Red Cell Distribution Width Values Research Articles

An Analysis of Hematological Parameters as a Diagnostic test for Malaria in Patients with Acute Febrile Illness: An Institutional Experience

Hematological changes are among the most common complications encountered in malaria. This study analyzes and statistically evaluates the hematological changes as a diagnostic test for malaria in patients with acute febrile illness and whether these could guide the physician to institute specific antimalarial treatment. The present study was an observational study, conducted from January to December 2012. A total of 723 patients presenting with acute febrile illness at our hospital were evaluated. A complete blood count and malarial parasite microscopy were performed for each patient. The findings showed that 172 out of 723 patients (24%) were diagnosed to have malaria by positive smear report. There were 121 males and 51 females with a male to female ratio of 2.3:1. Maximum number of cases were seen in the 20-30 years age group. There was a statistically significant reduction in hemoglobin (p<0.005), platelet count (p<0.001) and total leukocyte count (p<0.001) levels in patients with malaria compared to those without the disease. Likelihood ratios for a positive result of platelets (6.2) and total leukocyte count (3.4) was relevant as compared to hemoglobin (1.61) and Red cell distribution width (1.79). The negative predictive values for hemoglobin (79%), total leukocyte count (86%), platelets (94%) and Red cell distribution width (93%) were significant. Red cell distribution width values were found to be higher in patients with malaria than in patients without malaria (p<0.001). This study revealed that routinely used laboratory findings such as hemoglobin, leukocytes, platelet counts and even red cell distribution width values can provide a diagnostic clue in a patient with acute febrile illness in endemic areas, thus increasing the probability of malaria and enhancing prompt initiation of treatment.

The relationship between TIMI flow grade and hematological parameters in patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention

ST-segment elevation myocardial infarction (STEMI) is among the most important causes of mortality and morbidity. The relationship between hematological parameters and cardiovascular diseases is well known. In patients with STEMI, ensuring blood flow in infarct-related artery at early stages improves ventricular performance and reduces mortality. In our study, we aimed to reveal the relationship between the blood flow in infarct-related artery thrombolysis in myocardial infarction (TIMI) flow and hematologic parameters in patients presenting with acute STEMI and having coronary angiography and revascularization. Our study has a retrospective observational design. One hundred and forty one patients, 108 male and 33 female, who presented with acute STEMI and underwent percutaneous coronary intervention (PCI), participated in our study which was based on one center. The patients were divided into two groups; namely the spontaneous re-canalization of the infarct related artery and totally occluded infarct related artery. The relationship between hematological parameters and TIMI flow was investigated. Red cell distribution width (RDW), neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) values in the group of patients with totally occluded infarct related artery were found significantly higher than the group of patients with spontaneous re-canalization [respectively, 13.8 (13.1 – 15.2) vs. 13.6 (13.1 – 14.3); P = 0.041, 4.0 (2.3 – 7.8) vs. 2.9 (1.8 – 4.9); P = 0.002, 123.0 (74.6 – 237.4) vs. 112.3 (79.2 – 149.3) P = 0.013]. The multivariate logistic regression analysis revealed a relation between elevated NLR and RDW values and total occlusion of infarct related artery. In our study, we found that hematological parameters, NLR and RDW, were independent predictors of patency of infarct related artery in patients with STEMI.

Red Cell Distribution Width and Serum BNP Level Correlation in Diabetic Patients with Cardiac Failure: A Cross - Sectional Study.

