Red Cell Distribution Width Levels Research Articles

Red blood cell distribution width may predict the prognosis of vestibular neuritis

Objectives: The study aimed to determine whether red cell distribution width (RDW), as well as other inflammatory markers of complete blood count, have any predictive value for the etiology, diagnosis, and prognosis of vestibular neuritis (VN). Patients and Methods: Forty-two VN patients (28 females, 14 males; mean age: 46.7±11.0 years; range, 20 to 75 years) and 50 controls (32 females, 18 males; mean age: 44.4±6.0 years; range, 22 to 55 years) were included in the retrospective study between May 2016 and May 2018. Red cell distribution width and neutrophil, lymphocyte, platelet, and monocyte levels were documented from the hemogram records of all patients. Additionally, the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and lymphocyte-monocyte ratio were calculated. Results: In the VN group, NLR and PLR values were significantly high (p=0.001 and p<0.001, respectively). Red cell distribution width, platelet, lymphocyte, and monocyte levels were significantly high and hemoglobin was significantly low in VN patients with long-lasting spontaneous nystagmus (p<0.001, p=0.026, p=0.033, p=0.047, and p=0.006, respectively). Conclusion: High RDW and low hemoglobin levels may predict a poor prognosis in adult VN patients. Moreover, a low lymphocyte-monocyte ratio and high NLR and PLR values are supportive findings in the diagnosis of vestibular neuritis.

Possible Correlations between Mean Platelet Volume and Biological, Electrocardiographic, and Echocardiographic Parameters in Patients with Heart Failure.

(1) Background: Despite advancements in medical research and discoveries, heart failure (HF) still represents a significant and prevalent public health challenge. It is characterized by persistently high mortality and morbidity rates, along with increased rates of readmissions, particularly among the elderly population. (2) Methods: This study was conducted retrospectively on 260 patients with stable or decompensated chronic HF. The parameter of interest in the study population was the mean platelet volume (MPV), and the main objective of the research was to identify a possible relationship between MPV and several variables-biological (NT-proBNP, presepsin, red cell distribution width (RDW)), electrocardiographic (atrial fibrillation (AFib) rhythm, sinus rhythm (SR)), and echocardiographic (left ventricle ejection fraction (LVEF), left atrial (LA) diameter, left ventricle (LV) diameter, pulmonary hypertension (PH)). (3) Results: By applying logistic and linear regression models, we assessed whether there is a correlation between MPV and biological, electrocardiographic, and echocardiographic variables in patients with HF. The results revealed linear relationships between MPV and NT pro-BNP values and between MPV and RDW values, and an increased probability for the patients to have an AFib rhythm, reduced LVEF, dilated LA, dilated LV, and PH as their MPV value increases. The results were deemed statistically relevant based on a p-value below 0.05. (4) Conclusions: Through regression model analyses, our research revealed that certain negative variables in HF patients such as increased levels of NT-proBNP, increased levels of RDW, AFib rhythm, reduced LVEF, dilated LA, dilated LV, and PH, could be predicted based on MPV values.

RED CELL DISTRIBUTION WIDTH VALUE AS A PREDICTOR OF COPD SEVERITY: ORIGINAL RESEARCH ARTICLE

Objectives: The purpose of the study is to use the red cell distribution width (RDW) value for predicting chronic obstructive pulmonary disease (COPD) severity. Methods: Three hundred COPD patients are included in this retrospective analysis. Oxygen saturation, BODE index variables, and demographic characteristics were noted. All patients’ survival data were analyzed. RDW measurements were evaluated at the time of inclusion. Results: The patients had an average age of 65.2±8.6 years. The patients were divided into the following stages of COPD: stage 1: 14.66%, stage 2: 56.66%, stage 3: 25.6%, and stage 4: 3%. Red cell distribution width was observed differ significantly between stages. The very high RDW was found in the extremely serious stage (p<0.001). The BODE index has a median of 1 (0–3). RDW increased with the BODE index as it increased (p<0.001). The survival percentages for the groups of patients created based on the laboratory upper limit of RDW was 76% for groups with RDW<14.3% and 29% for groups with RDW>14.3%. Conclusion: Our study’s findings suggest that an elevated level of RDW may be linked to increased mortality and that a quick, non-invasive test could be used as an early biomarker to assess the severity of a disease.

