Red Cell Distribution Width In Patients Research Articles

The Value of Red Cell Distribution Width and Its Correlation with Other Parameters in Ovarian Cancer

Abstract Background: The red cell distribution width (RDW) is a measure of the range of variation in the red blood cell size. It reflects red blood cell volume heterogeneity and is a part of the whole blood cell count. The use of the RDW in the diagnosis of malignant tumors has recently attracted much attention. Related research has mainly focused on endometrial cancer, lung cancer, and liver cancer. Aim of the Study: This study investigated the correlation between the RDW and ovarian cancer by observing changes in the RDW in patients with different stages of ovarian cancer. Patients and Methods: A case–control study involving 50 females with ovarian cancer and 50 healthy females conducted at Baghdad Oncology Teaching Hospital, and Al-Imamian Al-Kadhimiyain Medical City from January 1, 2022, to December 30, 2022. Data collection included demographic data, complete blood count with the calculation of platelets to lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR), transferrin saturation, and cancer antigen 125 (CA-125). Adult females with histologically proven ovarian cancer were included in this research. Patients with conditions that affect red blood cells were excluded from the study. Results: The mean age was 52.6 ± 10.4 years old for the cases and 50.0 ± 11.4 years for the control group. Platelets count (PLT), absolute neutrophil count (ANC), PLR, NLR, RDW, and CA-125 were significantly higher in the women with ovarian cancer in comparison to the control group (P < 0.001). RDW values were found to be positively correlated with white blood cell, PLT, ANC, NLR, PLR, and CA-125 values (P < 0.001). RDW values were also positively associated with cancer stage; thus, higher values of RDW are to be expected with a higher stage of cancer (P < 0.001). The optimal cutoff point for RDW was found to be 14.6% with a sensitivity of 92%, specificity of 90%, and an area under the curve of 96%. Conclusion: The RDW is increased with ovarian cancer, and a clear cutoff point for the prediction of ovarian cancer has been observed. Furthermore, RDW was positively correlated with cancer stage and inflammatory markers including PLT, ANC, PLR, NLR, and a tumor marker CA-125.

Electroconvulsive therapy improves hematological inflammatory markers in bipolar disorder.

Immune dysfunction and inflammation participate in the pathophysiology of bipolar disorder (BD). Abnormal levels of inflammatory markers, namely, red cell distribution width (RDW) and platelet distribution width (PDW), were detected in BD. Electroconvulsive therapy (ECT) for various mental disorders including BD was linked to changes in these inflammatory mediators. Hence, we aimed to assess the impact of ECT on PDW and RDW in patients with BD. Seventy-two patients aged ≥ 16 were enrolled in the current prospective cohort study over 6 months, diagnosed as BD based on DSM-IV and indicated for ECT and complete blood count (CBC) drawn pre-ECT and after four ECT sessions. By the end of the ECT sessions, we noticed a significant elevation in PDW with lowering in RDW levels. However, no significant differences were detected before and after ECT regarding platelet (PLTs) count, mean platelet volume (MPV), and Plateletcrit (PCT). ECT seems to improve the CBC-derived inflammatory markers (RDW and PDW) subsequently, improving the underlying inflammatory process in BD without disturbing PLT homeostasis which support its anti-inflammatory role in BD.

Does red blood cell distribution width predict prognosis in metastatic renal cell carcinoma patients using first-line vascular endothelial growth factor receptor tyrosine kinase inhibitor therapy?

It is red cell distribution width (RDW) that has been reported to show an inflammatory response which has been studied recently. The aim of this study is to investigate whether the pre-treatment RDW in patients using first-line vascular endothelial growth factor tyrosine kinase inhibitor (VEGFR TKI) with the diagnosis of metastatic renal cell carcinoma (mRCC) predicts treatment response and is a prognostic factor or not. About 92 patients diagnosed with mRCC who were being treated with sunitinib or pazopanib in the first line between January 2015 and June 2021 were included in the study. The patients were divided into 2 groups, as being ≤15.3 and >15.3, according to the RDW cut-off value calculated by ROC analysis. The mOS of patients with a RDW of ≤15.3% was 45.0 (30.0-59.9) months, and of 21.3 (10.4-32.2) in those with a RDW of >15.3%. This difference was statistically significant (p < 0.001). In the group of patients with a RDW of ≤15.3, median progression free survival (mPFS) (38.04 [16.3-59.7] months) was found to be significantly higher than those with a RDW of >15.3 (17.1 [11.8-22.5] months) (p = 0.04). In multivariate analysis, RDW level (≤15.3, >15.3), was determined to be prognostic markers (p = 0.022). In mRCC patients, the RDW value measured before first-line VEGFR TKI therapy is an independent prognostic marker.