Red cell distribution width (RDW) is a red cell measurement given by fully automated hematology analyzers. It is a measure of heterogeneity in the size of circulating erythrocytes. Studies have shown that it is a prognostic marker in non - anemic diabetic patients with symptomatic cardiovascular disease but its correlation with cardiac failure in diabetics has not been studied so far. Moreover, studies have also shown that a higher RDW may reflect an underlying inflammatory state. Since Diabetes is a pro inflammatory state there is a possibility that it might have an influence on the RDW values even when there is no cardiac failure, but research data on this aspect is lacking. B-type natriuretic peptide (BNP) is a proven marker for cardiac failure whose values are comparable with echo cardio graphic findings in assessing the left ventricular dysfunction. This study aimed to find out the correlation between RDW% and serum BNP levels in Diabetics with heart failure (cases) when compared to those without failure (controls). Further, we compared the RDW % values of the cases with controls. Settings and Design : The study was approved by institutional ethical and research committee. A cross-sectional study was conducted with patients attending the Diabetes clinic of a tertiary care hospital in Chennai, India, during the period of October to December 2013. Hundred known cases of type II Diabetes mellitus attending Diabetes centre of the Hospital, with clinical and Echo cardio graphic features of cardiac failure were included as cases. Hundred age and gender matched diabetics with negative history of cardiovascular disease and with normal Echo cardio graphic features were included as controls. Informed consent was obtained from all the cases and controls. Demographic data and clinical history were gathered from all the cases and controls by using a standardized self - administered questionnaire. Biochemical and hematological parameters which included Fasting and Postprandial blood sugar, Glycosylated hemoglobin, Complete Blood count including RDW and serum BNP were performed for all the cases and controls. RESULTS were tabulated and analysed using SPSS 20.0 version A statistically significant correlation (p<.001) was found between Red cell Distribution Width % and Serum B type Natriuretic Peptide values in the cases. Further, RDW% showed a statistically significant difference between cases and controls. RDW% can be used as a screening parameter to identify cardiac failure in Diabetic patients similar to non-diabetic cardiac failure. RDW% values are significantly higher in cases of Diabetes with failure in comparison to uncomplicated Diabetes.

Association between parathyroid hormone levels and inflammatory markers among US adults.

Background and Aims. High levels of parathyroid hormone (PTH) appear to be associated with an increased mortality. Previous studies concerning the relationship of inflammatory markers with hyperparathyroidism have yielded inconsistent results. This study investigated whether serum PTH concentrations were independently associated with several inflammatory markers among the US adults. Materials and Methods. Using data from the National Health and Nutrition Examination Survey, we examined the relation between serum PTH and C-reactive protein (CRP), red cell distribution width (RDW), and platelet-to-lymphocyte ratio (PLR) levels with weighted linear regression. Additionally, we examined the relation with increased modified Glasgow Prognostic Score (mGPS) by using weighted logistic regression. Results. CRP, RDW, and PLR values increased with increasing serum PTH concentration. After extensively adjusting for covariates, CRP and RDW increased linearly and across PTH categories (all P < 0.001), while PLR marginally increased (P = 0.190 and P = 0.095 using PTH as a categorical and continuous variable, resp.). The odds ratio of increased mGPS was 1.11 and 1.31 across PTH categories and with increasing PTH levels continuously. Conclusion. These nationally representative data indicate that serum PTH levels are independently associated with several inflammatory markers in the US population. The casual relationship between PTH levels and inflammation remains to be elucidated.

Red Cell Distribution Width as an Independent Predictor of Exercise Intolerance and Ventilatory Inefficiency in Patients with Chronic Heart Failure

PurposePeak oxygen uptake (peak VO2) and ventilatory inefficiency (VE/VCO2 slope) have proven to be strong prognostic markers in patients with chronic heart failure (CHF). Recently increased red cell distribution width (RDW) has emerged as an additional predictor of poor outcome in CHF. We sought to evaluate the relationship between RDW and cardiopulmonary exercise test (CPET) parameters in CHF patients and healthy controls.Materials and Methods85 ambulatory CHF patients (68 men, 54±10 years) and 107 healthy controls, who underwent a symptom-limited CPET on a treadmill according to the modified Bruce ramp protocol, were enrolled. CHF patients and healthy controls were divided into RDW tertile groups and laboratory, echocardiographic, and CPET results were analyzed.ResultsFor patients with CHF, compared with patients in the lowest RDW tertile, those in the highest tertile had lower peak VO2 (22 mL/kg/min vs. 28 mL/kg/min, p<0.001) and higher VE/VCO2 slope (31 vs. 25, p=0.004). Multivariate regression analysis revealed RDW to be an independent predictor for peak VO2 (β=-0.247, p=0.035) and VE/VCO2 slope (β=0.366, p=0.004). The optimal cutoff value of RDW for predicting peak VO2 ≤20 mL/kg/min and VE/VCO2 slope ≥34 was 13.6% (sensitivity 53%, specificity 89%) and 13.4% (sensitivity 75%, specificity 82%), respectively. In contrast, for healthy controls, RDW was not related to both peak VO2 and VE/VCO2 slope.ConclusionHigher RDW is independently related to peak VO2 and VE/VCO2 slope only in patients with CHF. RDW assessment, an inexpensive and simple method, might help predict functional capacity and ventilatory efficiency in these patients.

