemic Stroke Patients

Background: Hemorrhagic transformation (HT) is a frequent complication of acute ischemic stroke (AIS). Red blood cell distribution width (RDW) is a cost-effective parameter associated with incidence and prognosis of cerebrovascular diseases. The purpose of this study was to assess whether RDW is associated with HT in AIS patients. Methods: AIS patients within 24 h from stroke onset between January 1, 2014, and December 31, 2018, were consecutively enrolled. Blood samples were collected. The primary outcome was HT, which was diagnosed by follow-up brain image and classified into hemorrhagic infarct (HI) and parenchymal hematoma (PH). Multivariate logistic regression analysis was performed to determine the relationship between RDW and HT as well as its subtypes. Potential effect modifier was identified by stratified logistic regression analysis. Results: Among the included 1383 patients, 220 (15.9%) developed HT (HI in 103 and PH in 117). Elevated RDW levels were associated with an increased risk of HT when 2 extreme tertiles were compared (OR 1.60, 95% CI 1.04–2.44, p = 0.031). The risk of HT increased stepwise across RDW tertiles (p for trend = 0.042). RDW significantly correlated with HI rather than PH. The association between RDW and HT could be modified by reperfusion therapy (p for interaction = 0.010), with no significant association between RDW and HT among patients underwent reperfusion therapy. Conclusions: Elevated RDW level was related to increased risk of HT among AIS patients without reperfusion therapy.

Red blood cell distribution width and platelet counts are independent prognostic factors and improve the predictive ability of IPI score in diffuse large B-cell lymphoma patients

BackgroundElevated red blood cell distribution width (RDW) and decreased platelet count (PLT) can be clinically relevant to the prognosis in cancer patients. However, their prognostic values in patients with diffuse large B-cell lymphoma (DLBCL) need to be further explored.MethodsHealthy donors (n = 130) and patients with DLBCL (n = 349) were included and evaluated retrospectively in this study. The prognostic influence of clinical and pathological factors including RDW and PLT on overall survival (OS) and progression-free survival (PFS) were studied by Kaplan-Meier curves. To evaluate the independent prognostic relevance of RDW and PLT, univariate and multivariate Cox proportional hazards regression models were applied. The adjusted IPI model was established based on the results of multivariate analysis, and verified by Harrell’s C statistical analysis.ResultsKaplan-Meier curves indicated that an elevated RDW value and thrombocytopenia are poor factors for OS (P < 0.001, P = 0.006) and PFS (P = 0.003, P < 0.001) in DLBCL patients. Multivariate analysis confirmed that elevated RDW value (HR = 2.026, 95%CI = 1.263–3.250, P = 0.003) and decreased PLT count (HR =1.749, 95%CI = 1.010–3.028, P = 0.046) were both independent prognostic factors. The c-index of IPI and NCCN-IPI were increased when RDW level and PLT were supplemented in our cohort.ConclusionsOur study shows that elevated RDW level and decreased PLT are independent poor prognostic factors in newly diagnosed DLBCL patients. Adding RDW and PLT to the IPI score may improve its predictive ability, and the adjusted IPI may be more powerful in predicting the survival of DLBCL patients in the rituximab era.

72 Vitamin D and Red Blood Cell Distribution Width: The Search for Predictive Markers in Primary Biliary Cholangitis Patients Receiving UDCA Continues

