|
1
|
Hong E, Jeong Y, An J, Choi S, Chung J, Ahn J. Relationship Between Red Blood Cell Indices and Myxomatous Mitral Valve Disease in Small-Breed Dogs: A Retrospective Study. Vet Med Sci 2025; 11:e70284. [PMID: 40013620 PMCID: PMC11866307 DOI: 10.1002/vms3.70284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 11/04/2024] [Accepted: 02/17/2025] [Indexed: 02/28/2025] Open
Abstract
BACKGROUND Red blood cell (RBC) indices provide information on the size and haemoglobin content of erythrocytes. The RBC distribution width (RDW) is an index of size variability of the circulating RBC population. The correlation between various diseases and RDW in dogs has been demonstrated. Some studies have evaluated RDW in dogs with myxomatous mitral valve disease (MMVD), and conflicting results have been reported. OBJECTIVES We aimed to evaluate the association between RBC indices, complete blood cell counts (CBC), and serum biochemical and echocardiographic variables in small-breed dogs with MMVD. METHODS RBC indices, CBC, and serum biochemical and echocardiographic variables were retrospectively investigated in 102 client-owned dogs with MMVD at various disease stages. RESULTS RBC indices were not statistically significant among groups (control group, compensated group, decompensated group). RDW had a significant positive correlation with haematocrit (Hct) (correlation coefficient, 0.452) and a negative correlation with MCH (correlation coefficient, -0.498) and MCV (correlation coefficient, -0.357). The end-diastolic volume index, fractional shortening (%), and left atrial-anteroposterior diameter normalised for body weight were echocardiographic variables that affected MMVD severity. CONCLUSIONS We observed no correlation between RBC indices and MMVD. However, conflicting results have been reported in several other studies; thus, further studies should be considered.
Collapse
Affiliation(s)
- Eui‐Joo Hong
- Department of Veterinary Internal Medicine and Institute of Veterinary ScienceCollege of Veterinary MedicineKangwon National UniversityChuncheonRepublic of Korea
| | - Yunho Jeong
- Department of Veterinary Internal Medicine and Institute of Veterinary ScienceCollege of Veterinary MedicineKangwon National UniversityChuncheonRepublic of Korea
| | - Ju‐Hyun An
- Department of Veterinary Emergency and Critical Care MedicineCollege of Veterinary MedicineKangwon National UniversityChuncheonRepublic of Korea
| | - Sooyoung Choi
- Department of Veterinary Diagnostic ImagingCollege of Veterinary MedicineKangwon National UniversityChuncheonRepublic of Korea
| | - Jin‐Young Chung
- Department of Veterinary Internal Medicine and Institute of Veterinary ScienceCollege of Veterinary MedicineKangwon National UniversityChuncheonRepublic of Korea
| | - Jin‐Ok Ahn
- Department of Veterinary Internal Medicine and Institute of Veterinary ScienceCollege of Veterinary MedicineKangwon National UniversityChuncheonRepublic of Korea
| |
Collapse
|
|
2
|
Dang HNN, Viet Luong T, Cao MTT, Bui VT, Tran TT, Nguyen HM. Assessing red blood cell distribution width in Vietnamese heart failure patients: A cross-sectional study. PLoS One 2024; 19:e0301319. [PMID: 39042640 PMCID: PMC11265657 DOI: 10.1371/journal.pone.0301319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 07/07/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Heart failure (HF) is becoming a growing public health concern. Diagnostic tests for determining the severity of HF often come with high costs and require specialized expertise, which makes it difficult to assess HF severity, especially in low-income countries or at primary healthcare facilities. Recently, red blood cell distribution width (RDW) has emerged as a promising, easily accessible marker associated with HF severity. The study aimed to assess changes in RDW levels in HF patients and the diagnostic value of RDW in detecting acute heart failure (AHF) among HF patients. METHODS We conducted a cross-sectional examination involving 351 participants divided into HF and non-HF cohorts. HF was defined and categorized according to the diagnostic and treatment guidelines for AHF and chronic heart failure (CHF) set forth by the European Society of Cardiology (2021). Univariate and multivariate analysis of factors associated with AHF was performed. RESULTS The study revealed that HF patients displayed higher median RDW levels (14.90% [13.70-17.00]) compared to non-HF individuals (13.00% [12.23-13.78]). RDW was notably elevated in HF patients with left ventricular ejection fraction < 50% compared to those with left ventricular ejection fraction ≥ 50%. ROC curve analysis of RDW for AHF detection identified a cutoff value of 13.85%, with a sensitivity of 86.05% and specificity of 47.18%, statistically significant at p < 0.001. RDW > 13.85% was identified as an independent risk factor for AHF in patients with HF, with odds ratios of 2.644 (95% CI, 1.190-5.875; p = 0.017). CONCLUSION The study revealed significant RDW variations in patients with CHF and AHF compared to the control group. These findings suggest that RDW could be a biomarker for detecting HF severity.
