Red Cell Distribution Width Values Research Articles

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

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

Red Cell Distribution Width and Its Association with Neonatal Bacteremia: A Case-Control Study

Background: Bacteremia is a major cause of prolonged hospital stay and mortality in neonates and its early diagnosis remains a challenge to pediatricians. Red cell distribution width (RDW) is a component of a complete blood count test which is accessible and inexpensive and has been reported to be a possible diagnostic marker for neonatal bacteremia. This study determined the association of RDW with neonatal bacteremia in term and preterm neonates. Methodology: This is a retrospective case-control study of 26 bacteremic neonates as cases and 104 non-bacteremic neonates, either symptomatic or with risk factors for bacteremia, as controls. Included newborns were seen between January 1, 2010 to September 30, 2021. Laboratory data obtained were CBC, C-reactive protein and blood culture. Results: RDW values between bacteremic and non-bacteremic neonates were not significantly different. There was an association between RDW and neonatal bacteremia at an RDW level of &gt; 16.1, where the likelihood of bacteremia was three times higher compared with lower RDW values. Significantly lower levels of hemoglobin, hematocrit, RBC count, WBC count, platelet count, MCH and MCHC, and a higher CRP level were seen among bacteremic neonates compared to those who were not. The median RDW for both term and preterm neonates was close to 16, with a narrow inter-quartile range at 1 and 2 for controls and cases, respectively. The range (minimum to maximum) of RDW values of bacteremic preterm neonates was more variable than those of term neonates. Using RDW to detect bacteremia, it had an equivocal discriminatory power or AUC of 0.6056. We found insufficient evidence to demonstrate a correlation between RDW and other CBC parameters, except for MCHC. For MCHC, the results suggest a very weak and indirect correlation. Conclusion: RDW was not significantly different between bacteremic and non-bacteremic neonates, but there was a suggested association between RDW and bacteremia at an RDW level of &gt; 16.1, at which level there was a 3-fold risk for bacteremia.

Relationships between RDW, NLR, CAR, and APACHE II scores in the context of predicting the prognosis and mortality in ICU patients.

Intensive care units (ICU) are tasked with critical care and treatment with a view to improving prognosis. The Acute Physiology and Chronic Health Evaluation II (APACHE II) is one of the most commonly used scoring systems to predict prognosis. In this context, the objective of this study is to evaluate the prognostic value of Red Cell Distribution Width (RDW), Neutrophil-Lymphocyte ratio (NLR), and C-reactive protein to albumin ratio (CAR) in predicting the prognosis and mortality in patients admitted to the ICU. The RDW, NLR, and CAR values and APACHE II scores of patients admitted into an ICU, where heterogeneous groups of patients are usually treated, were recorded, categorized based on survival status, and investigated for any correlation between surviving patients' mortality and length of stay (LoS) in ICU and the said parameters. The ICU mortality among the 2,147 patients included in the study was 43.2%. The most common diagnosis of the patients admitted to the ICU was sepsis. The RDW, NLR, and CAR values and APACHE II scores of the deceased patients were significantly higher than those of the survived patients. There was a significant correlation between LoS in ICU and the said parameters in the positive direction in the survived group only. The APACHE II score had the highest prognostic value in predicting mortality, followed by RDW, CAR, and NLR values in descending order. Among the parameters investigated in this study, RDW had the highest prognostic value in predicting the prognosis and mortality. Hence, it may be incorporated into or used alongside the APACHE II scoring system to predict patient outcomes with higher accuracy. However, further randomized controlled studies are needed to determine the cut-off values in predicting the prognosis and mortality.

