Red Cell Distribution Width Group Research Articles

Prognostic value of red cell distribution width in non-ST elevation myocardial infarction: A cohort study.

Non-ST elevation myocardial infarction (NSTEMI) has a higher risk of long-term mortality than ST-elevation myocardial infarction; thus, identifying such high-risk patients is essential. Red cell distribution width (RDW) recently emerged as a strong predictor of mortality in several cardiovascular diseases, however, it is scarcely known whether RDW has a prognostic value in NSTEMI patients, therefore, this study aims to elucidate this issue. 421 consecutive patients with NSTEMI between January 2020 and June 2022 were prospectively enrolled. Patients were divided into 2 groups by the optimal cutoff value of RDW using time-dependent receiver operating characteristic curves. The optimal cutoff value of RDW for predicting all-cause mortality was 13.4 and the study population was divided into low RDW (≤13.4) and high RDW (>13.4). The primary endpoint of this study was long-term all-cause mortality. The secondary endpoint was the association between RDW and long-term adverse events, including heart failure, gastrointestinal hemorrhage, stroke events, re-infarction rate, cardiovascular mortality, and major adverse cardiovascular events. The association of RDW with the outcome was analyzed by Cox regression analysis. Patients with high RDW tended to be older, had a higher history of previous MI, a higher history of percutaneous coronary intervention, a higher level of neutrophil, high-sensitivity C-reactive protein, a lower level of albumin, and a lower level of ejection fraction (all P < .05). During a median follow-up of 720 days (IQR, 534-913 days), the all-cause mortality was significantly higher in the high RDW group than in the low RDW group (24.8% vs 6.3%, P < .001). In the multivariate Cox proportional hazard analysis, RDW > 13.4 was an independent predictor for long-term all-cause mortality [hazard ratio 3.008; 95% confidence interval 1.005, 9.003, P = .049]. Admission RDW could be used as a new biomarker for predicting long-term mortality in patients with NSTEMI, and high RDW was associated with an increased risk of all-cause mortality.

New Incremental Model for Predicting Mortality in Pre-Capillary Pulmonary Hypertension.

In pulmonary hypertension (PH), the identification of easily obtainable prognostic markers associated with right ventricular (RV) dysfunction and survival is needed. To evaluate the association of red cell distribution width (RDW) with clinical, echocardiographic parameters and survival in patients with pre-capillary PH, with the development of a mortality prediction model. Observational, longitudinal, and prospective study conducted from May 2019 to December 2022. Thirty-four patients with pre-capillary PH underwent two-dimensional echocardiography and complete blood count. A cutoff point of 14.5% was considered to define RDW as altered (≥14.5%) or normal (<14.5%). P values <0.05 were considered significant. The median RDW was 14.4%. There was a significant difference in peripheral arterial oxygen saturation (SpO2) (p=0.028), RV strain (p=0.047), and pericardial effusion (p=0.002) between the normal and elevated RDW groups. During a median follow-up of 15 months, 20.6% died. Patients with increased RDW had a shorter overall survival (44.7%, log-rank p=0.019), which was a predictor of mortality in univariate Cox regression (HR 8.55, p=0.048). The addition of RV strain <16% and SpO2 ≤93% to the model including RDW alone showed incremental value in predicting mortality (χ2=8.2, p=0.049; χ2=12.4, p=0.041), with increased area under the receiver operating characteristic curve (0.729 vs. 0.837 vs. 0.909) and decreased probability of survival (44.7% vs. 35.6% vs. 25%, log-rank p=0.019). RDW provides information on the severity of pre-capillary PH by correlating with echocardiographic parameters of RV dysfunction and mortality, which is best predicted by a model including RDW, RV strain and SpO2.

Relationship between initial red cell distribution width and ΔRDW and mortality in cardiac arrest patients.

