Red Cell Distribution Width Research Articles

Association between anaemia and aflatoxin B1 and fumonisin B1 exposure in HIV-infected and HIV-uninfected pregnant women from Harare, Zimbabwe.

Aflatoxin B1 (AFB1) and fumonisin B1 (FB1) are poisons that contaminate poorly stored staple foods in resource-limited settings. Antenatal AFB1 and FB1 exposure may cause anaemia. We aimed to determine the associations of urinary aflatoxin M1 (AFM1) and FB1, biomarkers of AFB1 and FB1 exposure, respectively, with erythrocyte parameters and anaemia. A retrospective cross-sectional study was conducted in 68 HIV-infected and 61 HIV-uninfected pregnant women ≥ 20 weeks gestational age in Harare, Zimbabwe. AFM1 and FB1 were measured in urine via competitive ELISA, and levels were grouped into tertiles. The erythrocyte parameters assessed were haemoglobin (Hb), mean corpuscular volume, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration, red blood cell (RBC), haematocrit (HCT), and red blood cell distribution width. Associations of urinary AFM1 and FB1 with erythrocyte parameters, and anaemia were assessed in a multiple regression controlled for potential confounders. The presence of FB1 in urine decreased Hb levels in all women (β= -0.98, 95% CI: -1.94, 0.02) and HIV-uninfected (β= -1.99, 95% CI: -3.71, -0.26). FB1 tertile 3 decreased Hb levels (β= -0.88, 95% CI: -1.74, 0.01) and HCT levels (β= -2.65, 95% CI: -5.26, 0.03) in HIV-infected. AFM1 tertile 2 decreased RBC levels in HIV-infected (β= -0.34, 95% CI: -0.71, -0.03). The presence of FB1 in urine increased anaemia risk in HIV-uninfected (OR: 10.68 95% CI: 1.02, 112.34). AFM1 tertile 2 increased macrocytic anaemia risk in HIV-infected (OR: 13.72, 95% CI: 0.92, 203.55). There is need to ensure food safety through monitoring and nutritional interventions to improve maternal-infant health outcomes.

Associations between smoking and coronary heart disease: mediating role of RDW

IntroductionPrevious studies have demonstrated that both smoking and coronary heart disease (CHD) are linked to red cell distribution width (RDW). However, the role of the RDW in the association between smoking and CHD remains unclear. This study investigates the role of RDW in the association between smoking and coronary heart disease.MethodsData from 13,080 adults aged 40–80 years were analyzed from the National Health and Nutrition Examination Survey (NHANES) conducted between 2006 and 2017. Statistical methods included regression analysis, restricted cubic spline curve (RCS), subgroup analysis, and mediation analysis.ResultsResults showed higher RDW levels in participants with smoking and/or CHD than in those without. Smoking status was positively associated with RDW and CHD even after adjusting for potential confounders. A nonlinear relationship between RDW and CHD was observed (P for nonlinear <0.001). Subgroup analysis revealed that sex influenced the relationship between smoking and CHD (p = 0.0284). Mediation analysis showed that increased RDW levels mediated the association between smoking status and CHD (PM = 2.1959%, ACME = 0.000694, 95% CI = 0.000262–0.001259, p < 0.001).DiscussionOur research showed that smoking, RDW, and CHD are interrelated, with RDW playing as a mediator, offering a novel perspective for the prevention and management of CHD.

Hemoglobin-to-red blood cell distribution width ratio is negatively associated with stroke: a cross-sectional study from NHANES.

Numerous studies have suggested that the hemoglobin-to-red blood cell distribution width ratio (HRR) is associated with the onset, progression, and prognosis of various diseases. However, to the best of our knowledge, no research has conducted statistical analyses to determine the association between HRR and stroke. This cross-sectional study was conducted among adults with complete data on hemoglobin-red cell distribution width ratio (HRR) and stroke from the 2005-2018 National Health and Nutrition Examination Survey (NHANES). HRR was calculated by dividing hemoglobin (HGB) in grams per deciliter (g/dL) by the red blood cell distribution width (RDW). Weighted multivariable logistic regression and generalized additive models were employed to investigate the independent and nonlinear relationships between HRR and stroke. Threshold effects were assessed using two-piece linear regression models. Additionally, subgroup analyses and interaction tests were performed. A total of 36,215 participants were included, with 2.92% classified as stroke patients. The prevalence of stroke decreased across increasing tertiles of HRR (Q1: 5.07%; Q2: 2.63%; Q3: 1.69%; P < 0.0001). A negative association between HRR and stroke was observed in both unadjusted and adjusted models. In Model III, each one-unit increase in HRR was associated with a 58% reduction in the likelihood of stroke (Model III: OR = 0.42, 95% CI: 0.29-0.63). Subgroup analyses and interaction tests revealed that the association between HRR and stroke was BMI-dependent (P < 0.05), with the negative association only observed in participants with BMI < = 25 and BMI 25-30, but not in those with BMI > 30. Using a two-piece linear regression model, a threshold effect was identified at a BMI of 30 (K = 1.16). To the left of this breakpoint, there was a negative association between HRR and stroke (OR = 0.55, 95% CI: 0.27-0.97), whereas no such association was detected to the right of the breakpoint (OR = 6.49, 95% CI: 0.75-56.11). HRR is negatively associated with the likelihood of stroke, with a lower risk of stroke in individuals with higher HRR levels.