Assessment of the relationship between red cell distribution width and fragmented QRS in patients with non-ST elevated acute coronary syndrome

BackgroundRed cell distribution width (RDW) and fragmented QRS (fQRS) complexes have also been reported to be predictors of cardiac events and all-cause mortality in coronary artery disease (CAD). We aimed to investigate the association of serum red cell distribution width (RDW) levels and fQRS in patients with non-ST elevated acute coronary syndrome (NST-ACS).Material/MethodsWe retrospectively evaluated a total of 251 patients (191 men and 60 women) with NST-ACS. The NST-ACS consisted of unstable angina (UA) and non-ST elevated myocardial infarction (NSTEMI). The fQRS pattern was defined as the presence of an additional R’ or crochetage wave, notching in the nadir of the S wave or fragmentation of the RS or QS complexes in 2 contiguous leads corresponding to a major coronary artery territory. The relationships between the RDW and fQRS were assessed.ResultsThe patients in the fQRS group were older, left ventricular ejection fraction (LVEF) levels were significantly lower, and baseline RDW and troponin levels were significantly higher than in the group without fQRS. There were positive correlations between age, number of coronary arteries narrowed, and RDW, and negative correlations between triglyceride, LVEF, and RDW in study patients. There were positive correlations between number of fQRS leads, age, and RDW, and negative correlations between triglyceride, LVEF, and RDW in NSTEMI patients.ConclusionsOur results indicate that an elevated RDW values is associated with fQRS in NST-ACS. Elevated RDW values and fQRS together may be useful for identifying NSTEMI patients in NST-ACS.

Red cell distribution width is associated with hospital mortality in unselected critically ill patients.

Red cell distribution width (RDW) is a variability of red cell sizes and has been associated with outcomes in many clinical settings. Its prognostic value in intensive care unit (ICU) has been reported but requires confirmation. The study aimed to investigate the role of RDW in predicting hospital mortality in critically ill patients. This is a retrospective study conducted in a 24-bed ICU of a tertiary teaching hospital. Data on demographic characteristics and laboratory measurements were collected from medical information database. Baseline variables were compared between survivors and nonsurvivors. The primary endpoint was hospital mortality; and ICU length of stays (LOS) were compared between patients with RDW >14.8% and ≤14.8%. The predictive value of RDW was also measured using receiver operating characteristic (ROC) curves. Two-sided P<0.05 was considered to be statistically significant. A total of 1,539 patients were enrolled during study period, including 1,084 survivors and 455 nonsurvivors. In univariate analysis, variables such as age, sex, primary diagnosis, C-reactive protein (CRP), RDW and albumin were significantly associated with hospital mortality. RDW remained significantly associated with mortality after adjustment for sex, age, Charlson index albumin and CRP, with an odds ratio of 1.1 (95% CI: 1.03-1.16). Diagnostic performance of RDW in predicting mortality appeared to be suboptimal (AU-ROC: 0.62). Changes in RDW during a short follow up period were not associated with mortality. RDW measured on ICU entry is associated with hospital mortality. Patients with higher RDW will have longer LOS in ICU. Repeated measurements of RDW provide no additional prognostic value in critically ill patients.

Red cell distribution width and risk for venous thromboembolism: A population-based cohort study

Red cell distribution width (RDW) has been associated with venous thromboembolism (VTE), but whether RDW is a predictor of first event of VTE is unknown. We investigated the association between RDW and incidence of first event of VTE in a population-based cohort. RDW was measured in 27 042 subjects (aged 45-73 years, 60.6% women), without previous history of VTE or cancer within 5 years before follow-up, who participated in the Malmö Diet and Cancer study during 1991-1996. Incidence of VTE was identified from the patient register and the cause of death register during a mean follow-up of 13.8 years and studied in relation to RDW. During follow-up, 991 subjects (57.5% women) were affected by VTE (pulmonary embolism or deep venous thrombosis of the lower limbs). After adjustment for potential confounding factors the hazard ratios (HR) for VTE for the second, third and fourth RDW quartiles 1.15 (95% confidence interval 0.94-1.41), 1.41 (1.14-1.73), 1.74 (1.38-2.21), respectively, were compared with the bottom quartile of RDW. In the multivariate model subjects with the top 5% of RDW values compared with the bottom quartile had an even higher risk (HR=2.51, 1.78-2.54). In receiver operating characteristic (ROC) analysis, the male specific area under the ROC curve (AUC) for RDW was 0.57 (95% CI 0.54-0.59). The female specific AUC was 0.56 (95% CI 0.53-0.58). RDW was found to be associated with long-term incidence of first event of VTE among middle-aged subjects.