Role of red cell dstribution width in colorectal cancer diagnosis and prognosis

Objective: We aimed to assess whether red cell distribution width (RDW) was associated with pre-operative clinical features or post-operative clinicopathological outcomes in patients with colorectal cancer (CRC), and to determine the utility of RDW as a diagnostic or prognostic marker of CRC. Material and Method: This retrospective cohort study was conducted between January 2018 and May 2021 at a university hospital in Turkey. A total of 188 patients histologically diagnosed with CRC who had undergone surgery were included in the study. Results: Our study included 118 (62.77%) male patients, and the mean age of the patients was 66.28±11.71 years. We found that RDW values were significantly higher in females compared to males (p=0.033), in patients with T3 or T4 tumors compared to those with T1 or T2 tumors (p

Association of RDW, NLR, and PLR with Atrial Fibrillation in Critical Care Patients: A Retrospective Study Based on Propensity Score Matching

Objective Previous studies have shown inconsistent results in relation to the red cell distribution width (RDW), neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR) of atrial fibrillation (AF). This retrospective study is aimed at detecting the association of RDW, NLR, and PLR with AF. Methods A total of 4717 critical care patients were screened from the Medical Information Mart for Intensive Care- (MIMIC-) III database. The patients were separated into the non-AF and AF groups. The imbalances between the groups were reduced using propensity score matching (PSM). ROC curves were generated to detect the diagnostic value of RDW, NLR, and PLR. Logistic regression analysis was used to detect the risk factors for AF. Results A total of 991 non-AF patients paired with 991 AF patients were included after PSM in this study. The RDW level in the AF group was significantly higher than that in the non-AF group (15.09 ± 1.93vs. 14.89 ± 1.91, P = 0.017). Neither NLR nor PLR showed any significant difference between the two groups (P > 0.05 for each). According to ROC curve, RDW showed a very low diagnostic value of AF (AUC = 0.5341), and the best cutoff of RDW was 14.1 (ACU = 0.5257, sensitivity = 0.658, specificity = 0.395). Logistic regression analysis showed that an elevated RDW level increased 1.308-fold (95%CI = 1.077-1.588, P = 0.007) risk of AF. Neither elevated NLR nor elevated PLR was a significant risk factor for AF (OR = 0.993, 95%CI = 0.802-1.228, P = 0.945 for NLR; OR = 0.945, 95%CI = 0.763-1.170, P = 0.603 for PLR). Conclusions Elevated RDW level but not NLR or PLR levels is associated with AF. RDW > 14.1 is a risk factor for AF, but its diagnostic capacity for AF is not of great value.

The prognostic value of RDW, NLR and PLR in sequential radio-chemotherapy for advanced lung cancer

Introduction.Inflammation plays an important role in carcinogenesis, therefore morphology-based inflammatory indi­ces could be prognostic factors in lung cancer patients. This study aimed to analyze if red cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) are associated with patients’ prognosis in non-small cell lung cancer (NSCLC) patients. Material and methods.The study population included 110 patients treated with definitive sequential radio-chemo­therapy for stage IIIA–IIIB NSCLC. The data were retrospectively analyzed using the receiver operating characteristic (ROC) method, Kaplan-Meier estimator, log-rank testing, and Cox proportional hazards regression model. Results.The ROC analysis has shown that the optimal cut-off values were 14% for RDW, 2.1 for NLR, and 120 for PLR, with area under the curve (AUC) of 0.606, 0.509, and 0.564 respectively. The overall survival was significantly higher in patients with RDW ≤ 14% with a median survival of 31.2 months compared to 20.2 months for patients with RDW > 14%. RDW was an independent prognostic factor in multivariate analysis. Conclusions.RDW can provide additional information in assessing patients’ prognosis, but it is necessary to consider its modest sensitivity and specificity. NLR and PLR were not found to be independent prognostic factors.

Exploring red cell distribution width as a potential risk factor in emergency bowel surgery-A retrospective cohort study.