Red cell distribution width: a potential marker of reduced femoral neck bone mineral density in men and postmenopausal women.

Osteoporosis imposes significant burdens. Early detection of high-risk individuals through simple indicators can greatly improve prognosis. Red cell distribution width (RDW), a standard component of a complete blood count, shows promise, yet remains underexplored. This cross-sectional study aimed to investigate the association between RDW and femoral neck and spinal bone mineral density (BMD). Participants aged 20-79 years from the 2005-2010, 2013-2014, and 2017-2020 cycles of the National Health and Nutrition Examination Survey (NHANES) were included. BMD was measured using dual-energy X-ray absorptiometry (DXA). A total of 13,029 participants were included, comprising 6684 men, 3238 postmenopausal women, and 3107 premenopausal women, with the sample weighted to represent 98,712,128 people. After adjusting for covariates, RDW exhibited a negative association with femoral neck BMD in both men (β = -0.006; 95% CI: -0.010 to -0.002; p = 0.0053) and postmenopausal women (β = -0.005; 95% CI: -0.010 to -0.000; p = 0.0413). Subgroup and sensitivity analyses supported the robustness of these findings. A negative association between RDW and spinal BMD in men approached significance (β = -0.004; 95% CI: -0.008 to 0.000; p = 0.0557). Persistent trends were observed for RDW with spinal BMD in postmenopausal women and with both femoral neck and spinal BMD in premenopausal women. Our study suggests a negative association between RDW and femoral neck BMD in both men and postmenopausal women. These findings highlight the potential of RDW as a marker for identifying individuals at higher risk of osteoporosis.

The Roles of Vitamin D Levels, Gla-Rich Protein (GRP) and Matrix Gla Protein (MGP), and Inflammatory Markers in Predicting Mortality in Intensive Care Patients: A New Biomarker Link?

Objectives: Identifying reliable biomarkers to predict mortality in critically ill patients is crucial for optimizing management in intensive care units (ICUs). Inflammatory and metabolic markers are increasingly recognized for their prognostic value. This study aims to evaluate the association of various inflammatory and metabolic markers with ICU mortality. Methods: This prospective observational study was conducted from January 2023 to January 2024 in the City Hospital’s ICU. A total of 160 critically ill patients were enrolled. Laboratory parameters, including white blood cell (WBC) count, red cell distribution width (RDW), platelet count, neutrophil count, mean platelet volume (MPV), monocyte count, lymphocyte count, procalcitonin (PCT), C-reactive protein (CRP), calcium (Ca++), and vitamin D levels, were analyzed. Additionally, ratios such as the platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), systemic inflammatory index (SII), and pan-immune-inflammation value (PIV) were calculated. Plasma levels of Gla-rich protein (GRP) and dephosphorylated uncarboxylated matrix Gla protein (dp-ucMGP) were measured using ELISA. Results: The mean age of the patients included in the study was 60.5 ± 15.8 years. Cardiovascular disease was present in 72 patients (45%), respiratory system disease in 58 (36%), and chronic kidney disease (CKD) in 38 (24%). Additionally, 61 patients (38%) had diabetes, and 68 (42%) had hypertension. Inflammatory markers, including PLR, NLR, and PIV, were all significantly higher in non-survivors, while calcium and vitamin D levels were lower (p &lt; 0.05). Higher WBC, RDW, neutrophil count, PLR, NLR, PIV, CRP, procalcitonin, GRP, and dp-ucMGP levels were positively correlated with longer hospital stays and increased mortality. In contrast, platelet and lymphocyte counts were negatively correlated with both outcomes (p &lt; 0.05). Vitamin D levels showed an inverse relationship with both hospital stay and mortality, indicating that lower levels were associated with worse outcomes (p &lt; 0.05). In multiple logistic regression analysis, elevated WBC count (OR = 1.20, p = 0.02), RDW (OR = 1.35, p = 0.01), neutrophil count (OR = 1.25, p = 0.01), MPV (OR = 1.20, p = 0.02), PLR (OR = 1.30, p = 0.01), NLR (OR = 1.40, p = 0.001), PIV (OR = 1.50, p = 0.001), CRP (OR = 1.32, p = 0.01), procalcitonin (OR = 1.45, p = 0.001), GRP (OR = 1.40, p = 0.001), and dp-ucMGP (OR = 1.30, p = 0.001) levels were significantly associated with increased mortality. Conclusions: Inflammatory and metabolic markers, particularly NLR, PLR, PIV, GRP, and dp-ucMGP, are strong predictors of mortality in ICU patients. These markers provide valuable insights for risk stratification and early identification of high-risk patients, potentially guiding more targeted interventions to improve outcomes.