Red Cell Distribution Width may be Related to the Degree of Coronary Collateral Circulation

We read the article ‘‘Relation of Coronary Collateral Circulation With Red Cell Distribution Width in Patients With Non-ST Elevation Myocardial Infarction’’ by Tanboga et al with interest. They aimed to investigate the relationship between red cell distribution width (RDW) value and coronary collateral circulation (CCC) in patients with non-ST elevation myocardial infarction (NSTEMI). They concluded that high RDW, high creatine kinase-MB, and absence of preinfarction angina were found to be independent predictors for impaired CCC. We believe that these findings will enlighten further studies about the relationships of coronary collateral (CC) development. Thanks to the authors for their contribution. The CCC is an adaptive response to myocardial ischemia. Well-developed collaterals are associated with reduced mortality in patients with stable coronary artery disease and reduced infarct size in patients with acute myocardial infarction. There are interconnecting vessels between the main arteries, which can prevent ischemia despite coronary artery occlusion in many patients. These interconnections of vessels, which can be visualized and graded by angiography, represent the CCC, an alternative route for the myocardial perfusion. In this study, CCs were scored by visual analyses and were evaluated according to the Rentrop grading system; patients with Rentrop grades 0 and 1 were classified as group 1 (in whom CC development was coded as inadequate), and patients with Rentrop grade 2 and 3 were classified as group 2 (adequate CC development). Then, they compared between these 2 groups. But, in some studies like Refiker et al the patients were classified into impaired CC development (group 1, Rentrop grades 0-1-2) and adequate CC development (group 2, Rentrop grades 3) groups. Duran et al accepted Rentrop grade 0 as absence of CC vessels, and they accepted Rentrop grade 1 as presence of CC vessels. So, what are the criteria for the definition of adequate or inadequate CC development? A subgroup analysis of Rentrop grading system according to each of the 4 groups might affect the results of the study. It would be better if the authors added subgroup analysis according to Rentrop grading system, respectively. The RDW has been recently proposed as an independent predictor of all-cause long-term mortality in patients with NSTEMI 2 and in another study. Sometimes conditions like the differential diagnosis of anemia might affect RDW parameter, and so this parameter might be changed in such an underlying condition. The anemic disease situation may mask the chronic ongoing inflammation. After that, not only RDW but also neutrophil–lymphocyte ratio, gamma-glutamyltransferase, and uric acid are easy methods to assess the CCC in the patients. These might be useful in clinical practice. The RDW itself alone without other inflammatory markers may not give information to clinicians about the inflammatory condition and prognostic indication of the patient. So, we think that it should be evaluated together with other serum inflammatory markers. Finally, it would be better if the authors define how much time they spent in measuring RDW levels, because delayed blood sampling can cause abnormal results in RDW measurements. We think that further studies should be made to enlighten the role of RDW as a prognostic indicator in patients with NSTEMI.

Red cell distribution width is associated with long-term prognosis in patients with stable coronary artery disease

BackgroundData regarding the association between red cell distribution width (RDW) values and mortality in patients with stable coronary artery disease are scarce. We aimed to investigate the link between mortality and RDW in patients with stable coronary artery disease undergoing percutaneous coronary intervention (PCI).MethodsWe analyzed 2550 consecutive patients with stable coronary artery disease who underwent PCI between 2007 and 2011 at our institution. The patients were divided into four groups according to RDW quartiles. The association between the RDW values and the outcomes was assessed using Cox proportional regression analysis after adjusting for clinical, echocardiographic, hemodynamic and laboratory data in the whole population and in subgroups stratified by gender, presence of diabetes, anemia or heart failure.ResultsIn the entire population, there was a stepwise relationship between RDW intervals and comorbidities. Patients with the highest RDW values were older and more often burdened with diabetes, heart failure and chronic kidney disease. There was an almost 4-fold increase in mortality during an average of 2.5 years of follow-up between the group of patients with RDW values lower than 13.1% (25th percentile) and the group with RDW values higher than 14.1% (75th percentile), (4.3% vs. 17.1%, p < 0.0001). After adjusting for the covariates, RDW remained significantly associated with mortality in the whole cohort (HR-1.23 [95% CI (1.13-1.35), p < 0.0001]) and in the subgroups stratified by gender, age (over and under 75 years), presence of anemia, diabetes, heart failure and chronic kidney disease.ConclusionHigher RDW values correspond to higher comorbidity burdens and higher mortality. RDW is an independent predictor of mortality in patients with stable coronary artery disease.