There has been a lack of research examining the relationship between red cell distribution width (RDW) and the prognosis of cardiac arrest (CA) patients. The prognostic value of the changes in RDW during intensive care unit (ICU) hospitalization for CA patients has not been investigated. This study aims to investigate the correlation between RDW measures at ICU admission and RDW changes during ICU hospitalization and the prognosis of CA patients and then develop a nomogram that predicts the risk of mortality of these patients. A retrospective cohort study is used to collect clinical characteristics of CA patients (>18years) that are on their first admission to ICU with RDW data measured from the Medical Information Mart for Intensive Care IV Version 2.0 database. Patients are randomly divided into a development cohort (75%) and a validation cohort (25%). The primary outcome is 30 and 360day all-cause mortality. ΔRDW is defined as the RDW on ICU discharge minus RDW on ICU admission. A multivariate Cox regression model is applied to test whether the RDW represents an independent risk factor that affects the all-cause mortality of these patients. Meanwhile, the dose-response relationship between the RDW and the mortality is described by restricted cubic spine (RCS). A prediction model is constructed using a nomogram, which is then assessed using receiver operating characteristic curves, calibration curves, and decision curve analysis (DCA). A total of 1278 adult CA patients are included in this study. We found that non-survivors have a higher level of RDW and ΔRDW compared with survivors, and the mortality rate is higher in the high RDW group than in the normal RDW group. The Kaplan-Meier survival curve indicates that patients in the normal RDW group had a higher cumulative survival rate at 30 and 360days than those in the high RDW group (log-rank test, χ2 =36.710, χ2 =54.960, both P values <0.05). The multivariate Cox regression analysis shows that elevated RDW at ICU admission (>15.50%) is an independent predictor of 30 [hazard ratio=1.451, 95% confidence interval (CI)=1.181-1.782, P<0.001] and 360day (hazard ratio=1.393, 95% CI=1.160-1.671, P<0.001) all-cause mortality among CA patients, and an increase in RDW during ICU hospitalization (ΔRDW≥0.4%) can serve as an independent predictor of mortality among these patients. A non-linear relationship between the RDW measured at ICU admission and the increased risk of mortality rate of these patients is shown by the RCS. This study established and validated a nomogram based on six variables, anion gap, first-day Sequential Organ Failure Assessment score, cerebrovascular disease, malignant tumour, norepinephrine use, and RDW, to predict mortality risk in CA patients. The consistency indices of 30 and 360day mortality of CA patients in the validation cohort are 0.721 and 0.725, respectively. The nomogram proved to be well calibrated in the validation cohort. DCA curves indicated that the nomogram provided a higher net benefit over a wide, reasonable range of threshold probabilities for predicting mortality in CA patients and could be adapted for clinical decision-making. Elevated RDW levels on ICU admission and rising RDW during ICU hospitalization are powerful predictors of all-cause mortality for CA patients at 30 and 360days, and they can be used as potential clinical biomarkers to predict the bad prognosis of these patients. The newly developed nomogram, which includes RDW, demonstrates high efficacy in predicting the mortality of CA patients.

Association between Red Cell Distribution Width and Outcomes of Nonagenarians Admitted to the Intensive Care Unit-A Retrospective Cohort Study.

The red cell distribution width (RDW) measures the heterogeneity of the erythrocyte volume. Different clinical conditions are associated with increased RDW, and high levels (>14.5%) have been described as a predictive marker for unfavorable outcomes and mortality in critically ill patients. However, there is a lack of data on very elderly critically ill patients. Therefore, we aimed to investigate the association of RDW with outcomes in critically ill patients ≥ 90 years. A retrospective analysis was conducted for all consecutive critically ill patients ≥ 90 years who were admitted to the Department of Intensive Care Medicine of the Medical University Centre Hamburg-Eppendorf (Hamburg, Germany) with available RDW on admission. Clinical course and laboratory were analyzed for all patients with eligible RDW. High RDW was defined as (>14.5%). We clinically assessed factors associated with mortality. Univariable and multivariable Cox regression analysis was performed to determine the prognostic impact of RDW on 28-day mortality. During a 12-year period, we identified 863 critically ill patients ≥ 90 years old with valid RDW values and complete clinical data. In total, 32% (n = 275) died within 28 days, and 68% (n = 579) survived for 28 days. Median RDW levels on ICU admission were significantly higher in non-survivors compared with survivors (15.6% vs. 14.8%, p < 0.001). Overall, 38% (n = 327) had low, and 62% (n = 536) had high RDW. The proportion of high RDW (>14.5%) was significantly higher in non-survivors (73% vs. 57%, p < 0.001). Patients with low RDW presented with a lower Charlson Comorbidity Index (p = 0.014), and their severity of illness on admission was lower (SAPS II: 35 vs. 38 points, p < 0.001). In total, 32% (n = 104) in the low and 35% (n = 190) in the high RDW group were mechanically ventilated (p = 0.273). The use of vasopressors (35% vs. 49%, p < 0.001) and renal replacement therapy (1% vs. 5%, p = 0.007) was significantly higher in the high RDW group. Cox regression analysis demonstrated that high RDW was significantly associated with 28-day mortality [crude HR 1.768, 95% CI (1.355-2.305); p < 0.001]. This association remained significant after adjusting for multiple confounders [adjusted HR 1.372, 95% CI (1.045-1.802); p = 0.023]. High RDW was significantly associated with mortality in critically ill patients ≥ 90 years. RDW is a useful simple parameter for risk stratification and may aid guidance for the therapy in very elderly critically ill patients.

Red cell distribution width-a potential prognostic indicator for colorectal cancer patients after radical resection in China.

Red cell distribution width (RDW) can signal poor prognosis in inflammatory medical conditions. The purpose of the study was to investigate the relationship between preoperative RDW and colorectal cancer (CRC) in a large cohort of patients. A total of 6,224 CRC patients who underwent radical resection at the Fudan University Shanghai Cancer Center were evaluated retrospectively. The prognostic significance of RDW for overall survival (OS) and disease-free survival (DFS) was analyzed using Cox proportional hazards models and Kaplan-Meier method. Propensity score matching (PSM) was used based on survival confounding factors. The mean age of the study participants was 59.5±12.0 years and the study cohort was 44% female. The overall median and mean RDW values were 13.3% and 14.0%, respectively. Patients were stratified into three groups based on their RDW value (≤13.3%, 13.4-14.0%, and >14.0%). OS and DFS were shown to significantly deteriorate with increasing RDW category. In the PSM population, OS and DFS were significantly lower in the high RDW group compared with matched controls. However, the differences vanished in the comparisons between the middle RDW group and the control group. Our findings demonstrate that preoperative RDW may represent a simple and powerful prognostic factor for CRC patients after radical resection. Integrating RDW into clinical practice may better inform the prognosis and optimize therapeutic approaches for patients with CRC.