Ratio of red blood cell distribution width to albumin level and risk of mortality in sarcopenic obesity.

The aim of this study was to investigate the relationship between red blood cell distribution width and albumin ratio (RAR) levels and mortality in adult patients with sarcopenic obesity in the United States. The study included 1,361 adult patients with sarcopenic obesity from the National Health and Nutrition Examination Survey (1999-2006). The X-tile was used to determine the optimal subgroup thresholds for RAR values, and propensity score matching (PSM) was employed to reduce baseline bias. Cox regression analysis, Kaplan-Meier survival curves, and restricted cubic spline analysis were utilized to assess the relationship between RAR levels and all-cause and cardiovascular mortality. Subgroup analysis and the Subpopulation Treatment Effect Pattern Plot were employed to determine survival advantages across different subgroups. Time-dependent ROC analysis to evaluate the accuracy of RAR level in predicting survival outcomes at different time points. Post-PSM multifactorial Cox regression analyses revealed that RAR was a significant independent predictor of all-cause mortality (HR 1.487, 95% CI: 1.259-1.756) and an independent risk factor for cardiovascular mortality (HR 1.487, 95% CI: 1.260-1.758) in patients with sarcopenic obesity. The survival advantage was consistent across subgroups. Restricted cubic spline analysis indicated an approximate S-shaped association between RAR levels and mortality. Time-dependent ROC curves demonstrate that the areas under the all-cause mortality curves at the RAR level for 1-year, 3-year, 5-year, and 10-year are 0.79, 0.66, 0.64, and 0.63, respectively. The areas under the cardiovascular mortality curve are 0.80, 0.70, 0.66, and 0.61, respectively. Moreover, in comparison to the baseline model lacking covariates, the AUC values of the joint model exhibited heightened levels at various time points. Therefore, We demonstrated that the RAR level is an independent prognostic factor for mortality risk in the American population with sarcopenic obesity, and it is reasonable to consider the RAR level as a simple and effective risk prediction tool.

Hematological changes in women with cervical cancer before and after cancer treatment: retrospective cohort study.

Hematological changes is one of the most common complications occurred in cancer patients. Therefore, the current study aimed to assess the hematological toxicity of cervical cancer patients before and after the initiation of treatment. The retrospective cohort study was conducted from 2015 to 2022 at the University of Gondar Comprehensive Specialized Hospital. The hematological profile and sociodemographic and clinical data of the cervical cancer patients were collected using data extraction sheets. The Epidata version 3.1 and SPSS version 25 were used for data entry and analysis, respectively. Descriptive statistics were employed to summarize the data. To compare the median differences in hematological parameters before and after treatment, the Wilcoxon rank test was used. In addition, to assess the presence of an independent association between hematological abnormalities and the independent variables, logistic regression models were used. A p value less than 0.05 was considered to indicate statistical significance for all tests. In current study, the median (Interquartile range) of hemoglobin levels, white blood cell counts, and platelet counts, before treatment were 13.2 (12.1, 15) g/dl, 7.5 (5.8, 11.8) *109/L, and 330 (252, 383) *109/L, respectively. However, after treatment the median (Interquartile range) value of hemoglobin levels, white blood cell counts, and platelet counts were significantly lowered. On the other hand, red cell distribution width was significantly greater after treatment. At baseline, the magnitude of leucocytosis, anemia, and thrombocytosis were 27.9%, 24.6%, and 18.7%, respectively. After the treatment, anemia increased to 44.3%, but leucocytosis and thrombocytosis were replaced by leucopenia 18.3% and thrombocytopenia 17.8%, respectively. Hematological abnormalities such as anemia, leucopenia and thrombocytopenia were high after chemo-radiotherapy, and surgery. As the stage of cancer advances, the risk of developing anemia, leucocytosis, and thrombocytosis increased in 7.6, 6.9 and 9 times, respectively. Furthermore, being HIV patients and rural resident increased the risk of developing anemia about twofold. In conclusion hematological abnormalities were observed before and after cervical cancer treatment, with significance increment after chemo-radiotherapy and surgery. As the stage of cancer advances, the risk of developing hematological abnormalities increases. Therefore, routine monitoring of hematological changes before and after treatment and screening for major risk factors are important for improved patients' management.