Increased preoperative red cell distribution width (RDW) is associated with higher mortality following non-cardiac surgery in patients older than 65 years. Little is known if this association holds for all adult emergency laparotomy patients and whether it affects 30-day or long-term mortality. Thus, we examined the relationship between increased RDW and postoperative mortality. Furthermore, we investigated the prognostic worth of anisocytosis and explored a possible association between increased RDW and frailty in this cohort. We conducted a retrospective, single centre National Emergency Laparotomy Audit (NELA) database study at St Mary's Hospital Imperial NHS Trust between January 2014 and April 2018. A total of 356 patients were included. Survival models were developed using Cox regression analysis, whereas RDW and frailty were analysed using multivariable logistic regression. Underlying model assumptions were checked, including discrimination and calibration. We internally validated our models using bootstrap resampling. There were 33 (9.3%) deaths within 30-days and 72 (20.2%) overall. Median RDW values for 30-day mortality were 13.8% (IQR 13.1%-15%) in survivors and 14.9% (IQR 13.7%-16.1%) in non-survivors, p = 0.007. Similarly, median RDW values were lower in overall survivors (13.7% (IQR 13%-14.7%) versus 14.9% (IQR 13.9%-15.9%) (p<0.001)). Mortality increased across quartiles of RDW, as did the proportion of frail patients. Anisocytosis was not associated with 30-day mortality but demonstrated a link with overall death rates. Increasing RDW was associated with a higher probability of frailty for 30-day (Odds ratio (OR) 4.3, 95% CI 1.22-14.43, (p = 0.01)) and overall mortality (OR 4.9, 95% CI 1.68-14.09, (p = 0.001)). We were able to show that preoperative anisocytosis is associated with greater long-term mortality after emergency laparotomy. Increasing RDW demonstrates a relationship with frailty. Given that RDW is readily available at no additional cost, future studies should prospectively validate the role of RDW in the NELA cohort nationally.

Higher red cell distribution width and poorer hospitalization-related outcomes in elderly patients.

Red cell distribution width (RDW), an index for variation of red blood cell (RBC) size, has been proposed as a potential marker for poorer outcomes in several aging-related diseases and conditions. We tested whether greater variability of RBC size, presented as a higher RDW value, predicts poor prognoses among hospitalized patients over 60 years old. We retrospectively collected data from older hospitalized patients aged ≥60 years between January 2013 to December 2017 at Sutter Health, a large integrated health system in Northern California. The RDW was measured during hospital admission and categorized with 1% intervals (≤13.9, 14.0-14.9, 15.0-15.9, 16.0-16.9, 17.0-17.9 and ≥18.0%). The primary outcome was the rate of in-hospital mortality and secondary outcomes included 30-day re-admission rate and length of hospital stay (in days). A total of 167,292 admissions from 94,617 patients were included. The overall in-hospital mortality rate was 6.3%. As the RDW value increased, the rate of in-hospital mortality gradually increased from 2.7% for the lowest RDW category to 12.2% in the highest category (p-trend <0.001). The overall 30-day re-admission rate after discharge was 12.5% and the rate of 30-day re-admission also increased with increasing RDW categories (7.4% in the lowest group vs. 15.8% in the highest group, p-trend <0.001). Patients with the highest RDW values at admission stayed 1.5-2.0 times longer in the hospital than patients with lower RDW values who were admitted for the same causes. Greater variability of RBC size is significantly associated with worse prognosis in hospitalized elderly patients, indicating higher mortality, greater risk of early re-admission, and longer hospital stay days. Risk stratification strategies for hospitalized elderly should include RDW value.

PROGNOSTIC FACTORS IN DEEP NECK INFECTION

Objective: The present study aimed to evaluate the prognostic importance of hematologic test findings in addition to the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, systemic inflammation response index, and C-reactive protein in the patients with deep neck infection and to compare these results with healthy subjects.Material and Methods: The study included 32 patients diagnosed as deep neck infection and treated by surgical intervention and parenteral antibiotics. As none of the patients had life-threatening complications, the prognosis was determined by the length of stay in the hospital. The effect of age, sex, pre-treatment blood parameters, abscess culture results, and medical comorbidities on prognosis were analysed. Pre- and post-treatment blood parameters were compared in each patient. Blood parameters were also compared between healthy subjects and patients.Results: When comparing patients with length of stay in the hospital ≤7 days and &amp;gt;7 days, significant differences were observed for age (t=-2.568, p=0.015) and red blood cell distribution width values obtained preoperatively (Z=-2.343, p=0.019). The correlation analysis revealed a positive correlation between age and length of stay in the hospital. (r=0.450, p=0.010), and between length of stay in the hospital and comorbidity (r=0.366, p=0.039). Logistic Regression analysis revealed that age could be the best marker in the prediction of the patients with worse prognosis (percentage of predicting patients with worse prognosis=73.3%, B=0.054, Wald=4.967, p=0.026).Conclusion: The present study confirmed that the prognosis was worse in older patients and patients with comorbid disease whereas no relation was observed between the inflammatory markers and prognosis.