INTRODUCTION: Serum Vitamin D and red blood cell distribution width (RDW) levels have been recently proposed as potential biomarker models to predict primary biliary cholangitis (PBC) severity and response to treatment. However, most of these studies were small with considerable limitations. Therefore, we aimed to investigate the predictive value of these novel markers in patients with PBC receiving ursodeoxycholic acid (UDCA). METHODS: We retrospectively reviewed PBC patients who received UDCA (13–15 mg/kg/day) at our tertiary care center between November 1998 and February 2017. Adverse events were defined as liver transplantation or liver-related death. Transplant-free survival (TFS) was estimated by Kaplan-Meier method. Serum Vitamin D and RDW levels were extracted from manual chart review at baseline and after one year of UDCA therapy. RESULTS: We identified 352 patients, 50 (14%) were male, 319 (91%) were Caucasian, with a median age of 55 years at diagnosis. Twenty-two (6%), 47 (13%), and 55 (16%) patients had adverse events within 5, 10, and 15 years after diagnosis, respectively (Table 1). In 197 patients of our cohort, we evaluated vitamin D levels at baseline and after 1 year of UDCA therapy while RDW levels were evaluated in all 352 patients. Median vitamin D levels before and after 1 year of UDCA treatment were 15.9 (range: 7.2–21.8) and 16.0 (range: 12.8–45.4) in patients with adverse events (P = 0.05) vs. 13.7 (range: 7.0–88.6) and 13.8 (range: 7.5–63.0) in patients with no adverse events (P = 0.72), respectively. Median red cell distribution width (RDW) before and after 1 year of UDCA treatment in patients with adverse event vs. no adverse event were 16.9 (range: 7.0–66.0) and 16.5 (range: 8.8–160.0), P = 0.14, vs. 17.0 (range: 4.5–62.3) and 16.4 (range: 8.9–69.5), P = 0.06, respectively (Figure 1). Moreover, RDW pre/post UDCA treatment ratio was not a reliable marker for treatment response (overall ratio 1; P = 0.048). CONCLUSION: Our study doesn't support the routine use of the newly suggested biomarker prognostic models in patients with PBC receiving UDCA. Presence of multiple confounding factors such as sun exposure, vitamin D or iron supplementation, anemia, folate and vitamin B 12 levels limit the clinical utility of RDW and Vitamin D levels as predictive models for PBC patients.

Red Blood Cell Distribution Width Is Associated with All-Cause Mortality in Critically Ill Patients with Cardiogenic Shock.

BackgroundThere is no previously published epidemiological study exploring the association between red blood cell distribution width (RDW) and mortality in patients with cardiogenic shock (CS). The aim of this study was to examine the association between RDW and the risk of all-cause mortality in these patients.Material/MethodsWe analyzed clinical data from the MIMIC-III V1.4 database. We collected data on each patient’s demographic parameters, vital signs, laboratory parameters, vital signs, comorbidities, and scoring systems on ICU admission. Cox proportional hazards models were used to assess the association between RDW levels and the 30-day, 90-day, and 365-day mortality in patients with CS.ResultsThere were 1131 patients meeting inclusion criteria in our study. In multivariate analysis, following adjustment for age, sex, and ethnicity, higher RDW in tertiles and quintiles were all associated with increased risk of 30-day, 90-day, and 365-day all-cause mortality. Furthermore, after adjusting for more relevant confounders, RDW remained a significant predictor of risk of 30-day, 90-day, and 365-day mortality (tertile 3 versus tertile 1: HR, 95% CI: 1.66, 1.19–2.31; 1.73, 1.28–2.33; 1.80, 1.38–2.34). Similarly significant robust associations were found in RDW levels stratified by quintiles.ConclusionsHigher RDW is associated with increased risk of all-cause mortality in critically ill patients with CS.

Values of procalcitionin and red blood cell distribution width in evaluating severity and prognosis of septicemia in preterm infants