Use of Non-Invasive Biomarkers and Clinical Scores to Predict the Complications of Liver Cirrhosis: A Bicentric Experience

Background and objectives: Liver cirrhosis is a chronic, progressive condition characterized by fibrosis and architectural distortion of the liver, leading to impaired liver function and severe complications. Accurately predicting these complications is crucial to the improvement of patient outcomes. Therefore, this study aimed to evaluate the accuracy of various non-invasive biomarkers and clinical scores in assessing the risk of complications among cirrhotic patients. Materials and methods: We conducted an observational retrospective study involving 236 cirrhotic patients from two tertiary care hospitals in Italy and Romania, in a timespan ranging from January 2021 to March 2024. Data on clinical characteristics, liver function tests, hematological indices, various non-invasive biomarkers, and clinical scores were collected and analyzed. Receiver operating characteristic analysis was performed to assess the accuracy of these biomarkers and clinical scores in predicting complications, including the presence of varices and hepato-renal syndrome. Results: The Child–Pugh score showed the highest accuracy for cirrhosis-related complications, with an area under curve (AUC) = 0.667. The red cell distribution width coefficient of variation followed closely with an AUC = 0.646. While the Child–Pugh score had a high specificity (85.42%), its sensitivity was low (37.97%). In patients with varices, non-invasive scores such as platelet distribution width (PDW) and the RDW-to-platelet ratio (RPR) showed modest predictive ability, with an AUC = 0.594. For hepato-renal syndrome, the Model for End-Stage Liver Disease (MELD) score showed the highest diagnostic accuracy with an AUC = 0.758. Conclusions: The most reliable biomarkers for detecting complications, varices, and hepato-renal syndrome, are, respectively, the Child–Pugh Score, PDW along with RPR, and the MELD score. However, while these scores remain valuable, the moderate diagnostic accuracy of other indices suggests the need for a more integrated approach to risk stratification. Future research should focus on validating these tools across different populations and incorporating emerging biomarkers to enhance predictive accuracy and inform more effective clinical decision-making.

Prognostic Value of Red Cell Distribution Width in Outcome of Acute Ischemic Stroke

Background: Red cell distribution width (RDW) is a haematological parameter that indicates the range of sizes of red blood cells. It is now widely acknowledged as a prognostic indicator for ischaemic stroke. Aim and Objective: To Study theprognostic value of red cell distribution width (RDW) in outcome of acute ischemic stroke. Materials and Method: The cross-sectional study was undertaken at Aarupadi Veedu Medical College in Puducherry. It included 61 patients, aged 18-80 years, who were diagnosed with acute ischemic stroke within 48 hours. Clinical assessment of patient by NIHSS Score and measuring the outcome by modified Rankin scale. The study took place in both the Outpatient and Inpatient in Department of General Medicine. Results: The study indicates a notable proportion of male more than female ,older participants (64.0% aged 56 years and above), There is a significant occurrence of hypertension (62.3%) and diabetes mellitus (63.9%) a substantial frequency of individuals who do not smoke (63.9%), and a majority of participants who do not use alcohol (77.0%). Levels of RDW exhibited significant positive relationships with stroke severity. Conclusion: The study highlights the potential of Red Cell Distribution Width (RDW) as a helpful predictive indicator in outcome of ischemic stroke. Increased RDW levels were observed to have a substantial correlate with more severe stroke and disability, as indicated by strong associations with NIHSS and mRS scores. The study emphasizes the usefulness of RDW in assessing the severity of ischaemic stroke and emphasizes the need for additional research to improve its clinical use.

Analysis of periodontal status in Polish patients with rheumatoid arthritis treated with biological therapies