Home-based cardiac rehabilitation decreases red cell distribution width in chronic heart failure

Objective Red cell distribution width (RDW) is a measure of variation in the volume of circulating erythrocytes and has recently emerged as a powerful prognostic marker in heart failure. We studied the eff ect of 5-month, home-based cardiac rehabilitation on RDW.Methods and results Sixty-two patients (age: median 67 years, IQR 63-74) with chronic heart failure caused by reduced left ventricular systolic function were enrolled. Exercise time and physical activity levels out of the hospital were determined by a single-axial accelerometer. Baseline RDW values were: median 13.6, IQR 12.8-14.4%, with 13 patients (21.0%) showing values above the upper normal limit. RDW values were decreased significantly after training in the 13 patients with elevated baseline RDW values (P < 0.01), but not in the remaining 49 patients with normal baseline RDW values. There was a highly signifi cant correlation between baseline RDW and changes in RDW after exercise training (P= 0.0001, r2= 0.628, n = 62). The time spent for moderate (> 3 METs) exercise was: median 9.0, IQR 3.0-18.8 minutes per day.Conclusions Relatively low intensity, home-based cardiac rehabilitation was associated with decreased RDW in heart failure patients with abnormal RDW.

Increased Red Blood Cell Distribution Width Associates with Cancer Stage and Prognosis in Patients with Lung Cancer

BackgroundRed cell distribution width (RDW), one of many routinely examined parameters, shows the heterogeneity in erythrocyte size. We investigated the association of RDW levels with clinical parameters and prognosis of lung cancer patients.MethodsClinical and laboratory data from 332 patients with lung cancer in a single institution were retrospectively studied by univariate analysis. Kaplan-Meier survival analysis and Cox proportional hazard models were used to examine the effect of RDW on survival.ResultsThe RDW levels were divided into two groups: high RDW (>=15%), n=73 vs. low RDW, n=259 (<15%). Univariate analysis showed that there were significant associations of high RDW values with cancer stage, performance status, presence of other disease, white blood cell count, hemoglobin, mean corpuscular volume, platelet count, albumin level, C-reactive protein level, and cytokeratin 19 fragment level. Kruskal-Wallis tests revealed an association of RDW values with cancer stage in patients irrespective of comorbidity (patient with/without comorbidity: p<0.0001, patient without comorbidity: p<0.0001). Stages I-IV lung cancer patients with higher RDW values had poorer prognoses than those with lower RDW values (Wilcoxon test: p=0.002). In particular, the survival rates of stage I and II patients (n=141) were lower in the high RDW group (n=19) than in the low RDW group (n=122) (Wilcoxon test: p<0.001). Moreover, multivariate analysis showed higher RDW is a significant prognostic factor (p=0.040).ConclusionRDW is associated with several factors that reflect inflammation and malnutrition in lung cancer patients. Moreover, high levels of RDW are associated with poor survival. RDW might be used as a new and convenient marker to determine a patient’s general condition and to predict the mortality risk of lung cancer patients.

The role of red cell distribution width in the diagnosis of acute appendicitis: a retrospective case-controlled study

PurposeThe aim of this study was to seek whether red cell distribution width (RDW) has a role in the diagnosis of acute appendicitis. It was also aimed to show the relationship of RDW with leukocyte count and C-reactive protein (CRP) level.MethodsThis study was conducted via retrospective assessment of the hospital records of the adult patients who were operated for acute appendicitis between January 2010 and February 2013 and had a pathology report that confirmed the diagnosis of acute appendicitis. The patients in the control group were selected from healthy adults of similar age who applied to check-up clinic. Age, gender, leukocyte count, CRP, and RDW values were recorded. This study is a case controlled retrospective clinical study.ResultsA total of 590 patients in the acute appendicitis group and 121 patients in the control group were included, making up a total of 711 subjects. The mean RDW levels were 15.4 ± 1.5% in the acute appendicitis group, while 15.9 ± 1.4% in the control group. CRP, leukocyte count were significantly higher in the acute appendicitis group, and RDW level were significantly lower in the acute appendicitis group (p < 0.001, p < 0.001, p = 0.001, respectively). RDW, leukocyte count, and CRP had a sensitivity and specificity of 47% and 67%; 91% and 74%; and 97% and 41%, respectively in acute appendicitis. RDW was not correlated with CRP and leukocyte levels. However, we found a correlation between CRP and leukocyte levels.ConclusionRDW level was lower in patients with acute appendicitis. The magnitude of difference in RDW seen between acute appendicitis and controls was so slight as to be of no utility in diagnostic testing.