Collapse
Affiliation(s)
- Hai Nguyen Ngoc Dang
- The Faculty of Medicine, Duy Tan University, Da Nang, Vietnam
- Cardiovascular Center, Hue Central Hospital, Hue, Vietnam
| | - Thang Viet Luong
- University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Mai Thi Thu Cao
- University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Vinh Trung Bui
- University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Thanh Thien Tran
- University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Hung Minh Nguyen
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
| |
Collapse
|
|
3
|
Pang J, Qian LY, Lv P, Che XR. Application of neutrophil-lymphocyte ratio and red blood cell distribution width in diabetes mellitus complicated with heart failure. World J Diabetes 2024; 15:1226-1233. [PMID: 38983818 PMCID: PMC11229955 DOI: 10.4239/wjd.v15.i6.1226] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/04/2024] [Accepted: 04/19/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Accumulating clinical evidence has shown that diabetes mellitus (DM) is a serious risk factor for cardiovascular disorders and an important factor for adverse cardiovascular events. AIM To explore the value of the combined determination of the neutrophil-lymphocyte ratio (NLR) and red blood cell distribution width (RDW) in the early diagnosis and prognosis evaluation of DM complicated with heart failure (HF). METHODS We retrospectively analyzed clinical data on 65 patients with type 2 DM (T2DM) complicated with HF (research group, Res) and 60 concurrent patients with uncomplicated T2DM (control group, Con) diagnosed at Zhejiang Provincial People's Hospital between January 2019 and December 2021. The NLR and RDW values were determined and comparatively analyzed, and their levels in T2DM + HF patients with different cardiac function grades were recorded. The receiver operating characteristic (ROC) curves were plotted to determine the NLR and RDW values (alone and in combination) for the early diagnosis of HF. The correlation between NLR and RDW with the presence or absence of cardiac events was also investigated. RESULTS Higher NLR and RDW levels were identified in the Res vs the Con groups (P < 0.05). The NLR and RDW increased gradually and synchronously with the deterioration of cardiac function in the Res group, with marked differences in their levels among patients with grade II, III, and IV HF (P < 0.05). ROC curve analysis revealed that NLR combined with RDW detection had an area under the curve of 0.915, a sensitivity of 76.9%, and a specificity of 100% for the early diagnosis of HF. Furthermore, HF patients with cardiac events showed higher NLR and RDW values compared with HF patients without cardiac events. CONCLUSION NLR and RDW were useful laboratory indicators for the early diagnosis of DM complicated with HF, and their joint detection was beneficial for improving diagnostic efficiency. Additionally, NLR and RDW values were directly proportional to patient outcomes.