Artmış RDW Değeri ile Kolelitiazis İlişkisi

Objective: Red cell distribution width (RDW) ,an index of heterogenity of circulating red blood cell, has recently been found to be associated with multiple diseases and used as a marker to predict outcome in these patients. In the present study we aimed to investigate if RDW value is associated with cholelithiasis and symptoms of the disease.Material- Method: A total of 204 women (101 with cholelithiasis and 103 without the disease ) were included to the study. The demographic and the laboratory data of the routine complete blood cell parameters including RDW values were recorded. Women with cholelithiasis were divided into symptomatic or non-symptomatic group according to presence of biliary colic or pain. The patients were compared in terms of their demographic and laboratory characteristics.Results: Age and BMI were similiar between groups in the study population. In our study population mean RDW value was signifi¬cantly higher in women with cholelithiasis than without disease. However in subgroup analysis there was no significant difference of RDW value between symptomatic group and nonsymptomatic group Conclusion: In conclusion we demonstrated an association between serum RDW level and cholelithiasis in our study but not with disease symptom. However further studies are needed to understand the role of RDW in patients with cholelithiasis and if this simple , inexpensive and routinely reported parameter can be used for prognostic information in this disease.

Relationship Between High-Density Lipoprotein-Cholesterol and Red Cell Distribution Width in Patients With Coronary Artery Disease.

BackgroundA high red cell distribution width (RDW), which indicates ongoing inflammation, and low levels of high-density lipoprotein-cholesterol (HDL-C) are associated with increased mortality and morbidity in patients with coronary artery disease (CAD). Recent studies have suggested that HDL-C possesses anti-inflammatory and antioxidant effects, which may explain its anti-atherogenic properties. This study aims to determine the relationship between HDL-C levels and RDW in patients with CAD.Materials and methodsThis cross-sectional study was performed on 120 patients with CAD from July 2020 to June 2021 in the Hematology Department of Chughtai Lab Lahore. Patients were graded according to the degree of coronary artery stenosis as follows: Grade 1,30%-50%; Grade 2, 51%-70%; and Grade 3,>70%. The HDL-C level was measured from venous blood samples by a fully automated Abbot Alinity analyzer. The RDW was measured by Sysmex XN-5000. The sample size was calculated using the Select Statistics calculator. The mean RDW and HDL-C of the patients were calculated, and correlation analyses were performed using the Pearson correlation coefficient.ResultsThe HDL-C level was inversely related to the RDW. Of the 120 patients, 38, 44, and 38 had Grade 1, Grade 2, and Grade 3 stenosis, respectively. The mean HDL-C level and RDW were 30.58 ±3.77 mg/dL and 16.04% ±1.66%, respectively. The value of r was −0.8622 (strongly negative). Data were stratified based on the degree of stenosis. The values of r in Grades 1, 2, and 3 were −0.43 (moderately negative), −0.604 (moderately negative), and −0.27 (weakly negative), respectively.ConclusionThe RDW can be used as an additional marker to determine the disease status in CAD patients.

Red Cell Distribution Width (RDW) As Prognostic Factor in Acute Leukemia Patients Undergoing Allogeneic Hematopoietic Transplantation