Red cell distribution width as a predictor of impaired exercise capacity in patients with heart failure

Aim To test a hypothesis that increased values of red cell distribution width (RDW) in patients with chronic heart failure (CHF) can be related with low exercise tolerance.Material and methods 102 patients were evaluated who had CHF with mid-range and reduced left ventricular ejection fraction (LV EF) without anemia (72% men, mean age 66±10.2 years). Cardiopulmonary stress test (CPST), echocardiography, 6‑min walk test (6MWT), blood count, and measurements of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and serum iron were performed.Results The average LV EF was 39±8.7 %; the peak oxygen consumption (VO2peak) was 13.7±4.8 ml /kg /min; and the median NT-pro-BNP was 595.3 pg /ml (Q1-3 1443-2401). RDW variables, including the RDW coefficient of variation (RDW-CV) and RDW standard deviation (RDW-SD), were not significantly related with serum iron or hemoglobin concentrations. A one-factor linear regression analysis showed a significant correlation of VO2peak with RDW-SD (р=0.039). A multivariate linear regression analysis with adjustments for LV EF, hemoglobin concentration, and age did not reveal any significant correlation of VO2peak with RDW variables. The distance covered in the 6MWT was significantly associated with RDW-CV both in the one-factor analysis and with adjustments for LV EF, hemoglobin and serum iron concentrations, and age.Conclusion This study showed that high RDW values in CHF patients without anemia predicted low exercise tolerance regardless of the age, LV systolic function, and hemoglobin and serum iron concentrations. A 16% increase in RDW-CV significantly decreased the likelihood of covering a distance longer than 360 m during 6 min.

Prognostic significance of the mean corpuscular volume (MCV) and red cell distribution width (RDW) in obstructive colorectal cancer patients with a stent inserted as a bridge to curative surgery.

The prognostic significance of the mean corpuscular volume (MCV) and red cell distribution width (RDW) in patients with malignancy have not been intensely investigated and are largely overlooked. We, therefore, investigated the clinical significance of MCV and RDW in non-metastatic obstructive colorectal cancer (OCRC) patients with a self-expandable metallic stent inserted as a bridge to curative surgery. Eighty-five pathological stage II and III OCRC patients were retrospectively evaluated. The associations of the preoperative MCV and RDW values with short- and long-term outcomes were examined. There were 50 males and 35 females, and the median age was 71years old. The median interval between stenting and surgery was 17days, and the median postoperative hospital stay was 16days. Fifty-six patients were in the MCV ≥ 87 group, and 47 were in the RDW ≥ 13.8 group. Multivariate analyses revealed the MCV ≥ 87 status to be independently associated with a poor relapse-free survival (hazard ratio [HR] = 4.70, 95% confidence interval [CI] 1.52-14.58, P = 0.007). The RDW ≥ 13.8% was an independent predictor of postoperative infectious complications (HR = 7.28, 95% CI 1.24-42.70, P = 0.028). The MCV and RDW are simple but strong predictors of postoperative outcomes in OCRC patients.

Predictive value of preoperative inflammatory markers and serum CA 125 level for surgical outcome in Indonesian women with epithelial ovarian cancer.