Collapse
Affiliation(s)
- Jie Pang
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People’s Hospital (The Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Lin-Yan Qian
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People’s Hospital (The Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Ping Lv
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People’s Hospital (The Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Xiao-Ru Che
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People’s Hospital (The Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| |
Collapse
|
|
4
|
Zhang MQ, Tan WT, Li WD, Shen XY, Shen Y, Jiang XL, Wen HF. A positive association between RDW and coronary heart disease in the rheumatoid arthritis population: A cross-sectional study from NHANES. Medicine (Baltimore) 2024; 103:e37315. [PMID: 38457585 PMCID: PMC10919533 DOI: 10.1097/md.0000000000037315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 03/10/2024] Open
Abstract
Previous research has indicated that higher red blood cell distribution width (RDW) increases the risk of coronary heart disease. However, no studies have established a link between RDW and coronary heart disease in the rheumatoid arthritis population. This research aims to explore the association between RDW and coronary heart disease among individuals with rheumatoid arthritis. We selected demographic data, laboratory data, lifestyle, and medical history from the National Health and Nutrition Examination Survey (NHANES), specifically including age, gender, poverty, RDW, race, BMI, diabetes, education, coronary heart disease, hypertension, cholesterol, smoking, and drinking. RDW and coronary heart disease were found to have a positive association in the rheumatoid arthritis population (OR = 1.145, 95%CI: 1.036-1.266, P = .0098), even after adjusting for factors such as age, gender, race, education level, smoking, and drinking. Subgroup analysis showed a stronger positive association, particularly in individuals aged 55-66 years, males, and the Hispanic White population with diabetes or hypercholesterolemia. There is a significant correlation between RDW and coronary heart disease among individuals with rheumatoid arthritis.
Collapse
Affiliation(s)
- Mei Qi Zhang
- Department of Emergency, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Wen Tao Tan
- Department of Emergency, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Wei Dong Li
- Department of Emergency, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Xuan Yang Shen
- Department of Emergency, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Yuan Shen
- Department of Emergency, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Xiao Lu Jiang
- Department of Emergency, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Hong Fu Wen
- Department of Emergency, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| |
Collapse
|
|
5
|
Zhang Q, Zhou B, Li X, Cong H. In-hospital changes in the red blood cell distribution width and mortality in critically ill patients with heart failure. ESC Heart Fail 2023; 10:3287-3298. [PMID: 37671738 PMCID: PMC10682898 DOI: 10.1002/ehf2.14513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 06/11/2023] [Accepted: 08/18/2023] [Indexed: 09/07/2023] Open
Abstract
AIMS A high red blood cell distribution width (RDW) at admission or discharge is associated with a worse prognosis in hospitalized patients with heart failure (HF), and the prognostic value of the in-hospital change in RDW (∆RDW) remains debatable. METHODS AND RESULTS We included 5514 patients with critical illness and HF from the MIMIC-IV database. The ΔRDW was calculated by the RDW at discharge minus that at admission. Clinical outcomes included all-cause mortality at 90 day, 180 day, and 1 year after discharge. The median age of the patients was 73.91 years, and 46.37% were women. Kaplan-Meier curve and Cox regression analyses were used to examine the association between the ΔRDW and all-cause mortality at different time points. A multivariable Cox proportional hazard model showed that the ΔRDW (per 1% increase) was independently associated with all-cause mortality at 90 day, 180 day, and 1 year after adjusting for confounding factors (hazard ratio [HR] = 1.17, 95% confidence interval [CI] = 1.13-1.21, P < 0.001; HR = 1.17, 95% CI = 1.14-1.20, P < 0.001; and HR = 1.18, 95% CI = 1.15-1.20, P < 0.001, respectively). Restricted cubic splines showed a non-linear relationship between the ΔRDW and the risk of clinical outcomes. High ΔRDW was associated with a high risk of mortality at different time points. A subgroup analysis showed that this positive association remained consistent in pre-specified subgroups. CONCLUSIONS Our study suggests that an increased RDW during hospitalization is independently associated with short- or long-term all-cause mortality in critical-ill patients with HF.