Epidemiological and hematological aspects of idiopathic diarrhea in dairy cattle at Sirajganj district of Bangladesh

Cattle diarrhea poses a significant risk to the global livestock sector, leading to considerable economic setbacks and impacting the well-being of animals. This research aimed to assess the clinical and hematological changes associated with idiopathic diarrhea in cattle in the Baghabari area of the Sirajganj District of Bangladesh. The study involved surveying dairy cattle to record their case history, followed by the collection and measurement of hematological indices in those suffering from idiopathic diarrhea. The survey identified 39 diarrheic crossbred cattle (2 males and 37 females), ranging in age from 1 month to 11 years. The findings revealed a higher prevalence of diarrheal cases in cows (94.87%) compared to oxen (5.13%), particularly among pregnant cows (64.86%). The most common historical observations included repeat breeding (81.08%), abortion (78.38%), decreased milk production (43.24%), fever (15.64%), and congenital defects (17.95%) in diarrheic cattle. Hematological analyses indicated a significant increase in lymphocyte and immunoglobulin levels, while eosinophil, basophil, and red blood cell distribution width levels were notably lower in diarrheic cattle compared to healthy ones. However, other hematological parameters remained unaffected. In summary, the study suggests that bovine diarrhea may influence hematological profiles and body physiology, with the extent depending on the disease’s etiology and complexity.

Role of Inflammatory Markers in Early Diagnosis of Neonatal Sepsis; C-Reactive Protein or Procalcitonin or Red Cell Distribution Width; A Hospital-Based Study

Objective: To find out the utilization of C-reactive protein (CRP), Procalcitonin (PCT) and red cell distribution width (RDW) in diagnosing neonatal sepsis considering blood culture findings as gold standard. Study Design: Cross-sectional validation study. Place and Duration of Study: Neonatal Intensive Care Unit (NICU) of Dr Ziauddin Medical University, Karachi Pakistan, from Feb to Jul 2022. Methodology: A total of 42 neonates of either gender with the clinical diagnosis of neonatal sepsis were enrolled. Demographical and clinical characteristics of all neonates were noted at the time of enrollment. A blood sample of 5 ml was withdrawn for the evaluation of CRP, PCT and RDS. The association of different inflammatory markers with the outcome (neonatal sepsis) was assessed. Results: In 42 neonates, the mean age was 7.24±9.24 days, and 26 (61.9%) neonates were boys. Respiratory distress, reluctance to feed and hypoglycemia were the most frequent clinical presentations observed (19,45.2%), (14,33.3%) and (8,19.0%) neonates, respectively. Mean CRP levels among blood culture positive and negative neonates were 40.02±57.84mg/dl and 7.57±13.34 mg/dl, respectively, while the difference was statistically significant (p=0.0068). RDW (p=0.6488) and procalcitonin (0.9021) levels were not statistically significant differences among positive and negative neonates of blood culture. Conclusion: The CRP was a significant predictor of neonatal sepsis, while RDW and procalcitonin did not have a significant relationship with early prediction of neonatal sepsis.

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.

Internal and External Validation of the Predictive Scoring Systems from Essential Thrombocythemia to Post-ET Myelofibrosis

Essential thrombocythemia (ET) is one of the myeloproliferative neoplasms with a high risk of progression to post-ET myelofibrosis (post-ET MF). However, there still lacked the prediction model of post-ET MF. Here, we conducted a study of 708 ET patients identified by 2016 WHO diagnostic criteria in 13 hematology centers between 01 January 2010 to 01 July 2023, aimed to identify risk factors progression to MF and develop a prediction nomogram for post-ET MF(ChiCTR2200061208). The training cohort included 543 ET patients with ET from 8 hematology centers. The external validation cohort included 165 subjects from another 5 hematology centers. Univariable and multivariable analysis identified the red blood cell distribution width (RDW) level (P=0.002), lactic dehydrogenase (LDH) level (P=0.003), smoking(P=0.003) and splenomegaly (P=0.000) were independent risk factors of post-ET MF(Table A). These independent risk factors were included to develop a prediction model of nomogram (Figure B). The bias-corrected AUC were both high in the training cohort (AUC=0.899) and external validation cohort (AUC=0.892). Analysis of calibration curves showed that the apparent and bias-corrected lines were overlapped with the ideal line in both training and external validation cohorts, and the Hosmer−Leeshawn tests showed that the model were a good fit (P = 0.73 in training cohort, P=0.43 in external validation cohort) (Figure C, D). Decision curve analysis(DCA) was conducted to assess the clinical usefulness of nomogram by quantifying the net benefits at defferent threshold probability of post-ET MF. Threshold probabilities for the standardized net benefit nomogram in predicting the probability of the occurrence of post-ET MF ranged from 0.02 to 0.87 in the training cohort, 0.01 to 1 in the external validation cohort. In conclusion, we developed a nomogram that can predict the risk of progression to MF in ET patients, which can help clinicians adjust therapy timely to prevent disease progression to a great degree. Acknowledgement: This research was funded by the Key R&amp;D Program of Zhejiang, No. 2022C03137; Public Technology Application Research Program of Zhejiang, China, No. LGF21H080003; Zhejiang Medical Association Clinical Medical Research special fund project, No. 2022ZYC-D09. Correspondence to: Dr Jian Huang, Department of Hematology, The First Affiliated Hospital of Zhejiang University School of Medicine. No. 79 Qingchun Road. Hangzhou, Zhejiang, PR China.