It is essential in the management of ovarian cancers to identify the patients who will benefit from primary complete cytoreductive surgery and those who will rather benefit from neoadjuvant chemotherapy. To evaluate the predictive value of preoperative inflammatory markers, i.e. platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), red cell distribution width (RDW), and serum CA125 level for surgical outcome in epithelial ovarian cancer. A retrospective study was carried out in Sanglah Hospital, Denpasar, Bali. A total of 54 patients with epithelial ovarian cancer who underwent primary exploratory laparotomy from January 2018 to November 2019 was recruited. Data about clinical characteristics, preoperative inflammatory markers, serum CA125 level, and surgical outcome (optimal vs. suboptimal) was collected from the medical records. Predictive value of the markers were evaluated using ROC curve to determine their accuracy (area under the curve, sensitivity, specificity, positive and negative predictive value). Mean age, parity, and tumor size did not differ between the study groups (p> 0.05). The group with suboptimal outcome had significantly higher PLR, NLR, MLR, and RDW value (p< 0.05). Using the ROC curve, a cut off value was determined for each predictor, i.e. PLR: 196.50, NLR: 3.34, MLR: 0.24, RDW: 13.19, CA125: 300.85. AUC for each predictor were as follows: PLR 0.718 (95% CI: 0.578-0.859), NLR 0.676 (95% CI: 0.529-0.823), MLR 0.700 (95% CI: 0.560-0.839), RDW 0.712 (95% CI: 0.572-0.852), CA125 0.593 (95% CI: 0.436-0.750). Sensitivity, specificity, and accuracy for predicting suboptimal outcome were as follows: PLR (74.2%, 69.6%, 72.2%), NLR (64.5%, 60.9%, 62.9%), MLR (74.2%, 59.1%, 66.7%), RDW (74.2%, 60.9%, 68.5%), CA125 (54.8%, 60.9%, 57.4%). We have some limitations such as small numbers of sample, we generalized whole kinds of ovarian cancer, and this study does not describe follow-up features. Preoperative serum inflammatory markers (PLR, MLR, and RDW) may serve as useful markers to predict the surgical outcome with fair accuracy in patients with epithelial ovarian cancer.

Utility of Red Cell Distribution Width (RDW) as a Noninvasive Biomarker for the Diagnosis of Acute Appendicitis: A Systematic Review and Meta-Analysis of 5222 Cases.

Background: Despite great advances in medicine, numerous available laboratory markers, and radiological imaging, the diagnosis of acute appendicitis (AA) in some cases still remains controversial and challenging for clinicians. Because of that, clinicians are still looking for an ideal marker that would be specific to AA. The red blood cell distribution width (RDW) has been recently investigated in several studies as a potential biomarker for AA. The aim of this systematic review and meta-analysis was to systematically summarize and compare all relevant data on RDW as a diagnostic biomarker for AA. Methods: This systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Scientific databases (PubMed, Scopus, Web of Science, and Excerpta Medica database—EMBASE) were systematically searched for relevant comparative studies by two independent researches using keywords ((red cell distribution width) OR rdw) AND (appendicitis). An independent assessment of the methodological quality was performed by two authors using the Downs and Black scale. RevMan 5.4 software was used to perform the meta-analysis. Results: Fifteen studies were included in the final meta-analysis; the majority of the studies was retrospective. Nine studies compared the RDW values between AA and non-AA; four studies compared the same between AA and healthy controls, while two studies compared the RDW values among all three groups. The estimated heterogeneity among the studies for all outcome was statistically significant (I2 = 92–99%, p < 0.00001). The pooling the data demonstrated no statistically significant difference in the RDW values (weighted mean difference (WMD) = 0.03, 95% CI = (−0.46, 0.52), p = 0.91) between AA and healthy controls as well as between AA and non-AA cases (WMD = 0.23, 95%CI = (–0.19, 0.65), p = 0.28). A separate subanalysis was performed to evaluate the utility of this biomarker for the pediatric age group. Pooling the data demonstrated no significant difference among the AA and non-AA groups in terms of the RDW values (WMD = 0.99, 95% CI = (–0.35, 2.33), p = 0.15). Conclusion: The RDW value difference demonstrated no statistically significant difference in AA versus healthy individuals and AA versus non-AA individuals. At the moment, there is no evidence of RDW utility in diagnostic testing of AA. Further research with prospective, multicenter studies and studies targeting special patient groups with a large sample size are needed in this field.