Collapse
Affiliation(s)
- Qi Zhang
- Department of CardiologyTianjin Chest HospitalTianjinChina
| | - Bingyang Zhou
- Department of CardiologyTianjin Chest HospitalTianjinChina
| | - Ximing Li
- Department of CardiologyTianjin Chest HospitalTianjinChina
- Tianjin Medical UniversityTianjinChina
- Tianjin UniversityTianjinChina
| | - Hongliang Cong
- Department of CardiologyTianjin Chest HospitalTianjinChina
- Tianjin Medical UniversityTianjinChina
- Tianjin UniversityTianjinChina
| |
Collapse
|
|
6
|
Ferreira AI, Silva JE, Melo N, Oliveira D, Silva C, Lume M, Pereira J, Almeida J, Araújo JP, Lourenço P. Prognostic impact of red blood cell distribution width in chronic heart failure patients with left ventricular dysfunction. J Cardiovasc Med (Hagerstown) 2023; 24:746-751. [PMID: 37642949 DOI: 10.2459/jcm.0000000000001543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
AIMS Red blood cell (RBC) distribution width (RDW) measures RBC variations in size. Higher RDW values have been associated with poor outcome in acute heart failure (HF). We aimed to assess the prognostic impact of the RDW in chronic HF. METHODS We retrospectively analysed a cohort of chronic HF patients with left ventricular systolic dysfunction followed in our HF clinic between January 2012 and May 2018. Patients with missing data concerning RDW were excluded. Patients were categorized according to RDW tertiles: ≤13.5%; between 13.5 and 14.7%; and >14.7%. Patients were followed until January 2021; all-cause mortality was the end point analysed. The association of RDW with all-cause mortality was assessed with a Cox-regression analysis. Two multivariate models were built. RESULTS We studied 860 chronic HF patients, 66.4% males, mean age 70 (standard deviation, SD 13) years. Patients were followed for a median of 49 (29-82) months. During this period, 423 (49.2%) patients died. Mortality increased with increasing RDW tertiles. Patients with RDW >14.7% had a HR of mortality of 1.95 (1.47-2.58), p < 0.001 (model 1) and of 1.81 (1.35-2.41), p < 0.001 (model 2) when compared with those with RDW ≤13.5. Patients in the second RDW tertile had an all-cause death HR of 1.47 (1.12-1.93) and of 1.44 (1.09-1.90) in models 1 and 2, respectively. CONCLUSIONS Chronic HF patients with RDW values >14.7% presented an almost 2-fold higher risk of dying in the long term than those with RDW <13.5%. RDW is a widely available and easily measured parameter that can help clinicians in the risk stratification of chronic HF patients.
Collapse
Affiliation(s)
| | - João Enes Silva
- Internal Medicine Department, Centro Hospitalar Universitário de São João
| | - Nuno Melo
- Internal Medicine Department, Centro Hospitalar Universitário de São João
| | - Diana Oliveira
- Internal Medicine Department, Centro Hospitalar Universitário de São João
| | - Clara Silva
- Internal Medicine Department, Centro Hospitalar Universitário de São João
| | - Maria Lume
- Internal Medicine Department, Centro Hospitalar Universitário de São João
| | - Joana Pereira
- Internal Medicine Department, Centro Hospitalar Universitário de São João
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Jorge Almeida
- Internal Medicine Department, Centro Hospitalar Universitário de São João
| | - José Paulo Araújo
- Internal Medicine Department, Centro Hospitalar Universitário de São João
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Patrícia Lourenço
- Internal Medicine Department, Centro Hospitalar Universitário de São João
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| |
Collapse
|
|
7
|
Özdemir S, Özkan A. RDW and pro-BNP in predicting short-term mortality in geriatric patients presenting to the emergency department with acute decompensated heart failure. EMERGENCY CARE JOURNAL 2022. [DOI: 10.4081/ecj.2022.10747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
To reveal the ability of Red cell Distribution Width (RDW) to predict short-term mortality in geriatric patients presenting to the emergency department with acute heart failure and compare the results with pro B-type Natriuretic Peptide (pro-BNP). This prospective cohort study was conducted to evaluate the data of patients admitted to the emergency department between August 15th, 2021, and November 15th, 2021. The study population enrolled volunteers aged 65 years and over, who presented with acute heart failure signs and symptoms. Demographics, vital parameters, and laboratory parameters were noted. A total of 424 patients were included in the study. The 30 day-mortality rate of the study cohort was 14.4%. Older age, active malignancy, RDW, C-reactive protein, blood urea nitrogen, and pro-BNP were early independent predictors of short-term mortality. pro-BNP was a better predictor than RDW with a greater area under the curve value (0.841 versus 0.752, p=0.045, DeLong equality test). The created multivariate regression model was able to detect the risk of shortterm mortality with high accuracy (area under the curve: 0.943, accuracy: 0.936, sensitivity: 98.1, specificity: 67.2, p<0.001). Initial RDW and pro-BNP were significantly higher in the mortality group among the geriatric patients with acute decompensated heart failure presenting to the emergency department, and pro- BNP was found to be a better predictor of mortality than RDW. RDW presents as a promising hematological marker that aids in the prognosticating short-term mortality in this patient population.