IntroductionPeriodontitis, characterized by inflammation affecting the tooth-supporting tissues, may increase the risk of rheumatoid arthritis (RA) or cardiovascular diseases. The aim of the study was to evaluate the periodontal status in RA patients and its impact on the inflammatory markers and red cell parameters obtained from complete blood laboratory tests to study the risk of cardiovascular disease development.Material and methodsThe cross-sectional study included 50 patients with RA treated with biologi­cal therapies: tumor necrosis factor inhibitors, interleukin-6 blockers. Rheumatoid arthritis disease activity was assessed with Disease Activity Score with 28-joint count (DAS28). The periodontal indices modified Approximal Periodontal Index, modified Papillary Bleeding Index, and Periodontal Screening Index (PSI) were used to assess patients’ periodontal status. Serum levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were used as inflammatory markers and a potential cardiovascular risk factor.ResultsNo statistically significant correlation was found between the periodontal status and RA activity. However, a statistically significant correlation was found between the CRP results and the PSI scores (&lt;i&gt;R&lt;/i&gt; = –0.264510, &lt;i&gt;p&lt;/i&gt; = 0.048837). Evaluation of the red cell parameters showed statistically significant differences in the markers of inflammation ESR (&lt;i&gt;R&lt;/i&gt; = 0.369398, &lt;i&gt;p&lt;/i&gt; = 0.008289) and CRP (&lt;i&gt;R&lt;/i&gt; = 0.367405, &lt;i&gt;p&lt;/i&gt; = 0.008672). Red cell distribution width values were also correlated with RA activity (&lt;i&gt;R&lt;/i&gt; = 0.286387, &lt;i&gt;p&lt;/i&gt; = 0.043769) and duration of the disease (&lt;i&gt;R&lt;/i&gt; = 0.339425, &lt;i&gt;p&lt;/i&gt; = 0.015889).ConclusionsA satisfactory periodontal status was found in most of the study group. Increased CRP levels in patients with periodontitis may indicate the negative impact of periodontal status on the general clinical condition of the patient.

Redivision of reference intervals of the red blood cell distribution width in a healthy Chinese population based on natural geographic environment

Revealing the spatial distribution and regional differences of red blood cell distribution width (RDW) reference values in the healthy Chinese population is important for the monitoring, diagnosis and prevention of the top chronic diseases in the disease spectrum in China. Medical indicator data were matched with geographical data and environmental pollution data to predict RDW reference values for the whole region of China using ridge regression analysis, support vector machine and BP neural network. Taylor diagrams and assignment methods were used to select the optimal model, and the spatial distribution was mapped according to the prediction results of the optimal model, and the intervals of RDW reference values for different age groups of healthy people in China were redefined. It was suggested that the reference values of RDW in the young and middle-aged groups in China were divided into low-value areas in the north (12.31,12.80) and high-value areas in the south (12.80,13.18); the reference values of RDW in the elderly group were divided into low-value areas in the north (11.28,12.60) and high-value areas in the south (12.60,13.91).In turn, it can provide a more accurate reference basis in the monitoring, diagnosis and prevention of chronic diseases at the top of the disease spectrum.

Preoperative red cell distribution width and its relation with in-hospital morbidities including atrial fibrillation after coronary artery bypass

Background and Aims: Atrial fibrillation (AF) and other adverse events are significant concerns following coronary artery bypass grafting (CABG). In recent years, Red Cell Distribution Width (RDW) has been identified as a potential biomarker for predicting these adverse outcomes. This study aims to assess early in-hospital adverse events in patients undergoing isolated off-pump CABG (OPCAB) and to analyze the relationship between these events and preoperative RDW levels. Methods: This study prospectively included 150 patients who underwent elective isolated OPCAB procedures. Patients were categorized into an “event group” (those experiencing adverse events) and a “no-event group” (those who did not). Additionally, they were stratified according to preoperative RDW levels into three groups: Group A (RDW ≤14%), Group B (RDW 14-16%), and Group C (RDW ≥16%). A receiver operating characteristic (ROC) curve, followed by both univariate and multivariate regression analyses were utilized to evaluate the predictive value of RDW for in-hospital morbidity. Results: The in-hospital mortality rate was 2.7%, and AF occurred in 20.7% of the patient population. The ROC analysis for early adverse events yielded an Area Under the Curve (AUC) of 0.681 with a p-value &lt;0.001, indicating moderate predictive capability; the sensitivity was 73% and specificity was 64% for RDW ≥14.05%. Multivariate regression analysis demonstrated that RDW independently predicts in-hospital morbidity after OPCAB, with an odds ratio of 0.713 (95% CI 0.566-0.899, p=0.004). Conclusion: Elevated preoperative RDW levels serve as a simple and cost-effective independent predictor of early adverse events following isolated OPCAB.