Cut off Value of Red Cell Distribution Width (RDW) in Screening and Diagnosis of Iron Deficiency Anemia and b Thalassemia Trait

Background: The most concerning consequences of iron deficiency in children are the alterations of cognitive, motor, and behavioral performance. Persistent neurocognitive changes despite iron repletion have increased the importance of prevention and early detection of iron deficiency.&#x0D; Objectives: To evaluate the cut off value of red cell distribution width (RWD) in the screening and diagnosis of iron deficiency anemia (IDA) and â thalassemia trait (BTT).&#x0D; Methods: It is a cross sectional study performed at Dhaka Shishu (Children) Hospital from July 2006 to July 2008. Total 52 patients, age ranged from 1-12 years were included in the study. Among them 27 cases were IDA and 25 cases were BTT. Complete blood count (CBC), serum ferritin and hemoglobin (HB) electrophoresis were measured. The sensitivity, specificity, positive and negative predictive value of differential and cutoff value for RDW discrimination index in differentiation between IDA and BTT were performed.&#x0D; Results: Age ranged from 1-12 years. In IDA group male were found 16(59%), female were 11(41%) and in BTT group male were 15(60%), female were 10(40%). The Hb% value in IDA group was significantly (p&lt;0.0001) lower than value for BTT. An elevation of RBC distribution width (&gt;14.6) in IDA had a sensitivity of 81%, specificity of 84%, positive predictive value (PPV) of 85% and negative predictive value (NPV) of 81%; value of RBC distribution width (&lt;14.6) in BTT had a sensitivity of 84%, specificity of 81%, positive predictive value (PPV) of 81% and negative predictive value (NPV) of 85%. An elevation of RBC distribution width (&gt;16) had a sensitivity of 67%, specificity of 92%, and positive predictive value (PPV) of 90% in distinguishing iron deficiency anemia from thalassemia trait. Moreover, eleven (11) of 27 patients with iron deficiency had RBC distribution width values greater than 18 compared to one (1) of the patients with thalassemia trait. An elevation of RBC distribution width ³18 specificity of 96% and positive predictive value (PPV) of 92%.&#x0D; Conclusion: The rersult of the study, in patients with microcytic hypochromic anemia, RDW value e³14.6% and Hb level&lt; 10gm/dl, iron deficiency is the most likely diagnosis. RDW value (&gt;16) is a reliable diagnostic tool in differentiation between IDA and BTT. Red cell distribution width (RDW) above 16% is the best index of IDA.&#x0D; DS (Child) H J 2021; 37(1): 51-58

Can Neutrophil-Lymphocyte Ratio in Complete Blood Count Help in the Differential Diagnosis Between Acute Appendicitis and Right Ureteral Stones in Pediatric Age Groups?

Background and objectiveAbdominal pain is one of the most common problems in children presenting to the pediatric emergency departments and is often a diagnostic challenge for the physician. Clinical studies have been carried out on adult patients to differentiate between ureteral stones and acute appendicitis (AA) in which neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) were analyzed in the complete blood count, and it was found that NLR and PLR could help in the differential diagnosis. In this study, we investigated whether complete blood count parameters in pediatric patients could be helpful in the differential diagnosis between AA and right ureteral stones.MethodsThe files of pediatric patients who were followed up and treated for AA and right ureteral stones between January 2019 and March 2021 were reviewed retrospectively. The demographic characteristics of the patients and their WBC, NLR, PLR, and red cell distribution width (RDW) values were evaluated to determine whether there was a difference between the two groups.ResultsIn this study, 77 patients with AA and 48 patients with right ureteral stones were included. Univariate regression analysis revealed that age, gender, WBC, PLR, and NLR were factors likely responsible for AA. As per multivariate linear regression analysis, NLR level (odds ratio: 0.407; 95% CI: 0.293-0.566; p<0.001) was an independent predictor of AA.ConclusionBased on our findings, NLR can help in establishing the diagnosis in pediatric patients who present to the emergency department with right lower quadrant pain, and in whom physical examination, routine laboratory tests, and imaging methods cannot help distinguish between AA and ureteral stones.