Collapse
|
|
8
|
Red Blood Cell Distribution Width in Heart Failure: Pathophysiology, Prognostic Role, Controversies and Dilemmas. J Clin Med 2022; 11:jcm11071951. [PMID: 35407558 PMCID: PMC8999162 DOI: 10.3390/jcm11071951] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/26/2022] [Accepted: 03/30/2022] [Indexed: 12/12/2022] Open
Abstract
Red blood cell distribution width (RDW), an integral parameter of the complete blood count (CBC), has been traditionally used for the classification of several types of anemia. However, over the last decade RDW has been associated with outcome in patients with several cardiovascular diseases including heart failure. The role of RDW in acute, chronic and advanced heart failure is the focus of the present work. Several pathophysiological mechanisms of RDW’s increase in heart failure have been proposed (i.e., inflammation, oxidative stress, adrenergic stimulation, undernutrition, ineffective erythropoiesis, reduced iron mobilization, etc.); however, the exact mechanism remains unknown. Although high RDW values at admission and discharge have been associated with adverse prognosis in hospitalized heart failure patients, the prognostic role of in-hospital RDW changes (ΔRDW) remains debatable. RDW has been incorporated in recent heart failure prognostic models. Utilizing RDW as a treatment target in heart failure may be a promising area of research.
Collapse
|
|
9
|
Red Cell Distribution Width Has a Negative Prognostic Role in Dogs with Myxomatous Mitral Valve Disease. Animals (Basel) 2021; 11:ani11030778. [PMID: 33799710 PMCID: PMC7998152 DOI: 10.3390/ani11030778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/04/2021] [Accepted: 03/06/2021] [Indexed: 12/05/2022] Open
Abstract
Simple Summary The red cell distribution width (RDW) is a simple and inexpensive laboratory parameter that reflects the difference in size of the red blood cells (also known as anisocytosis) and is conventionally used in a clinical setting for the differential diagnosis of anemias. Nonetheless, recent studies have demonstrated that anisocytosis is commonplace in many non-hematological human disorders and an increased RDW has been associated with a negative prognosis in patients with different cardiovascular diseases. In dogs, no studies have evaluated the prognostic role of RDW with myxomatous mitral valve disease (MMVD). The present study evaluates clinical, echocardiographic, and laboratory parameters, including RDW, with a cohort of dogs with MMVD and followed up on for more than one year. We sought to evaluate if RDW acts as an independent prognostic marker for negative outcomes in dogs with MMVD with or without concurrent non-cardiac diseases. Abstract Red cell distribution width (RDW) is a quantitative measurement of anisocytosis. This hematological parameter is an important prognostic biomarker for different cardiovascular disorders in humans but its influence on survival has been poorly investigated in dogs with cardiovascular disease. The RDW and various clinical, complete blood count, serum biochemical and echocardiographic variables were retrospectively investigated in 146 client-owned dogs with myxomatous mitral valve disease (MMVD) at various disease stages, with or without concurrent diseases and treatment. Laboratory variables, including RDW, urea, and white blood cell (WBC), in addition to the echocardiographic variable left atrium to aorta ratio were found to be independent predictors of all-cause mortality at six months in a multivariable Cox proportional hazards regression model. In particular, the hazard ratio of RDW was 1.203 (95% confidence interval = 1.045–1.384; p = 0.010). The negative effect of increased RDW on outcome was confirmed using Kaplan–Meier curve analysis. The results of this study indicate that RDW acted as an independent predictor of negative outcome in dogs with MMVD.