Long-term prognostic scores may underestimate the risk of death in patients with heart failure with reduced ejection fraction in whom red cell distribution width is elevated.

Risk prediction in patients with heart failure with reduced ejection fraction (HFrEF) is one of the key challenges for clinicians. Novel biomarkers aggregating several important pathophysiological pathways may modify the diagnostic discrimination of validated scores. The red cell distribution width (RDW) is a cheap and easily available measure of anisocytosis, and was shown to have a strong independent prognostic power in short- and medium‑term prognosis in HFrEF. Our aim was to assess the prognostic power of RDW in optimally treated chronic HFrEF, and to investigate whether different RDW may impact the prognostic accuracy of validated long‑term scores in HFrEF. The study included 551 patients at a median (interquartile range [IQR]) age of 54 (47-59) years, of whom 86.6% were men. The patients represented the median New York Heart Association class III (IQR, II-III), and ischemic etiology occurred in 56.6% of the cases. In all patients, RDW as a coefficient of variation was calculated, along with Meta‑Analysis Global Group in Chronic Heart Failure Score (MAGGIC‑HF) and Seattle Heart Failure Survival Model (SHFSM). The patients were followed for 5 years and all‑cause mortality was assessed. We recorded 166 (30.1%) and 225 (40.8%) deaths at 3 and 5 years, respectively. Scores based on MAGGIC‑HF and SHFSM algorithms for the respective prediction of 3- and 5‑year mortality were calculated for each patient and compared with the observed mortality. There was a significant underestimation of mortality in the patients with RDW above 15.4% (reference values, 11.5%-14.5%), while in those with lower RDW SHFSM overestimated the actual risk. The excess mortality in the higher RDW group was confirmed by the Hosmer-Lemeshow statistic. The RDW has a strong prognostic value in chronic HFrEF, independently of the risk assessed by the MAGGIC‑HF or the SHFSM score.

Red Cell Distribution Width Predicts Long-Term Cardiovascular Outcomes in Patients with Chronic Coronary Syndrome.

Red cell distribution width (RDW) has been shown to be an independent risk factor for increased cardiovascular mortality, heart failure, and cardiovascular disease. However, the association between RDW and long-term clinical outcomes in patients with chronic coronary syndrome (CCS) remains uncertain. In this study, a total of 2,881 CCS patients who underwent their first percutaneous coronary intervention (PCI) and who had available data on pre-procedural RDW between 2002 and 2016 were enrolled. Of these, 1,827 without anemia and severe renal dysfunction were divided into quartiles based on their RDW values. The primary endpoint was a composite of all-cause death and non-fatal myocardial infarction. As a result, patients in the higher RDW quartile groups were more likely to be older and have chronic kidney disease. During a median follow-up of 6.2 years, 209 (11.4%) events were identified. Kaplan-Meier curves showed the highest RDW quartile group had a clearly higher incidence of the primary endpoint (log-rank P = 0.0002). The highest RDW group had a significantly higher risk of cardiovascular events compared with the lowest RDW group, even after adjustment for other risk factors (hazard ratio 1.95, 95% confidence interval 1.04-3.67, P = 0.04). Increasing RDW as a continuous variable was also associated with the incidence of the primary endpoint (hazard ratio 1.46 per 1% increase, 95% confidence interval 1.24-1.69, P < 0.0001). In conclusion, this study demonstrated that increased RDW was associated with worse clinical outcomes after elective PCI. Assessing pre-PCI RDW may be useful for risk stratification of CCS.

RDW Is an Independent Prognostic Biomarker in Patients with Chronic Graft-Versus-Host-Disease