Exploring red cell distribution width as a biomarker for treatment efficacy in home mechanical ventilation

BackgroundWith the growing practice of home mechanical ventilation, there is a need to identify biological markers for adequate follow-up. Red cell distribution width (RDW) is a promising candidate because it is convenient, objective and may reflect treatment effect over a long period of time. The aim of this study was to explore the possible role of RDW as a marker for home mechanical ventilation in real-life, unselected chronic respiratory patient populations.MethodsFirst, we identified characteristic RDW values for mixed case, unselected chronic respiratory failure and home mechanical ventilated patients through retrospective review within our institutional database. Next, we conducted a prospective observational study to identify RDW changes during the first six months of optimized home mechanical ventilation treatment. Adult patients starting home mechanical ventilation were included. Factors affecting RDW change during the first 6 months of treatment were analysed.ResultsRDW was elevated in both chronic respiratory failure and home mechanical ventilation patients compared to healthy individuals in the retrospective review. In the prospective study of 70 patients, we found that 55.4% of patients starting home mechanical ventilation have abnormal RDW values which are reduced from 14.7 (IQR = 13.2–16.2)% to 13.5 (IQR = 13.1–14.6)% during the first 6 months of HMV treatment (p < 0.001). RDW improvement correlates with improvement in self-reported health-related quality of life and sleepiness scale scores, as well as physical functional status during the same time frame. RDW proved to be a comparable marker to other parameters traditionally used to evaluate treatment efficacy.ConclusionsRDW is elevated in chronic respiratory failure patients and is significantly reduced in the first six months of optimized home mechanical ventilation. Although further research is needed to verify if RDW change reflects outcome and how comorbidities influence RDW values, our results suggest that RDW is a promising marker of home mechanical ventilation efficacy.Trial registration This study was approved by and registered at the ethics committee of Semmelweis University (TUKEB 250/2017 and TUKEB 250-1/2017, 20th of December 2017 and 1st of October 2019).

Eski ve Yeni Kuşak Antiepileptik İlaçların Hemogram Parametrelerine Etkileri Farklı Mı?

Aim: There are different comments related to hematological side effects caused by antiseizure drugs (ASDs). In our study, we investigated the effects of ASDs on hemogram parameters. Materials and Methods: Hemogram values of 293 patients including 156 women, who used ASDs for at least six months, were compared with the values of 36 healthy control participants group who did not. In addition, the hemogram values of the patients using old-generation antiepileptic drugs such as phenytoin (PHT), carbamazepine (CBZ), valproic acid were compared with those using new-generation antiepileptic drugs as levetiracetam, oxcarbazepine, pregabalin (PGB), gabapentin and two ASDs in combination. Results: Comparison of the patients using ASDs with the control group revealed that white blood cell (WBC) values of only PHT users were lower than the control group (p=0.045). Red cell distribution width (RDW) values were found to be higher in healthy controls than those using AEDs (p&amp;lt;0.001). When the groups using ASDs were compared among themselves, it was found that the WBC values of the users of old- generation ASDs as PHT and CBZ were significantly lower than those using PGB (p=0.006; P=0.005, respectively). Conclusion: As hematological side effects, ASDs may decrease WBC counts. The WBC decreasing effects of PHT and CBZ, which are older generation antiepileptics, are more pronounced than pregabalin, which is a new- generation antiepileptic drug. The effects of antiepileptic drugs on hemogram parameters of the patients should be taken into consideration while choosing appropriate ASDs and also while following the patient.