Collapse
|
|
10
|
Hammons L, Filopei J, Steiger D, Bondarsky E. A narrative review of red blood cell distribution width as a marker for pulmonary embolism. J Thromb Thrombolysis 2020; 48:638-647. [PMID: 31228037 DOI: 10.1007/s11239-019-01906-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Red blood cell distribution width (RDW) is a marker of variability in red blood cell size, and is routinely reported as part of a patient's complete blood count. RDW has been shown to be associated with the prediction, severity and prognosis of pulmonary embolism (PE) in recent studies. The underlying biomolecular mechanism of the relationship of RDW to PE is largely unknown, but is thought to be due to the relationship of RDW with acute inflammatory markers and variations in blood viscosity. This review substantiates that a high RDW level, defined using either an arbitrary number or according to receiver operator curve statistics, is associated with a higher risk of acute PE, increased severity (massive vs. submassive) of PE and increased mortality in patients with PE. Nevertheless, the comparison of current studies is limited due to the definition of high RDW (each study uses a different RDW cutoff level), the broad range of exclusion criteria and the inclusion of differing modalities used to diagnose a PE (computed tomography angiogram, ventilation-perfusion study, or clinical diagnosis). Despite the above limitations, these studies provide a promising future clinical use for RDW as a marker of PE.
Collapse
Affiliation(s)
- Lindsay Hammons
- Department of Internal Medicine, Mount Sinai Beth Israel, New York City, USA.
| | - Jason Filopei
- Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai Beth Israel, New York City, USA
| | - David Steiger
- Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai Beth Israel, New York City, USA
| | - Eric Bondarsky
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University, New York City, USA
| |
Collapse
|
|
11
|
Parizadeh SM, Jafarzadeh-Esfehani R, Bahreyni A, Ghandehari M, Shafiee M, Rahmani F, Parizadeh MR, Seifi S, Ghayour-Mobarhan M, Ferns GA, Avan A, Hassanian SM. The diagnostic and prognostic value of red cell distribution width in cardiovascular disease; current status and prospective. Biofactors 2019; 45:507-516. [PMID: 31145514 DOI: 10.1002/biof.1518] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/30/2019] [Indexed: 12/11/2022]
Abstract
The red blood cell distribution width (RDW) is an index of the heterogeneity of circulating red blood cell size, which along with other standard complete blood count (CBC) parameters are used to identify hematological system diseases. Besides hematological disorders, several clinical studies have shown that an increased in the RDW may be associated with other diseases including acute pancreatitis, chronic kidney disease, gastrointestinal disorders, cancer, and of special interest in this review, cardiovascular disease (CVD). The diagnostic and prognostic value of RDW in different CVD (acute coronary syndrome, ischemic cerebrovascular disease, peripheral artery disease, atrial fibrillation, heart failure, and acute ischemic stroke) has been reviewed in this article, to provide an understanding how its measurement may be applied to improve the management of these conditions.