Background Chronic graft-versus-host disease (cGVHD) is an important immunologic sequelae of allogeneic hematopoietic stem cell transplantation (HCT) that can lead to increased morbidity and mortality in long-term survivors. Red cell distribution width (RDW) is a measure of the variation of the mean corpuscular volume of red blood cells reflecting the degree of anisocytosis. Multiple epidemiological and longitudinal observational studies have shown that higher RDW values are associated with increased all-cause, cardiovascular and cancer-related mortality in different populations including patients as well as healthy participants but limited data exists in patients after HCT. Although RDW is affected to some degree by any type of anemia, the etiology of variation in RDW is considered to be multifactorial and overall incompletely understood. Whether RDW is affected by cGVHD activity or retains its prognostic significance for mortality is unknown. Patients and Methods The present study analyzed patients enrolled on the NIH cGVHD natural history study (NCT00092235) with existing measures of RDW (n=404). In addition to RDW, previously described laboratory markers of inflammation (Grkovic L. et al. Leukemia. 2012;26:633) significantly associated with cGVHD disease activity and other known prognostic factors associated with survival in cGVHD patients were considered. Results The median age of the cohort was 47.2 years (IQR 32-57) and male patients were slightly overrepresented (n=231, 57%). Information about the NIH global score was available in 98.5% of patients who had predominantly severe (72.4%) and moderate (25.6%) cGVHD (Table 1). The median potential follow-up of the total cohort was 11.9 years (IQR 8.4-14.5) and the 5-year overall survival (OS) 77.9% (95% CI, 68.3-77.0%), but the median OS was not reached. A clear split was identified between the first quartile and the remaining overlapping quartiles of RDW distinguishing two groups with statistically different OS: <13.4% vs ≥13.4% (p=0.0024, adjusted for 3 implicit cut-points). Five-year OS was 84.1% (95% CI, 75.3%-89.9%) and 69.1% (95% CI, 63.6%-74.0%) for patients with RDW <13.4% and ≥13.4%, respectively. In univariate analyses, RDW ≥13.4% was statistically associated with Karnofsky performance status (KPS) <80 (39% vs 19%; p=0.0003), cGVHD global score severe (77.6% vs 62%; p=0.0046), increasing involvement of skin (p=0.0023) and mouth (p=0.0043), steroid (70% vs 46%; p<0.0001) and mTOR inhibitor treatment (24% vs 7%; p=0.0002), extracorporeal photopheresis (22% vs 10%; p=0.0077), increased inflammatory markers CRP, C3 and C4 (all p≤0.0002, respectively) and lower IgG (p=0.0031) but not age, sex, kidney function (eGFR CKD-EPI 2021) or time from HCT to study consent. The multiple logistic model established oral cGVHD (OR 1.77; 95% CI, 1.2- 2.60), mTOR inhibitors (OR 3.49; 95% CI, 1.5- 8.30), LDH (OR 1.01; 95% CI, 1.01-1.02), Hb (OR 0.68; 95% CI, 0.57-0.80) and ANC (OR 1.21; 95% CI, 1.07-1.36) as independent factors associated with dichotomized RDW groups. The Cox proportional hazards model confirmed the independent association of RDW ≥13.4% with worse OS (HR 1.61; 95% CI, 1.05-2.47) and identified albumin <3.45 mg/dL (HR 1.78; 95% CI, 1.41-2.24) and IgG <6.3 g/L (HR 1.67; 95% CI, 1.20-2.31) as independent factors in addition to KPS <80 (HR 1.51; 95% CI, 1.06-2.14), eGFR <45 mL/min/1.73m2 (HR 2.27; 95% CI, 1.41-3.66) and lung cGVHD NIH grade 3 (HR 2.92; 95% CI, 1.86-4.57). Moreover, RDW ≥13.4% was associated with decreased relapse-free survival (5-year; 72.8% vs 87.8%; p=0.0062 for comparison of the full curves) and increased non-relapse mortality (5-year; 20.8% vs 7.6%; p=0.0082 for comparison of the full curves) but not with cumulative incidence of relapse (5-year; 6.5% vs 4.6%; p=0.45). Conclusion Patients with chronic GVHD and RDW ≥13.4% have a statistically worse overall survival due to higher risk of non-relapse mortality. Hypoalbuminemia and hypogammaglobulinemia — laboratory markers of increased inflammation and B-cell dysfunction — are additional independent poor prognostic factors identified by this study. It seems prudent that future therapeutic clinical trials should measure these laboratory markers to investigate whether they serve as surrogate biomarkers of chronic GVHD. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

The Prognostic Value of Systemic Immune-Inflammation Index (SII) and Red Cell Distribution Width (RDW) in Cervical Cancer Patients Treated with Radiotherapy

<h3>Purpose/Objective(s)</h3> To assess the association of pre-treatment systemic immune-inflammation index (SII) and red cell distribution width (RDW) with overall survival (OS) in patients treated for primary localized cervical cancer with radiotherapy. <h3>Materials/Methods</h3> The study cohort includes retrospectively collected data of 249 consecutive cervical cancer patients treated with radical intent between 2011 and 2017. The database was based on medical history of the patients and survival data from National Cancer Registry. The statistical analysis included Kaplan-Meier method, log-rank testing and Cox proportional hazards regression model. The cut-off values for log-rank testing were based on available literature data. <h3>Results</h3> The median age of the patients was 57.2 (IQR 49.2-64.5). The patients undergone a combination of external beam radiotherapy (100%), brachytherapy (98%) and concurrent chemotherapy (90%). The 5-year OS was 69.9% and 60.2% patients were alive at the time of the analysis. The results of the Cox model are presented in Table 1. Both SII and RDW were associated with survival in univariate analysis and remained independent prognostic factors in stepwise selection multivariate analysis. The OS was significantly higher in low SII (≤1000 and >1000; p=0.006) and low RDW (≤14.5% and >14.5%; p=0.002) groups. The 5-year OS was 73.5% and 60.2% for SII, and 74.3%, and 52.7% for RDW respectively. <h3>Conclusion</h3> SII and RDW are significantly associated with overall survival and could be used to improve the accuracy of pre-treatment prognostic assessment, in patients treated with radiotherapy for cervical cancer. Table: Univariate and multivariate Cox Regression analysis of HR for OS in patients with cervical cancer

Prognostic value of red cell distribution width and mean corpuscular volume on mortality in hemodialysis patients.