Associations of neutrophil to lymphocyte ratio and red cell distribution width on different days with the prognosis of aneurysmal subarachnoid hemorrhage patients.

The associations of neutrophil to lymphocyte ratio (NLR) and red cell distribution width (RDW) with the prognosis of aneurysmal subarachnoid hemorrhage (aSAH) patients were confirmed in a few studies. But NLR and RDW levels in most of these studies were on admission. Here we carried 1 retrospective study including 150 patients with aSAH who underwent surgeries in the First Affiliated Hospital of Yangtze University from January 2020 to February 2023 to explore the associations on the preoperative day, the first (1st), third (3rd), and seventh (7th) postoperative days. The level of RDW on the 3rd postoperative day and level of NLR on the 7th postoperative day in patients with poor prognosis were significantly higher than patients with good prognosis. The results of multivariate logistic analysis also confirmed the associations of RDW on the 3rd postoperative day (OR = 16.785, 95% CI: 4.077-69.107, P < .001) and NLR on the 7th postoperative day (OR = 8.399, 95% CI: 2.167-32.544, P = .002) with prognosis of aSAH patients. The results of receiver operating characteristic curve showed that cutoff values of RDW and NLR for predicting the prognosis in aSAH patients were 13.05% and 6.97, respectively. Higher RDW on the 3rd postoperative day and NLR on the 7th postoperative day were possibly associated with poor prognosis of aSAH patients. We should pay attention to the RDW and NLR levels during different hospitalization periods, especially in the short postoperative period. Moreover, the cutoff values for predicting prognosis need to be validated in larger-sample studies.

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.

Red Cell Distribution Width and Prediabetes in Adults in Northern Sudan: A Case-Control Study.

Diabetes mellitus (DM) is a major public health issue worldwide. Red cell distribution width (RDW) has been reported to have predictive value in several diseases, including DM. Few data exist on the association between RDW and the prediabetic stage. Thus, the present study aimed to investigate the association between RDW and prediabetes in adults in Sudan. This case-control study was conducted in Northern Sudan in 2022. The cases (n = 107) were prediabetic patients categorized according to the level of glycated hemoglobin (HbA1c), which ranged from 5.7% to 6.4%, while the controls (n = 107) were healthy participants. A questionnaire was used to collect the data. Standard methods were used to measure the HbAIc level and RDW. Logistic regression analysis was performed. The median (interquartile range (IQR)) of the RDW was significantly higher in prediabetic patients than in the controls (14.5% [13.8-15.3%] vs. 14.1% [13.6-14.7%], p = 0.003). Sex, educational level, occupational status, marital status, cigarette smoking, alcohol consumption, family history of DM, and body mass index were not associated with prediabetes. In the multivariate-adjusted model, higher age and higher RDW were associated with prediabetes. A positive correlation was found between RDW and HbA1c levels (r = 0.19, p = 0.006). In conclusion, this study supports the use of RDW as a predictor of DM.

Assessment of the Relation Between Red Cell Distribution Width and Atrial Fibrillation in Type-2 Diabetic Patiens

We aimed to investigate the level of red cell distribution width (RDW), in type-2 diabetic patients with atrial fibrillation. Patients aged 18 to 80 years old who were admitted to the internal medicine and cardiology outpatient clinics were enrolled. The data of the patient were retrospectively scanned from hospital database. 105 people were included in the study as 63 patients with diabetes mellitus and atrial fibrillation and 42 patients with diabetes mellitus and no atrial fibrillation. It was found that the age factor was statistically significant in men, women, and all patients between the groups, and Hb, hba1c, and LDL were statistically significant in men and all patients. The  level of RDW is investigated  in 2 groups of diabetic patients with and without atrial fibrillation. However, there was no significant difference between the two groups.