Association between Red Blood Cell Distribution Width (RDW) and Early-Onset Neonatal Sepsis

Background: Neonatal sepsis contributes substantially to neonatal morbidity and mortality and is an ongoing major global public health challenge. The aim of this study was to find out the association between RDW and early onset Neonatal Sepsis. Methods: This case-control study was conducted at the Paediatrics inpatient department of Shaheed Suhrawardy Medical College Hospital, Dhaka, from May 2019 to November 2019. Results: In this study shows mean postnatal age was 1.86±0.730days and gestational age was 38.83±1.59 weeks in case group besides mean postnatal age was 1.88±0.738 days and gestational age was 39.06±1.78weeks in control group. Mean birth weight of case group was 3240±135.44gm and control group was 3346.66±139.57gm. The mean heamoglobin was 12.76±0.85, WBC was 20.12±1.27, RBC was 4.63±0.77, MCV was 85±0.97, platelet was 232±11.86, CRP was 21±0.77 and RDW Percentage was 21.83±2.39 in case group whereas mean heamoglobin was 12.86±0.83, WBC was 14.81±1.23, RBC was 4.85±0.71, MCV was 82.23±1.19, platelet was 280±14.26, CRP was 3.55±0.70 and RDW Percentage was 15.23±1.85 in control group. The ROC analysis of RDW% in the diagnosis of neonatal sepsis found an AUC of 0.967 (95%CI 0.867- 0.017) which is statistically significant (p&lt;0.001). A cut-off value of ≥ 20.60 showed an 86.6% sensitivity and 95% specificity. Conclusion: RDW indices were higher in neonate present with early onset of neonatal sepsis. There is a strong correlation between RDW and CRP in the early onset of neonatal sepsis.

Red Cell Distribution Width and the Early Detection of Ovarian Cancer

Ovarian Cancer is a leading cause of mortality and morbidity, lacking clinical manifestations and effective early diagnostic techniques. The majority of cases are diagnosed at later stages; however, asymptomatic screening is currently not recommended due to its low predictive value and invasive nature. Furthermore, the current CA-125 biomarker used to monitor Ovarian Cancer is elevated in other conditions, including endometriosis or pelvic inflammation. Red Cell Distribution Width (RDW) is a parameter measured in a complete blood count, measuring the range of variation in red blood cell size and heterogeneity of red blood cell volume. RDW levels positively correlate with Ovarian Cancer progression, additionally increased in Ovarian Cancer groups compared to benign ovarian tumour groups. RDW possesses high sensitivity in distinguishing between cancerous and benign ovarian tumours, in line with ideal screening method standards. RDW additionally shows potential as a diagnostic biomarker in combination with other blood parameters, such as hemoglobin. The hemoglobin-RDW ratio (HRR) acts as an independent predictor of Ovarian Cancer stage. RDW’s mechanism of action is not fully elucidated but can be associated with iron/folic acid deficiency, ineffective hematopoiesis caused by chronic inflammation, or inflammatory cytokines such as IL-1 and IL-17. High RDW levels additionally possess prognostic value, acting as an indicator of low cumulative overall survival and poor chemotherapy responses in various cancers. Further research is needed on RDW’s mechanism of action and its implication as a marker in female cancers, particularly Ovarian Cancer, to implement effective early screening techniques and reduce fatalities.

Biological variation and analytical performance specification study of erythrocyte and related parameters

Objective: To study biological variation (BV) and analytical performance specifications (APS) of 15 erythrocyte and related parameters. Methods: Sixty healthy participants from Beijing Hospital were prospectively recruited for the study, from July to December, 2023, including 30 males [aged (41.3±11.9) years] and 30 females [aged (40.3±12.4) years]. The study was designed based on the Biological Variation Data Critical Appraisal Checklist and the characteristics of erythrocyte detection. Whole blood samples were collected 10 times at 2-week intervals during 20 weeks. All samples were tested in duplicate using Mindray BC-7500 hematology analyzer and its accompanying reagents. Within-subject biological variation (CVI) and between-subject biological variation (CVG) were estimated by the nested ANOVA method. The BV data in this study were compared with the BV data of the European Database of Biological Variation. APS, reference change value (RCV) and index of individuality (II) were calculated. Results: The CVI for 15 parameters ranged from 0.49% to 86.46%, and the CVI data for red cell distribution width (RDW)-CV, RDW-SD, reticulocyte (RET) percentage, RET count, reticulocyte hemoglobin content (RHE), medium fluorescence reticulocyte (MFR) and high fluorescence reticulocyte (HFR) were significantly higher in females than in males (all P<0.05). The CVG ranged from 1.27% to 100.79%, and the CVG data for HFR were significantly different between genders (P<0.05). The CVI data for red blood cell (RBC), hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC) and RHE in this study were lower than those recommended by the European database. The derived indicators of most parameters were influenced by gender. The II values for all parameters were<1.4, where the II values of MCHC and HFR were between 0.6 and 1.4; the II values for the remaining 13 parameters were<0.6. Conclusions: A BV study protocol for erythrocyte parameters is designed. When the reference intervals differ between genders, BV data should be calculated separately and the lower BV data are recommended for calculating APS; the RCV should be set separately for each gender.