Anemia is a common consequence of chronic kidney disease (CKD). Red cell distribution width (RDW) and mean corpuscular volume (MCV) are principally used for differential diagnosis of anemia. Limited evidence is available for its prognostic value for mortality in hemodialysis (HD) patients. We aimed to definite the relationship between RDW and MCV and mortality in HD patients. This cohort study examined all-cause and cardiovascular (CV) mortality with 181 maintenance HD patients from February 2015. Patients were divided into four groups according to the median of RDW and MCV. Pearson analysis was conducted to determine the related factors of RDW and MCV. The independent association of RDW and MCV with mortality was examined with Kaplan-Meier curve and Cox regression analysis. This study included 181 HD patients for a median follow-up of 71 months. We found RDW was positively related to neutrophil count, C-reaction protein, and ferritin, while negatively related to hemoglobin, albumin, and creatinine. Only neutrophil count and ferritin were significantly related to MCV in this study. In the multivariate Cox regression analysis, the high RDW group was associated with higher risk of all-cause mortality (odds ratio, 3.787; 95% confidence interval, 1.037 to 13.834; p = 0.044). The relationship between RDW and MCV and CV mortality was not significant. RDW could emerge as an additive risk factor for all-cause mortality in maintenance HD patients, independent of other factors. An absolute value of MCV to predict mortality and the underlying pathophysiologic mechanisms should be confirmed in the future.

Dynamic Changes in Red Cell Distribution Width Can Predict Major Adverse Cardiovascular Events after PCI in Patients with Unstable Angina Pectoris: A Retrospective Cohort Study.

Background The increased red cell distribution width (RDW) is related to a higher risk for cardiovascular disease (CVD). However, it is yet unclear whether the dynamic change of RDW is associated with the major adverse cardiovascular events (MACEs) for individual with CVD. Methods and Results A cohort study was conducted among 228 patients who had unstable angina (UA) and underwent PCI. RDW was measured preceding PCI and re-measured on the 16th week after PCI. The change of RDW values was defined as ΔRDW. The patients were divided into 3 groups in accordance with ΔRDW: improved, stable, and worsened RDW groups. The patients were followed up for 6 years, and MACE episodes were recorded. The survival analysis showed that the incidence of MACEs in stable RDW group was significantly lower than that in improved and worsened RDW groups. By the COX model, the risk of the occurrence of cardiovascular events in improved RDW group was 1.661 times higher than the risk in stable RDW group (HR =1.661, 95% CI: 1.583-2.880, p < 0.05) and the same situation was 3.307 times higher in worsened RDW group (HR =3.307, 95% CI: 1.830-5.041, p < 0.05). Conclusion The measurement of ΔRDW has potential to predict the MACEs in UA patients underwent PCI. The dynamic changes in RDW are associated with the outcome of CVD.

Nutritional Status Associated to Red Cell Distribution Width, Length of Stay, and Clinical Outcome patient with Chronic Kidney Diseases

INTRODUCTION: Red cell distribution width (RDW) shows the heterogeneity of erythrocyte size associated with inflammation and various clinical conditions including in patients with chronic kidney disease (CKD). Systemic inflammation and oxidative stress were commonly found in CKD patients. AIM: This study aimed to examine the relationship of nutritional status, length of hospital stay (LOS), and clinical outcome to RDW in CKD patients. METHODS: We conducted a retrospective cohort study of 1736 patients CKD patients who admitted from January 2017 to August 2020, aged between 18 and 60 years and were hospitalized at Wahidin General Hospital. From those, 239 were consulted with clinical nutrition specialist, of which 59 patients eligible with the criteria inclusion. Data were collected through medical records and through electronic data (biochemical data). RDW was categorized into normal and high RDW group, nutritional status based on subjective global assessment (SGA), LOS &lt;10 days and clinical outcome based on conditions at the time of hospital discharged. Data were analyzed using SPSS version 25.0. RESULTS: The data of 59 patients were analyzed, the mean age was 50.42 years (normal RDW) and 47.24 years (high RDW), most of them are women (57.7% vs. 60.6%). There were 42 patients with moderate malnutrition (23 normal RDW and 19 high RDW) and 17 patients with severe malnutrition (3 normal RDW and 14 with high RDW). The study found a significant differences between normal RDW and high RDW (p 0.021), but not significant differences in LOS (p 0.890) and clinical outcome (p 0.968). There were a significant differences in the levels of hemoglobin (p = 0.001), RBG (p = 0.030), and serum sodium level (p = 0.010). Patient with LOS &lt; 10 days had lower sodium levels and more severe anemia when compared with LOS &gt; 10 days and the poor clinical outcome had a heavier degree of anemia compared to the good clinical outcomes. CONCLUSION: Poor nutritional status was associated with an increase in RDW, degree of anemia, and sodium level.

Red Cell Distribution Width and Mortality in Patients Undergoing Percutaneous Coronary Intervention.