Prognostic value of red cell distribution width-to-platelet ratio in mortality of major burn in Sanglah Hospital Bali

Introduction: The mortality rate in Sanglah Hospital due to major burns is quite high. The ratio of red cell distribution width (RDW) and platelet (PLT) (RPR) as a prognostic marker of mortality in major burns has never been studied in Indonesia. Calculations of RPR are easy, widely available and cost-efficient.Method: This study was retrospective observational case-control, with 60 patients with major burns consisting of 30 cases and 30 controls. Samples were taken from the Sanglah Hospital Medical Record Unit from April 2019 to April 2021. Cases were samples with mortality after day seven, while controls were samples that survived. RDW and PLT value on day seven are associated with the incidence of mortality.Results: The mean of RPR in the case group was higher than in the control group. RPR mean of the control group was 0.0559, and the case group was 0.0947 (p&lt;0.001). The increase of RPR in the case group was 40.97%. Statistical analysis showed that high RPR was a significant mortality risk factor in patients with major burns (OR = 21.36; p &lt; 0.001).Conclusion: High RPR is a prognostic marker of mortality in major burns at Sanglah Hospital.

Association of red blood cell distribution width with post-operative new-onset atrial fibrillation following cardiac valve replacement surgery: a retrospective study

Purpose The aim of this study was to evaluate the impact of preoperative red blood cell distribution width (RDW) values on the risk of post-operative new-onset atrial fibrillation (PNAF) during hospitalization following cardiac valve replacement surgery. Materials and methods The clinical data of 148 patients with preoperative sinus rhythm who underwent cardiac valve replacement surgery at The First Affiliated Hospital of Anhui Medical University from September 2017 to June 2018 were retrospectively analysed. Univariate and multivariate logistic regression analyses were used to determine the relationship between preoperative RDW values and the development of PNAF. Results Forty-nine of the 148 patients (33.1%) developed PNAF. The median preoperative RDW was 13.1 (12.6–17.2), while the median RDW value was significantly higher in patients with PNAF than in those without PNAF [14.1 (13.2–15.0) vs. 12.9 (12.4–13.5), p < 0.001]. Multivariate logistic regression analysis showed that preoperative RDW values were significantly correlated with the occurrence of PNAF (odds ratio: 1.940, 95% confidence interval: 1.377–2.731, p < 0.001). Conclusions Preoperative RDW is an independent risk factor for PNAF during hospitalization following cardiac valve replacement surgery. This finding suggests that preoperative RDW measurement may be used to stratify the risk for PNAF development in patients undergoing cardiac surgery.

English

BACKGROUND The World Health Organization defined stroke as a "neurological deficit of cerebrovascular cause that persists beyond 24 hours or is interrupted by death within 24 hours". Stroke is one among the leading causes of death and disability in developed as well as developing countries. The red cell distribution width (RDW) is a numeric estimation of the erythrocyte size within the bloodstream. Elevated RDW has been proven to have a predisposing factor in the development of vascular thrombosis and therefore it is an instigator of cerebrovascular diseases. In this study, we intended to evaluate the relationship between RDW values with stroke severity and prognosis in patients in comparison with a healthy control group. METHODS This was an observational cross-sectional study conducted at Kanyakumari Govt Medical College, between June 2021 and December 2021. 150 patients with acute stroke were included in the study along with 150 age-matched controls. Red cell distribution width (RDW) was measured for cases as well as controls. Data were statistically analyzed using GraphPad Prism 8 software. RESULTS Red cell distribution width was positively associated with the occurrence of stroke, particularly ischemic stroke. It was not significantly associated with the occurrence of hemorrhagic stroke. CONCLUSIONS Thus red cell distribution width is a simple, cost-effective, easily attainable novel inflammatory marker that may help in detecting the severity and prognosis of acute ischemic stroke. It can be obtained even at primary health setups and may be used for decision making in the urgent referral of the patient for a better outcome. This study completely supported the routine calculation of this parameter that could add to risk stratification of patients with acute ischemic stroke. It was not significantly associated with the occurrence of hemorrhagic stroke. KEY WORDS RDW, Acute Ischemic Stroke, Cerebrovascular Accident.