Association Between Red Blood Cell Distribution Width in Late Pregnancy and the Incidence of Adverse Perinatal Outcomes: A Retrospective Cohort Study

This study aimed to quantify adverse perinatal outcomes (APO), including small/large for gestational age (SGA/LGA) and preterm birth (PTB), in pregnant women with abnormal red cell distribution width (RDW) and explore the related mechanisms. This study included 11,659 pregnant women who delivered in a specialized hospital. At the time of admission, the lipid profiles and whole blood cell counts were assessed, and APO was analyzed. Women with high RDW (>18.5% [the 97.5th percentile]) in late pregnancy had a higher risk of LGA compared with those with low RDW (<12.3% [the 2.5th percentile]), whereas women with low RDW had a higher risk of SGA and PTB, compared with those with high RDW. A 1% increase in RDW was associated with an increased risk of LGA and a decreased risk of SGA and PTB. Consistent associations were observed in sensitivity analysis among pregnant women of non-advanced age, non-obesity, non-pregnancy complications, and non-PTB (for SGA/LGA only). Increased RDW was significantly associated with increased triglycerides and decreased high-density lipoprotein cholesterol (HDL-C). Triglycerides and HDL-C significantly mediated 10.63 and 15.8% of RDW-associated LGA, 9.51% and 9.40 of RDW-associated SGA, and 8.44 and -8.25% of RDW-associated PTB, respectively. Abnormal RDW was associated with an increased risk of APO, and the RDW-associated APO risk could be partially mediated by triglycerides and HDL-C, suggesting that RDW may be a promising APO predictor.

Genotype-phenotype correlation analysis of patients with thalassemia in Quanzhou city, Southeast of China

BackgroundThe carrying rate of thalassemia is high in Quanzhou city. However, there are few large-scale studies on the correlation analysis between genotype and phenotype of thalassemia in Quanzhou. In this study, the genotype and phenotype data of 1076 individuals with thalassemia in Quanzhou city were analyzed to provide reference data for screening and diagnosis of thalassemia in this region. Material and MethodsReverse dot blot hybridization (RDB-PCR), Gap-PCR and nested PCR were used to detect the thalassemia genotype. Clinical and hematological parameters of 1076 individuals of thalassemia were collected to analyze the correlation between genotype and phenotype. ResultsAmong 2997 subjects, 1076 cases diagnosed as thalassemia gene carrier or patients, with detection rate 35.9%, among which Southeast Asian deletion (--SEA) / αα was the most common α-thalassemia genotype (48.4%) and one rare genotype was detected: HKαα/--SEA (0.1%). Subjects with thalassemia alone showed the least severe symptoms of anemia with higher red blood cell count (RBC) and hemoglobin (Hb), lower red blood cell distribution width (RDW) than those with iron deficiency (ID) or iron overload (IO) (p<0.05). The Hb, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) levels in gene carriers of α-thalassemia were higher than those of β-thalassemia, while RBC, RDW and serum ferritin (SF) levels were lower than the later(p<0.05). Among individuals with --SEA/αα, the Hb, MCV, MCH, mean corpuscular hemoglobin concentration (MCHC) and SF levels of subjects≥19 years old were higher than those of ≤18 years old. For cases ≥19 years old, the RBC, Hb and SF levels in male were higher than that in female, while MCHC level was lower than female(p<0.05). ConclusionThe difference of hematological phenotypes in patients with thalassemia is not only affected by their genotype, but also the influence of gender and age.

Role of Charlson comorbidity index in predicting intensive care unit readmission in patients with aortic aneurysm.

The purpose of this study was to investigate the value of the Charlson comorbidity index (CCI) in predicting intensive care unit (ICU) readmission in aortic aneurysm (AA) patients. Patient information came from the Medical Information Mart for Intensive Care- IV (MIMIC-IV) database. The relationship between CCI and ICU readmission was analyzed by restricted cubic spline, generalized linear regression, trend analysis, and hierarchical analysis. The clinical value of CCI in predicting ICU readmission was analyzed by receiver operating characteristic curve, decision curve analysis, XGBoost regression, and random forest regression. A total of 523 patients with AA were enrolled in the study. Patients with AA who were readmitted to the ICU had higher width of red blood cell distribution width (RDW) and higher CCI. CCI had better performance and clinical net benefit for predicting ICU readmission than RDW. An independent nonlinear relationship was found between CCI and ICU readmission. The trend analysis suggested that the risk of ICU readmission increased with higher CCI scores. The hierarchical analysis showed that their association was mainly found in surgery requirement populations regardless of AA types. Further, CCI was found to have better clinical value in predicting ICU readmission of thoracic aortic aneurysm (TAA) patients undergoing surgery. Age, renal disease, chronic lung disease, and dementia were important components of CCI in predicting ICU readmission of TAA patients undergoing surgery. CCI was independently associated with the ICU readmission of AA patients in a positive relationship and had more favorable prediction performance in TAA patients who underwent surgery.