Red cell distribution width (RDW) can effectively predict prognosis in coronary artery disease (CAD) patients following percutaneous coronary intervention (PCI). There is currently no relevant research to demonstrate a linear or non-linear association between RDW and mortality. This is a multi-center, retrospective cohort study, with data collected from 2006 to 2017. Source data included electronic medical records of the Integrated Medical Database of National Taiwan University Hospital, and health insurance claims from the National Health Insurance Administration. Patients were stratified into five groups according to RDW values (13.4%, 14.1%, 14.8%, and 15.9%). Multivariable logistic and Cox regression analyses were used to determine 1-year all-cause and cardiovascular (CV) mortalities. Data of 10,669 patients were analyzed and those with the lowest RDW (≤13.3%) served as the reference group. The adjusted odds ratios (ORs) of 1-year all-cause mortality from the second to fifth RDW group were 1.386, 1.589, 2.090, and 3.192, respectively (p for trend < 0.001). The adjusted ORs of 1-year CV mortality were 1.555, 1.585, 1.623, and 2.850, respectively (p for trend = 0.015). The adjusted hazard ratios (HRs) of 1-year all-cause mortality were 1.394, 1.592, 2.003, and 2.689, respectively (p for trend = 0.006). The adjusted HRs of 1-year CV mortality were 1.533, 1.568, 1.609, and 2.710, respectively (p for trend = 0.015). RDW was an independent predicting factor and had a linear relationship with the 1-year all-cause and CV mortalities in patients undergoing PCI. Thus, RDW may be a clinically useful parameter to predict the mortality in those patients.

Prognostic value of absolute lymphocyte/monocyte ratio, red cell distribution width and neutrophil/ lymphocyte ratio in diffuse large B-cell lymphoma patients.

Diffuse large B-cell lymphoma (DLBCL) is an aggressive and rapid-growing form of non-Hodgkin lymphoma (NHL). The objective of this research was to assess the predictive role of lymphocyte to monocyte ratio (LMR), red cell distribution width (RDW) and neutrophil to lymphocyte ratio (NLR) values in the survival of DLBCL patients. A retrospective analysis of 136 DLBCL patients admitted to Nanakali Hospital for blood diseases and oncology from 2010-2020 was done. We assessed the correlation of LMR, RDW and NLR with patients' characteristics and the impact on survival by the Kaplan-Meier method, the log-rank test, and Cox regression models for multivariate analysis. The complete remission rate was 61.7%, with a 5- year overall survival (OS) and progression-free survival (PFS) of 59.5% and 60%, respectively. The Log-rank test showed that LMR was significantly correlated with Ann Arbor staging (p= 0.040). There is a significant association between RDW and Eastern Cooperative Oncology Group performance status (ECOG-performance status) (p= 0.022), B symptoms (p= 0.026), Revised International prognostic index (R-IPI) (p= 0.004), lactate dehydrogenase (LDH) (p= 0.021), and beta 2 microglobulin (B2MG) (p= 0.007), whereas NLR had a significant correlation with LDH only (p=0.016). There were no significant differences in the 5-year OS or PFS in patients with different levels of RDW, LMR, and NLR. LMR, RDW and NLR were correlated with many of patients' characteristics. However, none of the LMR, RDW and NLR did possess value to predict OS and PFS, and they cannot be used as biomarkers for survival evaluation of DLBCL.

Red Cell Distribution Width as a Prognostic Factor and Its Comparison with Lactate in Patients with Sepsis.

Sepsis remains the leading cause of death in critically ill patients. Thus, regular measurement of lactate levels has been proposed in sepsis guidelines. Elevated red cell distribution width (RDW) is associated with mortality risk in patients with sepsis. This study aimed to investigate the association between RDW and the risk of other adverse outcomes in patients with sepsis and to compare the mortality discriminative ability between lactate and RDW levels. This is a single-centered, retrospective, case-control study that included 504 adult patients with sepsis in the emergency department between 1 January 2020 and 31 December 2020. Eligible patients were divided into normal (RDW ≤ 14.5%) and high (RDW > 14.5%) groups. The baseline characteristics and adverse outcomes were recorded and compared. Compared with the normal RDW group, the patients in the high RDW group had a significantly higher rate of ICU admission (48.8% vs. 32.4%, p = 0.03), septic shock (39.2% vs. 23.5%, p < 0.01), and 30-day in-hospital mortality (32.0% vs. 20.7%, p < 0.01). Furthermore, the RDW (area under curve (AUC) = 0.71) had superior mortality discriminative ability compared to lactate (AUC = 0.63) levels (p = 0.02). Clinicians could rely on this simple and rapid parameter for risk stratification to initiate prompt treatment for patients with sepsis.

Red Cell Distribution Width As a Predictor of Mortality in Patients With Sepsis.