Association of red cell distribution width and its changes with the 30-day mortality in patients with acute respiratory failure: An analysis of MIMIC-IV database.

Acute respiratory failure (ARF) is a common disease in the intensive care units (ICUs) with high risk of mortality. The red cell distribution width (RDW) is one of baseline ICU indicators which can be easily available, and has been used in the long-term prognostic analyses of diseases. However, no studies have explored the role of baseline RDW and its change during hospitalization in in-hospital mortality in ARF. Herein, this study aims to explore the association between RDW and its changes and the 30-day mortality in ARF patients. Demographic and clinical data of 7,497 patients with ARF were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database in 2012-2019 in this retrospective cohort study. Univariable and multivariable Cox regression analyses were used to explore the association between RDW and its changes and 30-day mortality with hazard ratios (HRs) and 95% confidence intervals (CIs). Subgroup analyses of different baseline RDW levels were also performed. We then assessed the predictive performance of RDW changes combined with the Sequential Organ Failure Assessment (SOFA) score on 30-day mortality using receiver operator characteristic curves (ROCs) with areas under curve (AUCs). Totally, 2,254 (30.07%) patients died in 30 days. After adjusting for covariates, we found that high baseline RDW [HR = 1.25, 95%CI: (1.15-1.37)] and RDW changes ≥0.3% [HR = 1.12, 95%CI: (1.01-1.24)] were both related to an increased risk of 30-day mortality. In patients whose baseline RDW level ≥14.9%, RDW changes ≥0.3% was also associated with an increased risk of 30-day mortality [HR = 1.19, 95%CI: (1.05-1.35)]. Moreover, the predictive value of RDW changes combined with SOFA on 30-day mortality was a little better than that of single SOFA score, with AUCs of 0.624 vs. 0.620. High baseline RDW level and its changes during hospitalization was relate to the increased risk of 30-day mortality in ARF, and the predictive value of RDW changes for ARF short-term mortality is still needed exploration.

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.

Survival and prognosis analysis of systemic lupus erythematosus patients with pulmonary hypertension: A systematic review and meta-analysis.

The study aimed to evaluate survival rates and prognosis in systemic lupus erythematosus (SLE) patients with pulmonary hypertension (PH) using meta-analysis. PubMed, EMBASE, Cochrane central register of controlled trials, China National Knowledge Infrastructure, China Science and Technology Journal Database, Wan-Fang Database, and Chinese biomedical database were searched. Information and data were screened and extracted by 2 researchers. The obtained data were analyzed using the R software meta package. Quality assessment was conducted using Newcastle-Ottawa Scale. The causes of heterogeneity were analyzed using subgroup analysis and sensitivity analysis. Publication bias was evaluated using Begger funnel plots and Egger test. The search strategy yielded a total of 21 studies involving 875 patients included in the final analysis. The pooled 1-, 3- and 5-year survival rates of patients with SLE-PH were 0.9020 (95%CI: 0.8576; 0.9397), 0.8363 (96%CI: 0.7813; 0.8852), 0.7301 (95%CI: 0.6327; 0.8181). The 1-, 3- and 5-year survival rates of echocardiography subgroup were 0.9000 (95%CI: 0.8480; 0.9551), 0.8435 (95%CI: 0.7744; 0.9187), 0.6795 (95%CI: 0.5746; 0.8035), respectively; and there were 0.9174 (95%CI: 0.8951; 0.9402), 0.8529 (95%CI: 0.8255; 0.8812), 0.7757 (95%CI: 0.7409; 0.8121) at right heart catheterization subgroup in the meantime. Multivariate analysis for predicting mortality in SLE-PH patients revealed that diminishing left ventricular ejection fraction, New York Heart Association classification, lupus nephritis, lower cardiac index, and higher red blood cell distribution width level were significantly associated with a higher mortality rate. Treatment with huge doses of cyclophosphamide, tricuspid annular plane systolic excursion/pulmonary artery systolic pressure, and Raynaud phenomenon signaled favorable outcomes. The 1-, 3-, and 5-year survival rates of SLE-PH patients in recent years (0.9020, 0.8363, 0.7301) were estimated in this study. SLE-PH patients diagnosed by echocardiography have a worse long-term prognosis than those diagnosed by right heart catheterization. Studies after 2015 have shown significantly better survival than earlier studies.