The predictive value of mean platelet volume, plateletcrit and red cell distribution width in the differentiation of autoimmune gastritis patients with and without type I gastric carcinoid tumors

Autoimmune gastritis is an autoimmune and inflammatory condition that may predispose to gastric carcinoid tumors or adenocarcinomas. The early diagnosis of these tumors is important in order to decrease morbidity and mortality. Platelet indices such as mean platelet volume and plateletcrit levels increase in inflammatory, infectious and malign conditions. The primary aim of this study was to explore wheter platelet indices and red cell distribution width have any predictive role in the discrimination of autoimmune gastritis patients with and without gastric carcinoid tumors. Also secondary aim of this study was to investigate whether any changes exist betwenn autoimmune gastritis and functional dyspepsia patients by means of platelet indices. Plateletcrit (0.22 ± 0.06 vs. 0.20 ± 0.03%, p < 0.001) and red cell distribution width (16.11 ± 3.04 vs. 13.41 ± 0.95%, p < 0.001) were significantly higher in autoimmune gastritis patients compared to control group. Receiver operating curve analysis suggested that optimum plateletcrit cut-off point was 0.20% (AUC: 0.646), and 13.95% as the cut off value for red cell distribution width (AUC: 0.860). Although plateletcrit (0.22 ± 0.06 vs. 0.21 ± 0.04%, p = 0.220) and mean platelet volume (8.94 ± 1.44 vs. 8.68 ± 0.89 fl, p = 0.265) were higher in autoimmune gastritis patients without carcinoid tumor compared to patients with carcinoid tumors, these parameters were not statistically significant. Changes in plateletcrit and red cell distribution width values may be used as a marker in the discrimination of autoimmune gastritis and fucntional dyspepsia patients but not useful in patients with gastric carcinoid tumor type I.

Red Cell Distribution Width Identifies Cerebral Venous Sinus Thrombosis in Patients With Headache

Diagnosing cerebral venous sinus thrombosis (CVST) in patients referring to emergency service or neurology outpatient unit with complaints of headache is a challenging task. Magnetic resonance (MR) venography is the gold standard, but there are limitations regarding its use. To evaluate the validity of red cell distribution width (RDW) in CVST diagnosis in patients presenting with headache. A total of 138 patients comprising 37 patients with CVST and 101 control primer headache cases were included in this retrospective cross-sectional study. Control group consists of hospitalized patients with primary headache. Venous blood hemoglobin (Hb), platelet, mean corpuscular volume (MCV), RDW, fibrinogen, and vitamin B12 levels of the patients were recorded at the first referral. Diagnosis of CVST was established by MR venography. The RDW ratio of patients with a diagnosis of CVST was significantly higher than that in patients with primary headache (15.3 ± 1.4 vs 13.3 ± 0.5; P <.0001). Fibrinogen and vitamin B12 levels were not significantly different between the 2 groups. In a total of 11 patients, there was more than 1 thrombosis. In 21 of the patients with CVST, gene mutation was detected. There was no significant difference between the patients with and without mutations regarding RDW values. Diagnostic validity of RDW was found to be excellent in differentiating patients with CVST and primary headache (area under the curve = 0.996; 95% CI: 0.990-1.000). Optimum RDW cutoff value was determined as 14.1% (sensitivity: 91.9%, specificity: 99%, positive predictive value: 92.8, negative predictive value: 0.082). We suppose that among patients presenting with the complaint of headache, RDW value may lead to diagnose CVST.

VASO-OKLUSİV KRİZ ORAK HÜCRELİ ANEMİDE HEMATOLOJİK PARAMETRELERİ NASIL DEĞİŞTİRİR?