IntroductionSepsis is a common medical condition that is associated with very high mortality and, in survivors, long-term morbidity. Conventional inflammatory markers, such as CRP, erythrocyte sedimentation rate (ESR), and white blood cell count (WBC), have proven to have a limited utility in sepsis patients by virtue of their poor sensitivity and specificity for infections. Recently, the commonly used index of red cell distribution width (RDW) has been implicated as a prognostic marker in sepsis. This study aimed at assessing the role of RDW in predicting outcomes such as mortality in patients with sepsis and to study its role as a prognostic marker.MethodsThis was conducted as a prospective comparative observational study over a two year period between 2018 and 2020 in a tertiary care center in South India. In total, 60 adult patients above 18 years of age who were diagnosed to have severe sepsis and septic shock were selected to be part of the study. To find the survival probability on overall survival, Kaplan-Meier analysis was used and a comparison was done using the Log-rank test. To find the most significant predictors of mortality, cox regression analysis was applied.ResultsA total of 60 patients (n=60) were enrolled in this study out of which 30 (50%) patients had a rise in RDW and 30 (50%) patients had a fall in RDW. A total of 17 (28.3%) patients died during this study. In the rise in RDW group, there were 12 (40%) deaths while in the fall in the RDW group, there were five (16.7%) deaths. There was a statistically significant association found between mortality with rise and fall in RDW (p<0.05). A cox multivariate regression analysis demonstrated statistically significant associations between a rise in RDW (p<0.05, HR: 5.6, CI 1.4 to 21.9) and serum hemoglobin < 13.6 g/dL (p<0.05, HR: 3.6, CI 1.1 to 11.4) with mortality in this study. Kaplan-Meier analysis of rise and fall in RDW with survival trended towards better survival outcomes in the fall in the RDW group but was not significant (p=0.07).ConclusionWe found that an increase in RDW from baseline during the initial 72 hours after admission is significantly associated with adverse clinical outcomes including mortality. The mortality in the rise in the RDW group, as well as overall mortality, were significantly higher than the mortality in the reduced RDW group. Hence, serial RDW measurements could be used as a prognostic factor in severe sepsis and septic shock.

The relationship between red cell distribution width and cardiac autonomic function in heart failure.

BackgroundBoth increases in red cell distribution width (RDW) levels and autonomic dysfunction are considered to be correlated with worsening heart failure. However, the relation of RDW levels to autonomic function remains uncertain. We aimed to investigate the association of RDW levels in heart failure with autonomic function, evaluated by heart rate variability (HRV) and heart rate turbulence (HRT), and prognosis.MethodsWe studied 222 hospitalized patients with stable heart failure before discharge, and Holter recordings (HRV and HRT) were performed. Additionally, RDW levels were measured, and high RDW was defined as over 14.5%. We then divided the patients into two groups based on RDW levels: high RDW group (>14.5%, n = 92) and low RDW group (≤14.5%, n = 130). The relation of RDW to autonomic function and prognosis was assessed.ResultsIn the high RDW group, severely impaired HRV and HRT were found compared to the low RDW group. In the linear regression analysis after the adjustment of multiple confounders, RDW levels were correlated with a low‐frequency (LF) to high‐frequency (HF) ratio and very low‐frequency (VLF) power (LF to HF ratio, β = −0.146, P = .027, and VLF power, β = −0.137, P = .041, respectively). During the observation period (median 1400 days), cardiac events (re‐hospitalization of heart failure, cardiac death or sudden death) were found in 73 (32.8%) patients. The Kaplan‐Meier analysis demonstrated that the high RDW group had a higher rate of cardiac events compared to the low RDW group (45.6% vs 23.8%, log‐rank P < .001).ConclusionHigh RDW levels were correlated with autonomic dysfunction, resulting in poor clinical outcomes.

Red Cell Distribution Width as a Marker of Periprocedural Myocardial Infarction in Patients with Elective Percutaneous Coronary Intervention.

We aimed to investigate whether red cell distribution width (RDW) was associated with periprocedural myocardial infarction (PMI) in patients undergoing elective percutaneous coronary intervention (PCI). Among 1723 consecutive patients undergoing elective PCI, a total of 230 (13.3%) met the diagnostic criteria of PMI. The high RDW (≥ 12.6%) group tended to have PMI (15.4% vs. 11.2%, P = 0.010). RDW was an independent predictor of PMI whether as a categorical variable (adjusted odds ratio = 1.442, 95% confidence interval = 1.088 to 1.911, P = 0.011) or a continuous variable (adjusted odds ratio = 1.236, 95% confidence interval = 1.079 to 1.415, P = 0.002). High RDW was also significantly associated with increased risk of major adverse cardiovascular events (MACE) during follow-up. However, anemia was not independently associated with PMI or MACE in the current study. In conclusion, RDW showed strong and independent association with PMI in patients undergoing elective PCI.