[Prognostic value of hemoglobin-to-red cell distribution width ratio in patients with cardiopulmonary resuscitation after out-of-hospital cardiac arrest].

To investigate the prognostic value of hemoglobin-to-red cell distribution width ratio (HRR) in patients with cardiopulmonary resuscitation (CPR) after out-of-hospital cardiac arrest (OHCA). A retrospective study was conducted. Patients aged ≥ 18 years with OHCA who were transferred to intensive care unit (ICU) after successful CPR from the emergency room of the First Affiliated Hospital of Zhengzhou University from August 2016 to February 2022 were enrolled. General clinical data, initial vital signs, acute physiology and chronic health evaluation II (APACHE II), Glasgow coma scale (GCS), first laboratory indicators after admission to ICU [including white blood cell count (WBC), red blood cell count (RBC), hemoglobin (Hb), pH value, lactic acid (Lac), 6-hour lactic acid clearance (LCR), red cell distribution width (RDW), HRR], length of ICU stay were collected. According to whether the patients died in hospital, the patients were divided into survival group and death group. Binary Logistic regression was used to analyze the independent factors influencing the prognosis of patients after CPR. Receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of independent influencing factors for the prognosis of patients after CPR. A total of 122 patients were enrolled after OHCA CPR, of which 88 died in hospital, the in-hospital mortality was 72.13%. There were no significant differences in age, past medical history, initial vital signs and WBC in ICU between the two groups. Compared with the death group, the survival group had higher GCS score, RBC, Hb, pH value, 6-hour LCR, HRR, lower APACHE II score, Lac, RDW level, and longer length of ICU stay. Multivariate Logistic regression analysis showed that APACHE II score, GCS score, 6-hour LCR, HRR, length of ICU stay were independent factors influencing the prognosis of patients after CPR [APACHE II score: odds ratio (OR) = 0.784, 95% confidence interval (95%CI) was 0.683-0.901, P = 0.001; GCS score: OR = 1.390, 95%CI was 1.059-1.823, P = 0.018; 6-hour LCR: OR = 1.039, 95%CI was 1.015-1.064, P = 0.001; HRR: OR = 2.047, 95%CI was 1.383-3.029, P < 0.001; length of ICU stay: OR = 1.128, 95%CI was 1.046-1.216, P = 0.002]. ROC curve analysis showed that HRR, 6-hour LCR and APACHE II score could predict the prognosis of patients after CPR. The sensitivity was 85.3% and the specificity was 54.5% when the area under the ROC curve (AUC) of HRR was 0.731, and the cut-off value was 8.555. The sensitivity was 88.2% and the specificity was 46.6%, when the AUC of 6-hour LCR was 0.701, and the cut-off value was 28.947%. The sensitivity was 73.9% and the specificity was 79.4% when the AUC of APACHE II score was 0.848, the cut-off value was 22.000. The predictive value of the combination of HRR and 6-hour LCR was higher than that of a single index. The sensitivity was 79.3% and the specificity was 76.1%, when the AUC was 0.796, the cut-off value was 0.296. HRR, 6-hour LCR and APACHE II score have high prognostic value in patients with OHCA after CPR. HRR < 8.555, 6-hour LCR < 28.947% and APACHE II score > 22.000 indicated poor prognosis.

The Relationship of Hematological Parameters and C-reactive Protein (CRP) With Disease Presence, Severity, and Response to Systemic Therapy in Patients With Psoriasis.