Collapse
Affiliation(s)
- Seyed M Parizadeh
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Jafarzadeh-Esfehani
- Department of Medical Genetics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amirhossein Bahreyni
- Department of Clinical Biochemistry and Immunogenetic Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
| | - Maryam Ghandehari
- Student Research Committee, Faculty of Medicine, Islamic Azad University, Mashhad, Iran
| | - Mojtaba Shafiee
- Student Research Committee, Faculty of Medicine, Islamic Azad University, Mashhad, Iran
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farzad Rahmani
- Department of Medical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammar R Parizadeh
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Medical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sima Seifi
- Department of Medical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Ghayour-Mobarhan
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Modern Sciences and Technologies, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gordon A Ferns
- Brighton & Sussex Medical School, Division of Medical Education, Brighton, Sussex, UK
| | - Amir Avan
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Modern Sciences and Technologies, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed M Hassanian
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Medical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
|
12
|
Lechiancole A, Sponga S, Vendramin I, Valdi G, Ferrara V, Nalli C, Tursi V, Livi U. Red blood distribution width and heart transplantation: any predictive role on patient outcome? J Cardiovasc Med (Hagerstown) 2018; 20:145-151. [PMID: 30575600 DOI: 10.2459/jcm.0000000000000747] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Red blood cell distribution width (RDW) has been emerging as a strong predictor of mortality among patients with cardiovascular disease. The aim of this study was to verify if RDW is able to predict survival after heart transplantation (HTx). METHODS Two hundred and eighteen recipients who underwent HTx between 2000 and 2013 were classified into three groups according to the pre-HTx RDW tertile values (14.6 and 16.4%), and their outcomes were compared. Mean follow-up was 6.6 ± 4.2 years. RESULTS RDW correlated with other markers of chronic pathological conditions, such as the Index for Mortality Prediction after Cardiac Transplantation (IMPACT) score (P = 0.002) and Charlson Comorbidity Index (P < 0.001), and with creatinine levels (P = 0.007), previous cardiac surgery (P < 0.001), diabetes mellitus (P = 0.02), haemoglobin value (P = 0.004), pulmonary capillary wedge and central venous pressures (P = 0.019 and 0.01, respectively), systolic and mean pulmonary artery pressures (P = 0.002 and 0.014, respectively). The rate of 30-day mortality from the lowest to the highest RDW tertile was 1.4, 4 and 9% (P = 0.02), respectively.Long-term mortality correlated at multivariate analysis with recipient age [hazard ratio 1.06, 95% confidence interval (95% CI) 1.02-1.09], donor age (hazard ratio 1.02, 95% CI 1.0-1.04) and RDW (hazard ratio 1.13, 95% CI 1.04-1.23). The survival probability at 4, 8 and 12 years was 90, 84 and 74% for recipients with RDW less than 14.6%, while it was 72, 60 and 42% for recipients with RDW more than 16.4% (hazard ratio 3.29, 95% CI 1.74-6.24). No differences were found between causes of death. CONCLUSION RDW correlated with survival in HTx recipients. This marker of blood cell size may represent a surrogate of disease and a helpful tool in the risk-assessment process.
Collapse
|
|
13
|
Targoński R, Sadowski J, Starek-Stelmaszczyk M, Targoński R, Rynkiewicz A. Prognostic significance of red cell distribution width and its relation to increased pulmonary pressure and inflammation in acute heart failure. Cardiol J 2018; 27:394-403. [PMID: 30234900 DOI: 10.5603/cj.a2018.0103] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 09/11/2018] [Accepted: 06/10/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Red cell distribution width (RDW) in acute heart failure (AHF) is accepted as a prognostic indicator with unclear pathophysiological ties. The aim of this study was to evaluate the prognostic value of RDW in AHF patients in relation to clinical and echocardiographic data. METHODS 170 patients with AHF were retrospectively studied. All patients had laboratory testing and an echocardiogram performed within 24 h of admission to the Cardiology Department. RESULTS During the mean 193 ± 111 days of follow-up, 33 patients died. More advanced age, high RDW and low peak early diastolic velocity of the lateral mitral annulus (MVe') were independent predictors of all-cause mortality with hazard ratios of: 1.05 (95% CI 1.02-1.09), p < 0.005, 1.40 (95% CI 1.22-1.60), p < 0.001, and 0.77 (95% CI 0.63-0.93), p < 0.007, respectively. In a stepwise multiple linear regression model, RDW was correlated with hemoglobin concentration (standardized b = -0.233, p < 0.001), mean corpuscular volum (standardized b = -0.230, p < 0.001), mean corpuscular hemoglobin concentration (standardized b = -0.207, p < 0.007), the natural logarithm of C-reactive protein (CRP) (standardized b = 0.184, p < 0.004) and tricuspid regurgitation peak gradient (TRPG) values (standardized b = 0.179, p < 0.006), whereas MVe' was correlated with atrial fibrillation (standardized b = 0.269, p < 0.001). CONCLUSIONS The present data demonstrates a novel relation between higher levels of RDW and elevated TRPG and high sensitivity CRP values in patients with AHF. These findings suggest that RDW, the most important mortality predictor, is independently associated with elevated pulmonary pressure and systemic inflammation in patients with AHF. Moreover, in AHF patients, more advanced age and decreased MVe' are also independently associated with total mortality risk.