RED CELL DISTRIBUTION WIDTH CORRELATES WITH NT-PROBNP IN PULMONARY HYPERTENSION

SESSION TITLE: Pulmonary Vascular Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: N-terminal pro-brain-type natriuretic peptide (NT-proBNP) is an established biomarker for pulmonary hypertension (PH), as an indicator of disease severity, and a predictor of mortality and morbidity. Red Cell Distribution Width (RDW), the measure of anisocytosis amongst red cells, is increasingly being realized to be a biomarker for various conditions. The purpose of this study was to assess the correlation between RDW and NT-proBNP in the setting of the new definition of PH as per the 6th World Symposium, which includes all patients with a mean pulmonary artery pressure (mPAP) of over 20 mm Hg. METHODS: Patients who underwent right heart catheterization (RHC) at our hospital system between November 2014 and November 2019 were included in this retrospective study. Exclusion criteria included patients under the age of 18, active malignancy, known hemoglobinopathy, blood transfusion within one month of laboratory testing, and a lack of RDW or NT-proBNP measured within 3 months of RHC. Hemodynamic parameters obtained on RHC were documented. The closest RDW and NT-proBNP values obtained within 3 months of the RHC were noted. Student’s t-test was used to compare NT-proBNP between patients with elevated RDW (> 14.5%) and normal RDW (≤ 14.5%). Secondly, mean RDW was compared between elevated BNP (≥ 300 pg/mL) and normal BNP (< 300 pg/mL). RESULTS: 231 patients were included in this study. 176 of them had RHC-proven PH. Amongst PH patients, there was a statistically significant significant difference in the mean NT-proBNP between the elevated RDW (> 14.5%, n = 90) and the non-elevated RDW (≤ 14.5%, n = 86) groups (7401.57 vs 3663.83 pg/mL, p = 0.0076). Patients with elevated NT-proBNP (≥ 300 pg/mL, n = 142) tended to have a higher RDW than those with normal BNP (< 300 pg/mL, n = 34) (15.03 vs 14.36%, p = 0.0264). These relationships held true when generalized to include patients without PH. The elevated RDW group (n = 100) had a significantly higher NT-proBNP than the normal RDW group (n = 131) (6866.19 vs 3136.6 pg/mL, p = 0.002). The elevated NT-proBNP group (n = 172) also had a higher RDW than the normal NT-proBNP group (n = 69) (14.84 vs 13.96%, p = 0.0003). CONCLUSIONS: NT-proBNP has previously been shown to be a valid biomarker for assessing disease severity, and to predict mortality and morbidity in patients with PH. The correlation between RDW and NT-proBNP in the setting of PH implies that RDW may also be a useful surrogate marker for disease severity in PH. CLINICAL IMPLICATIONS: RDW is a relatively cheap marker that could be used alongside other biomarkers such as NT-proBNP to measure the severity of disease in PH. Further studies are required to directly validate this relationship. DISCLOSURES: No relevant relationships by Syed Haider, source=Admin input No relevant relationships by Pius Ochieng, source=Web Response No relevant relationships by Divya Ravi, source=Web Response No relevant relationships by NISHANT SHARMA, source=Web Response No relevant relationships by Metlapalli Venkata Sravanthi, source=Web Response No relevant relationships by Pandi Todhe, source=Web Response

CORRELATION BETWEEN PULMONARY VASCULAR RESISTANCE AND RED CELL DISTRIBUTION WIDTH IN PULMONARY HYPERTENSION

SESSION TITLE: Pulmonary Vascular Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Red Cell Distribution Width (RDW) is a mathematically derived value, used to evaluate the size variation of red cells. It can be elevated in situations of recent blood loss or transfusion, renal dysfunction, etc. A literature review shows that RDW has been correlated with various cardiac hemodynamic parameters in the setting of pulmonary hypertension (PH). The 6th World Symposium on Pulmonary Hypertension (PH) recently defined pre-capillary PH to include PH patients with a pulmonary vascular resistance (PVR) of over 3 Woods Units (WU). The purpose of this study was to determine the presence of a correlation between RDW and PVR. METHODS: Patients who underwent right heart catheterization (RHC) at our center between November 2014 and November 2019 were included in this retrospective study. Exclusion criteria included patients under the age of 18, active malignancy, known hemoglobinopathy, blood transfusion within one month of laboratory testing, and patients without an RDW measured within 3 months of RHC. Hemodynamic parameters obtained on RHC were documented, along with RDW values from the closest CBC obtained within 3 months of the RHC. Student’s t-test was used to compare PVR between patients with elevated RDW (> 14.5%) and normal RDW (= 14.5%). Additionally, RDW was compared between patients with elevated PVR (> 3 WU) and those without. RESULTS: 306 patients were included in this study. The elevated RDW group (> 14.5%, n = 117) tended to have a higher PVR than normal RDW group (= 14.5%, n = 189), and this was found to be statistically significant (3.02 vs 2.43 WU, p = 0.495). On the other hand, patients with an elevated PVR (= 3 WU, n = 71) were also found to higher RDW than the non-elevated PVR (< 3 WU, n = 235) group, in a statistically significant fashion (15.05 vs 14.31%, p = 0.0369). CONCLUSIONS: This study implies that a statistically significant correlation exists between PVR and RDW. The elevation of RDW in the setting of an elevated PVR could be due to the fact that RDW is tied to the severity of inflammatory state. PH likely has an inflammatory component; there have been studies demonstrating increased expression of C-reactive protein receptor lectin-like oxidized low-density lipoprotein receptor-1 the pulmonary vasculature cells of patients with CTEPH. Furthermore, endothelial dysfunction, inflammation, and smooth muscle proliferation is causative of elevations in PVR. CLINICAL IMPLICATIONS: Given the importance of PVR in the classification of PH, a cheap biomarker to predict the PVR in patients with PH would be of utility. RDW could serve useful in this setting, however, larger studies are needed to validate this association. DISCLOSURES: No relevant relationships by Syed Haider, source=Admin input No relevant relationships by Pius Ochieng, source=Web Response No relevant relationships by Divya Ravi, source=Web Response No relevant relationships by NISHANT SHARMA, source=Web Response No relevant relationships by Metlapalli Venkata Sravanthi, source=Web Response No relevant relationships by Pandi Todhe, source=Web Response