Systemic inflammation has an important role in psoriasis, which is a chronic disease with an increasing prevalence and is associated with comorbidity. Our aim is to investigate the relationship of hematological parameters and C-reactive protein (CRP) with the presence and severity of the disease in patients with psoriasis. It is also to investigate whether it can be used as a biomarker in monitoring the response to systemic treatment. This retrospective study was conducted with the participation of 139 psoriasis patients receiving biological therapy (BT) and conventional therapy (CT) and 140 healthy controls. Demographic, clinical, and laboratory data of patients and controls were examined and all parameters were compared with the psoriasis area severity index (PASI) score. In addition, the changes in these parameters before the treatment and in the third month of the treatment were examined in the patient groups who received BT and CT. White blood cell (WBC), neutrophil, monocytes, platelet (PLT), plateletcrit, red blood cell, neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) monocyte-lymphocyte ratio (MLR), red cell distribution width (RDW), CRP and erythrocytesedimentation (ESR) levels were higher compared to the healthy control group in psoriasis patients (p<0.05). Baseline PASI values were positively correlated with WBC, neutrophils, monocytes, NLR, MLR, and CRP. WBC, neutrophil, NLR, CRP, and ESR levels decreased in all patients in the third month of treatment (p<0.05). WBC, PLT, neutrophil, and NLR in patients receiving BT; while WBC, neutrophil, NLR, CRP, and ESR levels decreased in patients receiving CT, RDW levels increased (p<0.05). Adalimumab; NLR and basophil, methotrexate; WBC, NLR, neutrophil, and ESR levels caused a significant decrease (p<0.05). The fact that increased WBC, neutrophils, monocytes, NLR, MLR, and CRP levels are associated with the severity of psoriasis indicates that these parameters reflect systemic inflammation in psoriasis. In addition, the decrease in these parameters after BT and CT suggests that they can be considered simple and reliable markers that can be used as a complement to the PASI score in assessing disease severity and response to treatment.

Selected haematological markers and C-reactive protein, not AGTR1 SNP, are associated with essential hypertension in Tharaka Nithi County, Kenya

Background: Essential Hypertension (EH) accounts for majority of hypertension cases globally. Genetic factors along with haematological and biochemical changes may underlie EH and these have not been well studied in Kenya. A meta-analysis in African populations (excluding East Africa) identified the 1166A&gt;C (rs5186) single nucleotide polymorphism (SNP) in the angiotensin II type 1 receptor gene (AGTR1) that encodes the angiotensin II type 1 receptor as likely to predispose some Africans to hypertension.&#x0D; Aim: The purpose of the study was to determine whether the AGTR1 (rs5186) mutation, C-reactive protein (CRP) and selected haematological biomarkers may be associated with the onset of EH in Tharaka Nithi County, Kenya).&#x0D; Study Design: A case control study design was adopted.&#x0D; Place and Duration of Study: The research was conducted from March to July 2022 at Chuka County Referral Hospital in Tharaka Nithi County.&#x0D; Methodology: A total of 272 participants, both hypertensive and normotensive, were recruited and blood samples obtained. DNA was extracted and analyzed by PCR RFLP. Independent T-test, Mann Whitney U test and Odds ratios were used to compare the two groups. P values less than 0.05 were considered statistically significant.&#x0D; Results: Median values for Red Cell Distribution Width (RDW), C-reactive Protein (CRP) and mean values for Mean Platelet Volume (MPV) and Neutrophil to Lymphocyte ratio (NLR) were significantly higher (P &lt; .001) in hypertensive group compared to normotensive individuals. Mean Platelet Distribution Width (PDW) was not significantly different between cases and controls. (P=.519) There was no significant association between the AGTR1 1166A&gt;C (rs5186) SNP frequency and EH in both groups (P=0.6236, OR=0.4952(95%CI:0.0442-5.5456)&#x0D; Conclusion: The AGTR1 (rs5186) SNP is not associated with EH in Tharaka Nithi County, Kenya. EH is associated with elevated levels of CRP, RDW, MPV and NLR in the absence of other inflammatory and chronic diseases. Further studies of the genetics of hypertension in Kenya need to be conducted.