Background:Red cell distribution width (RDW) is an erythrocyte index influenced by anisocytosis and useful in approaching patient with various types of anemia or suspected myelodysplasia. RDW can predict mortality in sepsis, chronic kidney diseases and cardiovascular disease, RDW has a prognostic value also in patients with breast cancer, lung cancer, glioblastoma, myeloma and chronic lymphocytic leukemia. No data, however, are available on the prognostic value of RDW in patients affected by acute leukemia. We studied prognostic value of RDW-SD assessed at pre-transplant evaluation, in acute leukemia patients who underwent allogeneic transplantation.Methods:We retrospectively studied the prognostic value of RDW-SD in a group of 94 adult acute leukemia patients affected by AML (70) ALL (19) or advanced MDS (5). RDW-SD was measured after patients had received induction and consolidation chemotherapy to achieve maximal anti-leukemic response. A MINDRAY BC6800 automatic cell counter was used. Patients, subsequently, underwent allogeneic transplantation from a sibling or from an alternative donors (MUD or Haplo-identical donors). Median age was 46 years (18-70). Ninths-five percent of patients received a fully myeloablative conditioning. Cytogenetic classification of leukemic cells was available in 95% of AML/MDS patients (72/75). Fifty-four percent of all patients were in an early phase of disease (1st complete remission) while 46% in the advanced phase (2nd CR or active disease). RDW-SD upper normal limit was 55 fL and patients were grouped according to this threshold. Data were analyzed by R software.Results:At baseline, before the transplant, an RDW-SD higher than normal (=/> 56 fL) was observed in 44% of all acute leukemia patients. RDW-SD correlates with MCV (r=0.611, p=0.0001) but not with other hematological parameters present at the time of RDW assessment. A high co-morbidity score (HTC-CI score 2-5) at the pre-transplant screening was a factor significantly associated to high RDW-SD, in fact, 27% of patients having an “RDW-SD over normal” had a comorbidity score of 2-5, while in the group of patients having an “RDW-SD within normal” a comorbidity score 2-5 was observed only in 9% (Chi-square-test p:0.02). The group of patients having an “RDW-SD over normal” had in respect to group “RDW-SD within normal” a higher serum LHD (p: 0.02). An unfavourable cytogenetics was observed in 26% of patients in the group “RDW-SD over normal” versus 8% in the group “RDW within normal” (p=0.10). The two groups of patients were not significantly different in age, gender, diagnosis, phase of the disease, level of WT-1 before transplant, previous transplantation, C-reactive protein, ferritin, creatinine and arterial diastolic pressure. In the whole set of patients, the Overall Survival at 3 y was 45% with a median follow up, for uncensored patients, of 99 weeks. OS at 3 years in the group “RDW within normal” was 61% versus 25% in the group “RDW-SD over normal” (log-rank, p=0-01). Differences in OS between these two groups was present also when patients were stratified according to cytogenetics or phase of disease (Fig 1). In univariate analysis other factors important for OS were phase of disease (p=0.004), graft from an alternative donor (p=0.03) and age (p=0.005). The comorbidity score was not an important factor for OS. In multivariate analysis, using Cox proportional hazard, factors important for OS remained age (HR: 1.040; CI: 1010-1070; P=0.008) and a pre-transplant “RDW-SD over normal ” (HR, 3.274; CI: 1.694-6.328; p=0.0004). The group of patients having an “RDW over normal” had a Relapse Rate (RR) higher than the group having “RDW-SD within normal” (RR: 60% versus 30%, Gray test p= 0.05). Treatment related mortality (TRM) was 14% in the group “RDW within normal” versus 22% in the group “RDW over normal” (Gray test not significant).Conclusions:Abnormal RDW-SD is frequently found in acute leukemia patients treated by chemotherapy and in complete or partial response before allogeneic transplantation, “RDW-SD over normal” at time of pre-transplant screening is an independent negative prognostic factor for outcome after transplantation. The poor OS of the group of patients showing “RDW-SD over normal” is, at least in part, due to a higher relapse rate. The association of “RDW-SD over normal” and adverse cytogenetics deserves further studies. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Association between red blood cell distribution width and in-hospital mortality in acute myocardial infarction.