Aim: To compare hematological parameters between children with steady-state sickle cell disease (SCD) and those with vaso-occlusive crisis. Materials and methods: Forty-seven patients (under 18 years of age) , 23 in the steady state and 24 in crisis were in this study. Control group included 24 age-matched children without chronic disease. Hematological parameters were recorded. Complete blood counts were measured by automated analyzer. Results: In crisis group, white blood cells (WBC), red cell distribution width (RDW), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), platelet (PLT), neutrophil and monocytes mean values (17045 /mm3, 21.62 %, 28.12 pg, 34.96 gr/dl, 432 x 109/L, 10858 /mm3, 1676 /mm3) were higher than control (7429 /mm3, 14.66 %, 26.49 pg, 33.65 gr/dl, 288 x 109/L, 3883 /mm3, 508 /mm3), (p<0.05). Red blood cell (RBC), hemoglobin (HGB), hematocrit (HCT) and mean platelet volume (MPV) levels (2.98 x106 /mm3, 8.35 gr/dl, 23.64 %, 9.46 fL) in crisis group were lower than control (4.75 x 106/mm3, 12.62 gr /dl, 37.49 %, 10.16 fL), (p <0.05). In steady-state group, RBC, HGB, HCT and MPV levels (3.19 x 106/mm3, 8.49 gr /dl, 24.77 %, 10.16 fL) were lower than control (4.75 x 106/mm3, 12.62 gr/dl, 37.49 %, 10.16 fL) (p<0.05). In steady-state group, WBC, RDW, neutrophils, lymphocytes and monocytes values (12924 /mm3, 21.37%, 10150 /mm3, 3985 /mm3, 1240 /mm) were higher than control (7429/mm3, 14.66%, 3883 /mm3, 2691 /mm3, 508 /mm3), (p<0.05). Conclusion: MCH, MCHC and PLT counts can be superior diagnostic markers for vaso-occlusive crisis

Multiplicative interaction between mean corpuscular volume and red cell distribution width in predicting mortality of elderly patients with and without anemia

Recent studies have shown that an elevated red cell distribution width (RDW) is an important predictor of adverse outcomes. However, the strength of this biomarker has not been tested in a large outpatient elderly population. Also since increased RDW can be due to a variety of etiologies, additional biomarkers are needed to refine the prognostic value of this variable. We assembled a cohort of 36,226 elderly (≥65yo) patients seen at an outpatient facility within the Einstein/Montefiore system from January 1st 1997 to May 1st 2008 who also had a complete blood count performed within 3 months of the initial visit. With a maximum follow-up of 10 years, we found that an elevated RDW (>16.6) was associated with increased risk of mortality in both non-anemic (HR = 3.66, p < 0.05) and anemic patients (HR = 1.87, p < 0.05). The effect of RDW on mortality is significantly increased in non-anemic patients with macrocytosis (HR = 5.22, p < 0.05) compared to those with normocytosis (HR = 3.86, p < 0.05) and microcytosis (HR = 2.46, p < 0.05). When comparing non-anemic patients with both an elevated RDW and macrocytosis to those with neither, we observed an elevated HR of 7.76 (higher than expected in an additive model). This multiplicative interaction was not observed in anemic patients (HR = 2.23). Lastly, we constructed Kaplan-Meier curves for each RDW/MCV subgroup and found worsened survival for those with macrocytosis and an elevated RDW in both anemia and non-anemic patients. Based on our results, the addition of MCV appears to improve the prognostic value of RDW as a predictor of overall survival in elderly patients.

Red cell distribution width is associated with mortality in kidney transplant recipients

Red cell distribution width (RDW), a parameter routinely reported as part of the complete blood count, is associated with increased morbidity and mortality risk in different patient populations. No published data are available about the association between RDW and mortality in kidney transplant recipients. We collected socio-demographic, clinical parameters, medical and transplant history and laboratory data at baseline in 723 prevalent kidney transplant recipients between June and October 2008 [mean age 51 ± 13 (SD) years, 56 % men, 21 % diabetics]. Associations between baseline RDW values and all-cause mortality over 3 years were examined in unadjusted and adjusted models. Increasing RDW was associated with increased mortality in both unadjusted [(HR(1 % increase) = 1.63; 95 % CI 1.41-1.89) and (HR(>median) = 2.74; 95 % CI 1.68-4.48)] and fully adjusted models [(HR(1 % increase) = 1.60; 95 % CI 1.27-1.89) and (HR(>median) = 1.33; 95 % CI 0.76-2.35)]. In reclassification analyses, RDW improved the predictive value of all-cause mortality prediction models [the net reclassification improvement (NRI) was 0.189; p < 0.001]. RDW, a cheap and readily available but largely neglected parameter independently, predicts mortality in prevalent kidney transplant recipients and could potentially been used in everyday risk assessment of kidney transplant recipients.