Akromegali Hastalarında Hematolojik İndekslerin Değerlendirilmesi

Objective: Acromegaly is a chronic systemic disease characterized by autonomous and excessive secretion of growth hormone (GH). Acromegaly is most commonly caused by ais a somatotroph adenoma of the anterior pituitary. In acromegaly, mortality primarily results from are cerebrovascular, cardiovascular, respiratory diseases and malignancies. Monocyte/lymphocyte ratio (MLR), neutrophil/lymphocyte ratio (NLR), red cell distribution width (RDW), platelet distribution width (PDW) and delta neutrophil index (DNI) are popular inflammatory markers. This study’s purpose was to assess pre/post-treatment levels of NLR, GH, RDW, MLR, PDW and DNI in acromegalic patients and to investigate the impact of acromegaly treatment on these markers. Materials and Methods: Twenty-six patients with acromegaly, treated and followed at our endocrinology outpatient clinic between April 2014 and February 2022 were included in the study. Age, sex, comorbidities, medications, complete blood count, kidney and liver function tests, pathology reports, tumor size, pre/post-treatment levels of IGF-1, GH, DNI, NLR, MLR, RDW and PDW were retrieved from patients’ files and outcomes were evaluated. Results: Among 26 patients included in the study, 12 (46%) were female and 14 (53%) were male. The average age of the patients was 53.73±16.21 years (range, 25-79). There were 11 (42%) patients with type 2 diabetes mellitus and 9 (34%) patients with hypertension. A statistically significant reduction was observed in post-operative GH, IGF-1, NLR, DNI, PDW and RDW values compared to preoperative values (during active disease phase) and at 6 months in patients with postoperative cure, and compared to pretreatment values in patients without postoperative remission who received medical treatment. A reduction was also observed in post-treatment MLR compared to pretreatment ratio but the difference was non-significant. There was no statistically significant correlation between the IGF-1 levels at the time of diagnosis and NLR, RDW, PDW in patients with acromegaly. Conclusion: Studies on the values of circulating inflammatory biomarkers in patients with acromegaly and their relationship to treatment remain unclear. In our study, higher pre-treatment GH, IGF-1, NLR, DNI, PDW, RDW values were found compared to post- treatment. This suggests that having chronically higher than normal values of IGF-1 may also lead to increased inflammatory markers such as NLR and increased atherosclerotic risk. Chronic subclinical inflammation caused by uncontrolled disease might lead to an increase in mortality and morbidity in acromegalic patients. Therefore, early diagnosis and treatment of acromegaly are crucial.

Association between iron deficit repletion with ferric carboxymaltose relative to iron sucrose in children with inflammatory bowel disease: a retrospective cohort study.

Iron deficiency and iron deficiency anemia are common in pediatric inflammatory bowel disease and often require supplementation with iron. There is a paucity of literature regarding optimal iron formulation. The aim of this study is to compare outcomes in pediatric patients with inflammatory bowel disease receiving either iron sucrose or ferric carboxymaltose during inpatient hospitalizations. This was a single-center retrospective study of pediatric patients with inflammatory bowel disease admitted for newly diagnosed disease or flare who received either iron sucrose or ferric carboxymaltose. Linear regression was used to assess differences in iron repletion. Longitudinal linear mixed-effects models and generalized estimating equations compared hematologic and iron outcomes six months post iron repletion. Thirty patients received ferric carboxymaltose. Sixty-nine patients received iron sucrose. Baseline hemoglobin and iron deficits were similar in both groups. A larger percentage of iron deficit was repleted in the ferric carboxymaltose group (81.4%) compared to iron sucrose (25.9%) (p<0.001) with fewer infusions. Cumulative doses of ferric carboxymaltose administered (18.7 mg/kg) were higher than iron sucrose (6.1 mg/kg) (p<0.001). Hemoglobin increased more quickly with ferric carboxymaltose compared to iron sucrose (p=0.04 and p=0.02, respectively). Total iron binding capacity and red cell distribution width levels decreased more over time with ferric carboxymaltose versus iron sucrose (p<0.01 and p=0.01, respectively). No adverse effects were seen. Hematologic and iron parameters responded more quickly with fewer infusions in patients who received ferric carboxymaltose versus iron sucrose. Patients who received ferric carboxymaltose achieved a higher percentage of iron deficit repleted. This article is protected by copyright. All rights reserved.

Predicting Long-Term Mortality in Acute Pulmonary Embolism: The Role of RDW Levels

Objective: Acute pulmonary embolism (PE) is a life-threatening cardiovascular emergency. PE long-term mortality data is scarce. Red cell distribution width (RDW) may predict PE mortality independently. This research examined the association between admission RDW and long-term mortality in acute PE patients. Material and Methods: A prospective registry-based cohort design was used in this investigation. Included were a total of 115 discharged individuals with acute PEThe documentation of clinical features, test data, cardiovascular risk factors, and comorbidities was conducted for patients who were observed for a median of 140 months (range: 2-168) to determine the occurrence of cardiovascular mortality. Results: The mean age of the patients was 62±16 years. After follow-up, 52 of 115 patients (45%) died from cardiovascular causes. Those who perished had greater RDW levels than those who survived [16.4±3.1 vs. 14.6±2.1%, p&lt;0.001]. The optimum RDW threshold for predicting long-term mortality was &gt;14.6% (AUC =0.704, 95% CI =0.608-0.808). Conclusion: Long-term mortality in PE patients was likely associated with elevated RDW levels..