Previous studies have shown an independent association between increased red cell distribution width (RDW) and mortality after acute myocardial infarction (AMI). However, evidence regarding the predictive significance of repeated measures of RDW in patients with AMI remains scarce. We aimed to investigate the association between the dynamic profile of RDW and in-hospital mortality in patients with AMI.This was a cross-sectional study. We extracted clinical data from the Medical Information Mart for Intensive Care IIIV1.4 database. Demographic data, vital signs, laboratory test data, and comorbidities were collected from the database. The clinical endpoint was in-hospital mortality. Cox proportional hazards models were used to evaluate the prognostic values of basic RDW, and the Kaplan–Meier method was used to plot survival curves. Subgroup analyses were performed to measure mortality across various subgroups. The repeated-measures data were compared using a generalized additive mixed model.In total, 3101eligible patients were included. In multivariate analysis, adjusted for age, sex, and ethnicity, RDW was a significant risk predictor of in-hospital mortality. Furthermore, after adjusting for more confounding factors, RDW remained a significant predictor of in-hospital mortality (tertile 3 vs tertile 1: hazard ratio 2.3; 95% confidence interval 1.39–4.01; P for trend <.05). The Kaplan–Meier curve for tertiles of RDW indicated that survival rates were highest when RDW was ≤13.2% and lowest when RDW was ≥14.2% after adjustment for age, sex, and ethnicity. During the intensive care unit stay, the RDW of nonsurvivors progressively increased until death occurred.Our findings showed that a higher RDW was associated with an increased risk of in-hospital mortality in patients with AMI.

Elevated Red Blood Cell Distribution Width as a Poor Prognostic Factor in Patients With Hematopoietic Stem Cell Transplantation.

Red cell distribution width (RDW), a measure of erythrocyte size variability, has been recently reported as an effective prognostic factor in critical illness. Hematopoietic stem cell transplantation (HSCT) has become the first choice of most patients with hematological malignancies. The aim of this study was to assess the changes of RDW in patients with HSCT and analyze the relationship between RDW and HSCT. In this study, we retrospectively enrolled 114 hematopoietic stem cell transplant patients during the period from 2015 to 2019. Logistic regression and Kaplan–Meier survival analysis were used for retrospective analysis. Multivariate analysis suggested that patients with elevated RDW (>14.5%) at three months post-transplantation have a poor clinical outcome compared with those with normal RDW ≤14.5% [odds ratio (OR) 5.12; P = 0.002]. Kaplan–Meier method analysis demonstrated that patients with elevated RDW levels (>14.5%) after hematopoietic stem cell transplantation experienced shorter progression-free survival compared to those with normal RDW levels (P = 0.008). Our study demonstrated that RDW could be an easily available and potential predictive biomarker for risk stratification in patients with HSCT. Further prospective studies are determined to confirm the prognostic value of RDW in HSCT patients.

Analysis of red cell distribution width in patients presented with interstitial lung disease

Background: Redcell distribution width (RDW) is a prognostic tool of different clinical conditions and a powerful predictor of mortality in elder adults. Increased RDW values were related to underlying chronic inflammation including interstitial lung disease(ILD). RDW as a biomarker to assess the severity of disease in ILD patients was reported. This study was aimed to evaluatethe change in RDW in ILD patients in late stages of the disease. Methods: A retrospective observational study was conducted among patients who died with ILD. Values of RDW during the later stages of disease (close to and 2 months beforedeath)werecollected from medical records. Variations of RDW in patients with or without smoking habits, occupational exposures, and types of ILD were also studied. Data were statistically analysed. Results: Forty-two patients died with ILD included. The value of RDW at 2 months before death was 15.4 ±1.8, whereas the valueclose to death was 16.1 ±2.4(p=0.030). The change in RDW values during late stages of ILD is significant. There was no association between RDW value 2 months before death with smoking history(p=0.112) or occupation(p=0.119) or types of ILD(P=0.121). But 86% of people with the smoking history presented with abnormal RDW value (&gt;14.5%) at the time of their first presentation itself. No variation in RDW was found among patients with history of smoking status, occupational exposures, or types of ILD Conclusion: Increase in RDW was associated with later stages of ILD. Change in RDW value in later stages of can be used as a biomarker for poor survival.

Prognostic Value of the post-operative Red Blood Cell Distribution Width in rectal cancer patients with neoadjuvant chemoradiation followed surgery.