Objective To analyze the variations of procalcitionin (PCT) and red blood cell distribution width (RDW) in premature infants with septicemia and to investigate their values in evaluating the severity and prognosis of septicemia. Methods A retrospective study was conducted to analyze the medical records of 96 premature infants diagnosed with septicemia and admitted to the First Affiliated Hospital of Anhui Medical University from December 1, 2014 to December 1, 2018. According to the severity of the disease and neonatal shock score, there were 42 cases selected to the severe septicemia group (severe clinical condition with shock, shock score >6 points) and 54 in the mild septicemia group (mild clinical condition without shock or shock score ≤6 points). Moreover, after three days' treatment, they were divided into two groups: death group (n=10) and survival group (n=86, survived during hospitalization). Peripheral venous blood samples were collected before and on the first and third day after treatment to detect PCT and RDW. Dynamic changes of the two indexes were compared between different groups. Mann-Whitney U test, Wilcoxon rank sum test, Friedman test or receiver operating characteristic (ROC) curve was used for statistical analysis. Results (1) Before and on the first and third day after treatment, the severe septicemia group had a higher level of PCT than the mild group [3.7 (0.4-37.3) vs 1.4 (0.2-5.0) ng/ml, 43.1 (18.7-83.0) vs 17.1 (4.1-34.6) ng/ml, 26.1 (3.8-67.3) vs 4.8 (0.3-32.9) ng/ml; Z=-2.017, -3.350 and -2.932; all P<0.05]. In both groups, PCT level on the first day after treatment was the highest, and that on the third day after treatment was higher than that before treatment (all P<0.05). On the first and third day after treatment, RDW in the severe group was higher than that in the mild group [16.5% (16.2%-18.6%) vs 16.3% (15.5%-17.3%), 16.1% (15.5%-19.4%) vs 15.7% (15.1%-16.5%); Z=-1.992 and -2.165; both P<0.05]. In the severe and mild groups, RDW on the first day after treatment was higher than that before and on the third day after treatment; in the mild group, RDW on the third day after treatment was lower than that before treatment, while in the severe group, RDW on the third day after treatment was higher than that before treatment (all P<0.05). (2) On the first and third day after treatment, PCT and RDW in the death group were higher than those in the survival group [PCT: 162.0 (62.9-187.2) vs 19.9 (4.3-46.1) ng/ml, 122.6 (65.0-180.8) vs 6.2 (0.5-32.9) ng/ml; Z=-4.114 and -4.594; RDW: 18.4% (16.9%-21.2%) vs 16.3% (15.7%-17.2%), 21.8% (20.6%-22.2%) vs 15.8% (15.2%-16.5%); Z=-3.307 and -4.831; all P<0.05]. In both groups, PCT on the first day after treatment was higher than that before and on the third day after treatment, and the level on the third day after treatment was higher than that before treatment (all P<0.05). In the death group, RDW on the first and third day after treatment were higher than that before treatment, and RDW on the third day after treatment was higher than that on the first day; in the survival group, RDW on the first day after treatment was higher than that before treatment, but on the third day after treatment, it was lower than that before and on the first day after treatment (all P<0.05). (3) The cut-off values of PCT for predicting severe septicemia in premature infants before and on the first and third day after treatment were 3.475, 29.765 and 3.460 ng/ml, respectively, and the sensitivity and specificity were 54.8% and 75.9%, 69.0% and 72.2%, and 83.3% and 46.3%, respectively. The cut-off values of PCT for predicting the death of premature infants with septicemia on the first and third day after treatment were 40.595 and 64.855 ng/ml, respectively, with the specificity of 73.3% and 87.2% and sensitivity of both 100.0%. The predictive thresholds of RDW for severe septicemia on the first and third day after treatment were 15.650% and 18.300%, respectively, and the sensitivity and specificity were 95.2% and 29.6%, 33.3% and 92.6%, respectively. The predictive thresholds for death were 16.650% and 18.450%, and the sensitivity and specificity were 100.0% and 68.6%, 100.0% and 91.9%, respectively. Conclusions Dynamic monitoring of PCT and RDW levels may help with early diagnosis, determination of severity and prognosis prediction of severe septicemia in premature infants. Key words: Neonatal sepsis; Calcitonin; Erythrocyte indices; Infant, premature; Prognosis

Can red blood cell distribution width predict long-term cardiovascular event after off-pump coronary artery bypass? A retrospective study.

The effect of red blood cell distribution width (RDW) on long-term major cardiac and cardiovascular event (MACCE) in patients with off-pump coronary artery bypass (OPCAB) has not been adequately studied. We investigated the relationship between RDW and the risk of MACCE in patients who underwent OPCAB. We retrospectively analyzed the data of 440 consecutive, nonanemic patients (362 males; 82.27% and mean age 60.8 ± 8.9 years) who underwent OPCAB between October 2009 and September 2012 in Fuwai Hospital. Long-term follow-up was obtained through phone calls, hospital records, and clinic visits. MACCE (death, ST elevated infarction, repeat coronary revascularization, stroke) was determined. Over a median of 7.0-year follow-up, 80 incident MACCE events were identified. The RDW levels on admission were significantly higher in MACCE group than non-MACCE group (13.1 ± 0.7 vs 12.8 ± 0.7; P = .005). Using the Cox proportional hazards models, we found that per 1% increment of RDW, the incident of MACCE was increased in different models (hazard ratio [HR] was 1.520, 1.532, and 1.795, respectively; P = .002, .004, and .002). The receiver-operating characteristic analysis revealed an RDW cut-off value of 13% predicting MACCE. Therefore, patients were grouped on this cut-off value. The Kaplan-Meier plot revealed significantly lower event-free survival in the higher RDW group (P = .0158). Compared with subjects in the RDW <13% in full model, subjects in the RDW ≥13% had an HR of 1.829 (95% confidence interval, 1.103-3.032; P = .019). An RDW level greater than 13% in hospital admission is independently associated with an increased incidence of long-term MACCE after OPCAB.