Relationship Between Red Cell Distribution Width and the GRACE Risk Score With In-Hospital Death in Patients With Acute Coronary Syndrome

The aim of this study was to evaluate the relationship between red cell distribution width (RDW) and Global Registry of Acute Coronary Events (GRACE) risk score in patients with unstable angina pectoris (UAP) and non-ST elevation myocardial infarction (NSTEMI). We retrospectively enrolled 193 patients with UAP/NSTEMI (mean age 63.6 ± 12.6 years; men 57%) in this study. Higher RDW values were associated with increased in-hospital mortality (P = .001). There is a significant correlation between RDW and GRACE score (P < .001). In multivariate logistic regression analysis, RDW was found to be an independent predictor of high GRACE score (odds ratio: 1.513, 95% confidence interval: 1.116-2.051, P = .008). A cutoff value of >15.74 for RDW predicted high GRACE score, with a 64% sensitivity and 65% specificity. Our study results demonstrated that high RDW was an independent predictor of high GRACE score, and it is associated with in-hospital mortality in UAP/NSTEMI.

The association between red cell distribution width and non-small-cell lung cancer

We have read the article ‘Preoperative red cell distribution width (RDW) in patients undergoing pulmonary resections for nonsmall-cell lung cancer’ by Warwick et al. [1]. They aimed to investigate the association of red cell distribution width (RDW) in patients undergoing lung resections for non-small-cell lung cancer with respect to in-hospital morbidity, mortality and longterm survival. They concluded that RDW is a significant factor after risk adjustment, determining in-hospital morbidity, mortality and long-term survival in patients undergoing post-potentially curative resections for non-small-cell lung cancer. RDW is a measure of the variability in the size of circulating erythrocytes and is expressed as the coefficient of variation of the erythrocyte volume. As several routine haematology instruments can analyse erythrocyte volume, RDW is available in most clinical settings. RDW independently predicts long-term mortality in many clinical conditions [2]. It is reported routinely as part of the full blood count, and it may be elevated by inflammation, uraemia and transfusion history. Recently, a number of studies have demonstrated that elevated RDW levels are associated with poor prognosis in the setting of coronary artery disease, coronary bypass surgery, heart failure, stroke, peripheral arterial disease and older age [3]. Nowadays, although anaemia is a predictor of postoperative complications and is a risk factor for mortality in post-cardiac surgery patients, RDW is described as an independent early marker of haemoglobin evolution and an independently identified risk factor for new-onset anaemia, providing predictive information for haematological abnormalities beyond haemoglobin concentrations and other known risk factors. It is commonly used as a method for the differential diagnosis of anaemia and could be elevated in any conditions, where reticulocytes are released into circulation [4]. However, the value of RDW is instrument dependent, forcing each laboratory to establish its own reference values. A common underlying cause of high RDW is iron or B12/folate deficiency, where normal erythrocytes are mixed with smaller or larger ones produced during the deficiency. The correlation with bilirubin could also be due to liver damage and excessive alcohol intake, resulting in macrocytosis and increased RDW. Additionally, not only RDW but also mean platelet volume, neutrophil lymphocyte ratio [5], C-reactive protein, gamma-glutamyl transferase and uric acid are easy methods to evaluate the prognosis of the patients. These markers might be helpful in clinical practice. Finally, because Warwick et al. [1] evaluated patients undergoing pulmonary resections for non-small-cell lung cancer retrospectively in their study, the authors might not accurately define how much time elapsed before measuring RDW levels; delaying blood sampling can cause abnormal results in RDWmeasurements [6]. In conclusion, RDW are affected by many conditions. So one should keep in mind that RDW itself without other inflammatory indicators may not give exact information to clinicians about the inflammatory status and prognostic indication of the patients. Finally, from that point of view, we think that it should be evaluated taking into consideration other serum inflammatory markers.