Purposes: Several studies have reported that elevated red cell distribution width (RDW) is related to poor prognosis in several cancers; however, the prognostic significance of perioperative RDW in patients with rectal cancer that received neoadjuvant chemoradiation therapy (NACRT) is unclear.Methods: A total of 120 patients with rectal cancer who received NACRT followed surgery were retrospectively reviewed from Affiliated Cancer Hospital of Zhengzhou University between 2013 and 2015. Data for peripheral blood tests prior to the initiation of NACRT, before surgery and first chemotherapy after surgery were collected, respectively. The optimal cutoff values of RDW were determined by ROC analysis, respectively. The relationship between RDW and the prognosis of patients was evaluated by the Kaplan Meier method, respectively.Results: The post-operative RDWHigh patients had significantly worse 5-year overall survival (OS, P=0.001) and disease-free survival (DFS, P<0.001) than the post-operative RDWLow patients, respectively. Whereas high pre-operative RDW was the only marker correlated with worse DFS (P=0.005) than the pre-operative RDWLow patients, no relationship was found between pre-RDW and prognosis (OS, P=0.069; DFS, P=0.133). Multivariate analysis showed post-operative RDW had better predictive value than pre-RDW and pre-operative RDW.Conclusion: Post-operative RDW might be a useful prognostic indicator in patients with rectal cancer received neoadjuvant chemoradiation.

Correlation of clinical signs and symptoms of Beh\xe7et\u2019s disease with mean platelet volume (MPV) and red cell distribution width (RDW)

BackgroundA strong correlation was previously found between mean platelet volume (MPV), red blood cell distribution width (RDW), and the severity of signs and symptoms in patients suffering from inflammatory and autoimmune diseases. The current study evaluated these correlations in patients with Behçet’s disease (BD) as well the relationship between MPV and RDW and disease activity score on the Iranian Behçet’s Disease Dynamic Activity Measurement (IBDDAM).MethodsThis cross-sectional study included 319 patients with BD for whom demographic and epidemiological data, IBDDAM scores, and duration of illness was recorded. Blood samples were then obtained and the relationships between their disease status and manifestations and their laboratory parameters were evaluated with statistical models to find possible correlations.ResultsOur analysis showed a significantly higher RDW in patients with BD who had ocular manifestations (p < 0.001) and oral aphthae (p = 0.004). Patients with active BD had higher RDW (p < 0.001) and MPV (p < 0.001) in comparison to those with currently inactive BD. Similarly, patients who had any type of ocular manifestation had higher RDW (p < 0.001) and MPV (p < 0.001). Regression analyses identified a statistically significant model for the effect of RDW and MPV in predicting active BD status (p < 0.001), as well as its significant relationship with active ocular manifestations (p < 0.001).ConclusionBD was found to be associated with an increase in MPV and RDW, particularly during active phases. RDW and MPV were also found to have predictive value for screening to detect BD activity and its ocular complications.

Red cell distribution width for prognosis in patients with pulmonary embolism: A systematic review and meta-analysis.

Patients with pulmonary embolism (PE) have a higher red cell distribution width (RDW), which may complicate the interpretation of the prognosis of PE. We aim to evaluate the diagnostic utility of the RDW in patients with PE. Eligible studies were identified by searching PubMed and EMBASE from inception to December 23, 2018. The data were pooled using Stata 12 to evaluate the prognostic value. The sources of heterogeneity were detected. For the analysis of prognosis, 7 studies with 2146 patients were included, with median RDW values ranging from 13.4% to 15.7% and a median cut-off point of 18.27%. A total of 247 patients (11.5% mortality) among the 2146 participants died. Overall, RDW was positively associated with the prognosis of PE in the overall analysis (HR=1.19, 95% CI=1.10-1.29, I2 =73.4%; P=0.000). Subgroup analyses by study design, sex and follow-up time indicated that they were not sources of heterogeneity. An elevated RDW has the potential to be a biomarker for prognosis in PE patients.

The Predictive Value of Red Cell Distribution (RDW) in Patients with Type 1 and Type 2 Diabetes Mellitus