Immuno-hematological parameters among adult HIV patients before and after initiation of Dolutegravir based antiretroviral therapy, Addis Ababa, Ethiopia.

Immuno-hematological abnormalities are common among HIV infected individuals as well as patients with highly active antiretroviral therapy (HAART). However, the immuno-hematological outcome of Dolutegravir based antiretroviral therapy (ART) usage is not well investigated. To assess hematological and immunological parameters among adult HIV patients before and after initiation of Dolutegravir based ART regimen at St. Peter Specialized Hospital, Addis Ababa, Ethiopia. A cross-sectional study was conducted from May to July 2021 at St. Peter Specialized Hospital among adult HIV patients. A total of 422 HIV patients on Dolutegravir based ART (combination of Dolutegravir/lamivudine/tenofovir disoproxil fumarate (DTG/3TC/TDF)) for a minimum of 3 months were selected using convenient sampling methods. Socio-demographic as well as clinical data of the participants was obtained using pre-tested structured questionnaires and a review of medical records. Hematological parameters such as CBC was obtained using Beckman coulter automated hematology analyzer and immunological parameters such as CD4 count were determined using BD FACS presto. Statistical analysis of the data was done using SPSS version 21. Paired t-test was used to compare dependent variables before and after initiation of the new HAART and binary logistic regression was used to determine predictors of immuno-hematological abnormalities. P-value < 0.05 was considered as statistically significant. Of 422 adult HIV patients, about 273(64.7%) were females. The mean age of study participants was 42.2 years (±10.4SD). The mean white blood cell (WBC) count, red blood cell (RBC) count, hemoglobin (Hb), platelet distribution width (PDW), CD4 count, as well as lymphocyte percentage, neutrophil percentage, and platelet counts (PLT) were increased significantly(P<0.05) after 3 months of the Dolutegravir based therapy. While, red cell distribution width (RDW) and mean cell hemoglobin (MCH) were decreased (P<0.05) after the treatment. Other hematological parameters such as mean cell volume (MCV), hematocrit (HCT), mean cell hemoglobin concentration (MCHC), mean platelet volume (MPV) and platelet distribution width (PDW) showed no significant change. On the other hand, the most common hematological abnormalities identified after the new HAART were anemia (12.1%); followed by Leucopenia (11.3%), neutropenia (6%), and thrombocytopenia (4%). Anemia was associated with female sex (AOR = 7.8, 95% CI: 1.9-32.2, P<0.005) and WHO clinical stage III/IV (AOR = 16, 95% CI: 10.63-66.46, P<0.01). There was a significant change in certain immuno-hematological parameters such as WBC count, RBC count, PLT count, Hb, PDW, CD4 count, lymphocyte and neutrophil percentage after initiation of the Dolutegravir based therapy. Anemia was the most common hematological abnormality. Further studies are required to fully comprehend the outcome of the new treatment regimen on immuno-hematological parameters.

Enhancing the Understanding of Abdominal Trauma During the COVID-19 Pandemic Through Co-Occurrence Analysis and Machine Learning.

This study examines the impact of the COVID-19 pandemic on abdominal trauma management by comparing pre-pandemic (17 February 2018-26 February 2020) and pandemic periods (27 February 2020-7 March 2022). Analyzing data from 118 patients at the Emergency County Clinical Hospital of Craiova, we identified significant shifts in clinical practices affecting patient outcomes. During the pandemic, a moderate increase in surgical interventions for specific abdominal traumas indicated the effective adaptation of the medical system. Prioritizing critical cases and deferring non-urgent procedures optimized limited resources. Demographic and clinical factors-including age, sex, body mass index (BMI), and red cell distribution width (RDW)-significantly influenced the hospitalization duration and recovery outcomes. Gender disparities in mortality lessened during the pandemic, possibly due to standardized interventions and the physiological effects of SARS-CoV-2. The link between occupation and obesity highlighted how work environments impact trauma severity, especially as lifestyle changes affect BMI. While age remained a major predictor of mortality, its influence slightly decreased, potentially due to improved protocols for elderly patients. RDW emerged as an important prognostic marker for disease severity and mortality risk. Employing advanced co-occurrence analysis enhanced with machine learning, we uncovered complex relationships between clinical and demographic variables often overlooked by traditional methods. This innovative approach provided deeper insights into the collective impact of various factors on patient outcomes. Our findings demonstrate the healthcare system's rapid adaptations during the pandemic and offer critical insights for optimizing medical strategies and developing personalized interventions in global crises.