Background: Epidemiologically speaking the diabetes mellitus is one of the common leading causes of mortality and morbidity worldwide. Prognosis of the disease is variable and depends on the development of macrovascular and microvascular complications. Researchers are nowadays spending plenty of time trying to identify prognostic factors in order to make treatment approach be tailored according to the predictive value of such prognostic factors. One of these newly introduced factors is red cell distribution width (RDW).Aim of the study: The current study was aiming at shedding light of the possible prognostic role of RDW in patients with type 1 and 2 diabetes mellitus.Patients and methods: The present case control study was carried out at diabetes center in Al-Diwaniayh Teaching Hospital, Al-Diwaniyah Province, Iraq. The study started on January 2019 and ended on August 2019. The study included 30 patients with established diagnosis of type 2 diabetes mellitus, 30 patients with type 1 diabetes mellitus and 30 apparently healthy control subjects. Diabetic patients were selected randomly from the pool of patients already registered in that center.Results: We grouped diabetic patients into two groups according to HbA1c level, ?7% and > 7% and contrasted hematological levels between those new groups. The results showed no significant difference in mean hematological values between the two groups in diabetic type 1 and type 2 patients (P > 0.05).Conclusion: There was no significant role for RDW in predicting poor glycemic control of patients with type 1 or type 2 diabetes mellitus.

Red Cell Distribution Width (RDW) Index as a Predictor of Severity of Acute Ischemic Stroke: A Correlation Study.

Introduction:Globally, stroke is one of the leading causes of death and disability-adjusted life-years (DALYs). The red cell distribution width (RDW) is a readily available and inexpensive test which is done routinely as a part of complete blood count in these patients.Objective:In this study, we tried to correlate the RDW with severity of acute ischemic stroke (AIS).Methods:Patients presenting to emergency department (ED) within 24 hours of the onset of clinical signs and symptoms suggestive of AIS were assessed for Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) score followed by non-contrast computed tomography (NCCT) scan. RDW value for all the patients who were included in the study were co-related with the severity of the stroke.Results:The median (IQR) RDW in the patients with minor stroke on the basis of GCS was 13.5 (13.3–13.5), moderate stroke was 13.8 (13.5–14.4) and with severe stroke was 15.4 (15.1–15.6) (p < 0.001). The median (IQR) RDW in the patients with minor stroke on the basis of NIHSS score was 13.4 (13.2 – 13.6), moderate stroke was 13.8 (13.5–14.3), and moderate to severe stroke was 14.7 (14.5–15.3) and with severe stroke was 15.5 (15.1–15.7) (p < 0.001). The median RDW in patients who were alive was 13.8 (13.5–15.1) and in patients who expired was 15.5 (14.5–15.7) (p = 0.048).Conclusion:Based on the findings of this study, RDW index has statistically significant correlation with the severity of AIS. So it can potentially be an important parameter to predict the prognosis of AIS patients.

Prognostic Significance of Pre- and Post-operative Red-Cell Distribution Width in Patients with Gastric Cancer

BackgroundHigh red cell distribution width (RDW) is reportedly provoked by chronic inflammation and poor nutritional status; high pre-operative RDW is related to poor prognosis in some cancers. However, the prognostic significance of post-operative RDW in gastric cancer (GC) patients is unclear. MethodsWe enrolled 221 patients who had undergone curative surgery for histopathologically diagnosed gastric adenocarcinoma. ResultsOptimal cutoff values were determined by ROC analysis to be 14.85 (pre-operative) and 14.05 (post-operative). We accordingly divided patients into the high (pre-RDWHigh; ≥ 14.85) and low (pre-RDWLow; < 14.85) pre-operative RDW groups, and the high (post-RDWHigh; ≥ 14.05) and low (post-RDWLow; < 14.05) post-operative RDW subgroups. Five-year overall survival (OS) rates differed significantly in pre-RDWHigh group (52.4%) and pre-RDWLow group (78.0%; P < 0.0001). Five-year OS rates also differed significantly in post-RDWHigh (52.7%) and post-RDWLow subgroups (88.3%; P < 0.0001). Multivariate analysis showed post-operative RDW, but not pre-operative RDW, to be an independent prognostic indicator for OS. ConclusionsPost-operative RDW may be a useful prognostic indicator in GC patients.

Accuracy of Mean Platelet Volume (MPV) and Red Cell Distribution Width (RDW) for the Diagnosis of Acute Appendicitis: Evaluation of Possible New Biomarkers.

Introduction:Acute appendicitis is the most common cause of the abdominal pain in surgery. Despite its significant prevalence, the diagnosis is associated with many problems in some cases, which leads to false appendectomy.Objective:The aim of this study was to determine the validity of diagnostic tests of mean platelet volume (MPV) and red cell distribution width (RDW), as a new possible tool in the diagnosis of acute appendicitis. Methods: In this study, all patients who referred to the emergency department of Besat Hospital, Hamadan, Iran, in 2015, with abdominal pain and first impression of acute appendicitis, undergone appendectomy, were evaluated. The diagnostic markers of pre-operative and post-operative pathology and the validity of MPV and RDW were determined in diagnosis of acute appendicitis.Results:Laboratory and clinical data from 438 patients, presenting the signs and symptoms of acute appendicitis with the mean age of 26.51±13.9 years, were examined (55.6% men). The sensitivity, specificity, positive and negative predictive value of MPV in the diagnosis of acute appendicitis were 59.77, 98.66, 99.5 and 34.26 percent, and for the RDW were 57.79, 56.00, 86.07 and 21.98 percent, respectively. The area under the receiver operating characteristic (ROC) curve for RDW and MPV was 0.61and 0.90, respectively. The mean of MPV in patients with normal pathologic outcome was 9.52±1.60 and in patients with acute appendicitis was 7.51±1.22. There was a significant difference between the mean MPV in both groups (p<0.001). The mean of RDW in patients with normal pathology were 13.42±1.97 and 13.05±1.09, in patients with acute appendicitis. There was a significant difference between the mean RDW of the two groups (p=0.009).Conclusion:MPV and RDW indexes have the potential to be used by the surgeons in diagnosis of acute and perforated appendicitis, especially in adults, in order to reduce unnecessary appendectomy, but MPV is more valid in screening acute appendicitis, compared to the RDW.

Red Cell Distribution Width as a Novel Marker for Different Types of Atrial Fibrillation in Low and High Altitude.

Background Increased red cell distribution width (RDW) can predict the incidence and mortality of cardiovascular diseases. However, there are limited data on the relationship between RDW and altitude and the subtype of atrial fibrillation (AF). We investigated the effects of altitude on RDW in patients with different types of AF. Methods A total of 303 patients with nonvalvular AF were included. Of these, 156 lived in low altitude (77 paroxysmal AF, PAF; 79 persistent AF, PeAF) and 147 in high altitude (77 paroxysmal AF, PAF; 70 persistent AF, PeAF). In these groups, baseline characteristics, complete blood counts, serum biochemistry, and echocardiography were evaluated. Multivariate logistic regression analysis was conducted to determine the independent predictors of AF at the different altitudes. Results In both low and high altitudes, RDW and left atrial diameter (LAD) were higher in AF than control subjects (P < 0.05) and higher in persistent AF than paroxysmal AF (P < 0.05). Compared with any groups (PAF group, PeAF group, or control group) of low-altitude, RDW and LAD were found higher in high-altitude corresponding groups. Multivariate logistic regression analysis demonstrated that RDW, mean corpuscular volume (MCV), and LAD levels independently associated with AF patients in low altitude (RDW, OR 1.687, 95% CI 1.021–2.789; P < 0.05), while in high altitude, RDW, MCV, creatinine (Cr), and LAD were independent predictors for AF patients (RDW, OR 1.755, 95% CI 1.179–2.613; P < 0.05). Conclusion Elevated RDW levels may be an independent risk marker for nonvalvular AF, affected by type of AF and altitude.

Role of Redcell Distribution Weight in Predicting Disease Severity, Mortality and Complication in Patients With Acute Pancreatitis

The goal of the present study was to in-vestigate the significance of the Red Cell Distribution Width (RDW) in identifying the severity, mortality and complications of the disease at an early stage in patients with acute pancreatitis (AP).343 patients with AP presented to the emergency department during one year were included in this retrospective study. Demographic, laboratory and imaging re-sults were recorded. Bedside Index for Se-verity in AP (BISAP) score was calculated. The patients who developed pancreatitis-related mortality were recorded.The diagnostic powers of RDW values in the diagnosis of BISAP Score (≥3), exitus, severe pancreatitis and pancreatitis with complication were analysed by means of Receiver Operating Characteristic Curve (ROC) analysis. p<0,05 was considered statistically significant.The mean age of the subjects was 59,7 ± 18,0 years. Area under curve (AUC) in ROC analysis conducted for RDW in patients with BISAP score≥ 3 was 0,649 (95% Cl 0,576-0,722) and p <0,001. For developed complications, AUC for RDW was 0,558 (95% Cl 0,454-0,662) and p was 0,243. For RDW<14,4 cut-off value; the sensitivity was 66,25%, specificity was 71,48% in the prediction of BISAP≥ 3, sen-sitivity was 87,5%, specificity was 65,14% in the prediction of mortality, sensitivity was 72,73%, specificity was 71,12% in the prediction of severe AP.RDW is as significant as the BISAP score in predicting the severity and mortal-ity of pancreatitis in the patients with acute pancreatitis in the emergency department(ED). But it cannot predict the complications in AP.

Diagnostic Performance of Red Cell Distribution Width in Adult Iraqi Patients with Ankylosing Spondylitis.

Background Ankylosing spondylitis (AS) is a chronic, progressive inflammatory rheumatic disease that leads to structural damage, functional impairment, and decrease in the quality of life. Red cell distribution width (RDW) is a part of the complete blood count (CBC) and estimates erythrocyte variability. Objective To analyse RDW in patients with AS and to evaluate the relationships with acute phase reactants (APRs) and disease activity index. Patients and Methods A total of 100 patients with AS (78 males and 22 females) were diagnosed according to the modified New York classification criteria for AS and 146 (99 males: 47 females) healthy individuals matched in age and sex as controls enrolled in the study. Demographic data, disease activity scores using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), medical history, C-reactive protein (CRP), erythrocytes sedimentation rate (ESR), and complete blood count (CBC) were measured. Results The mean age for patients and controls was 38.0 ± 9.0 and 35.8 ± 9.0 years, respectively (p=0.057). RDW was significantly higher in patients with AS compared with controls (14.133 ± 1.613 versus 12.299 ± 1.031, p < 0.001). There was a direct correlation of RDW with both ESR and CRP (P < 0.001); RDW had r=0.38 for C-reactive protein (CRP) and r=0.413 for ESR. Also BASDAI was directly correlated with RDW (r=0.326 p<0.001). RDW was a valid measure to differentiate between patients with AS and controls (AUC=0,84, p<0.001) and at optimum cut-off value>13% has highest accuracy (78.9%) with very good sensitivity test (81%) and NPV (85.6%) as well as good specificity (77.4%) and PPV (71.1%). Conclusion RDW was higher in AS patients compared with controls and was directly correlated with ESR, CRP, and BASDAI. RDW was a valid simple measure with good accuracy to differentiate between patients with AS and controls.

Prognostic value of red blood cell distribution width in patients with left ventricular systolic dysfunction: Insights from the COMMIT-HF registry.

Previous studies have reported that in patients with heart failure, an increased value of red cell distribution width (RDW) is associated with adverse outcomes. Nonetheless, data regarding the association between RDW values and long-term mortality in patients with left ventricular systolic dysfunction (LVSD) are lacking. The aim of this investigation was to examine the relationship between mortality and RDW in patients with ischemic and non-ischemic LVSD. Under analysis was 1734 patients with a left ventricular ejection fraction (LVEF) ≤ 35% of whom were hospitalized between 2009 and 2013. Patients were divided into three groups based on RDW tertiles. Low, medium and high tertiles were defined as RDW ≤ 13.4%, 13.4% < RDW ≤ 14.6% and RDW > 14.6%, respectively. There was a stepwise relationship between RDW intervals and comorbidities. Patients with the highest RDW values were older and more often diagnosed with anemia, diabetes, atrial fibrillation and chronic kidney disease. The main finding of our analysis was the presence of an 8-fold increase in all-cause mortality in the entire cohort between high and low RDW tertile. Cox hazard analysis identi-fied RDW as an independent predictive factor of mortality in all patients (HR 2.8; 95% CI 2.1-3.8; p < 0.0001) and in subgroups of patients with ischemic (HR 2.8; 95% CI 2.0-3.9; p < 0.0001) and non-ischemic (HR 3.3; 95% CI 2.01-5.5; p < 0.0001) LVSD. The highest RDW tertile was independently associated with higher long-term mortality compared with low and medium tertiles, both in all patients with a LVEF ≤ 35% and in subgroups of patients with ischemic and non-ischemic LVSD.