Collapse
Affiliation(s)
- Ryszard Targoński
- Department of Cardiology, University of Warmia and Mazury in Olsztyn, Oczapowskiego 2, 10-900 Olsztyn, Poland.
| | - Janusz Sadowski
- Department of Cardiology, University of Warmia and Mazury in Olsztyn, Oczapowskiego 2, 10-900 Olsztyn, Poland
| | | | | | - Andrzej Rynkiewicz
- Department of Cardiology, University of Warmia and Mazury in Olsztyn, Oczapowskiego 2, 10-900 Olsztyn, Poland
| |
Collapse
|
|
14
|
Ćatić J, Jurin I, Lucijanić M, Jerkić H, Blažeković R. High red cell distribution width at the time of ST segment elevation myocardial infarction is better at predicting diastolic than systolic left ventricular dysfunction: A single-center prospective cohort study. Medicine (Baltimore) 2018; 97:e0601. [PMID: 29718862 PMCID: PMC6393031 DOI: 10.1097/md.0000000000010601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Multiple studies have demonstrated the association of red cell distribution width (RDW) with the ultrasound parameters of both systolic and diastolic heart dysfunction. We aimed to further investigate the clinical associations of RDW in the setting of ST-elevation myocardial infarction (STEMI) and to comparatively evaluate its predictive properties regarding systolic and diastolic dysfunction.A total of 89 patients with STEMI were prospectively analyzed. RDW was obtained at the time of STEMI and compared to the parameters of systolic and diastolic dysfunction obtained by transthoracic heart ultrasound on the 5th through 7th day post-STEMI.The median RDW was 13.9%, and among other factors, RDW was significantly associated with older age (P < .001), arterial hypertension (P = .017), hyperlipoproteinemia 2, nonsmoking (P = .027), increased thrombolysis in myocardial infarction score (P = .004), and multivessel disease (P = .007). A higher RDW was observed in patients with parameters that indicated systolic and diastolic dysfunction (ejection fraction of the left ventricle < 50% [P = .009], early/late diastolic filling wave ratio [E/A] < 1 [P = .001], ratio of peak early transmitral velocity and early diastolic annular velocity [E/E'] >10 [P < .001], and combined E/A < 1 and E/E' > 10 [P < .001]). The best discriminatory properties were observed for combined E/A < 1 and E/E' > 10. RDW remained significantly associated with the aforementioned parameters in a series of multivariate regression models.Elevated RDW is significantly associated with the parameters of systolic and diastolic dysfunction even after adjusting for several confounding factors in the setting of STEMI and subsequent percutaneous coronary intervention. RDW seems to be better at discriminating patients with diastolic rather than systolic dysfunction.
Collapse
Affiliation(s)
- Jasmina Ćatić
- Department of Cardiology, Clinical Hospital “Dubrava”, Zagreb
- Faculty of Medicine, “J.J. Strossmayer” University of Osijek, Osijek
| | - Ivana Jurin
- Department of Cardiology, Clinical Hospital “Dubrava”, Zagreb
| | | | - Helena Jerkić
- Department of Cardiology, Clinical Hospital “Merkur”
| | - Robert Blažeković
- Faculty of Medicine, “J.J. Strossmayer” University of Osijek, Osijek
- Department of Cardiac and Transplant Surgery, Clinical Hospital “Dubrava”, Zagreb, Croatia
| |
Collapse
|
|
15
|
Wang J, Yan X, Yang Y, Chang H, Jia B, Zhao XA, Chen G, Xia J, Liu Y, Chen Y, Wang G, Wang L, Zhang Z, Ding W, Huang R, Wu C. A novel predictive model using routinely clinical parameters to predict liver fibrosis in patients with chronic hepatitis B. Oncotarget 2017; 8:59257-59267. [PMID: 28938634 PMCID: PMC5601730 DOI: 10.18632/oncotarget.19501] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/28/2017] [Indexed: 12/19/2022] Open
Abstract
Objectives Noninvasive models have been established for the assessment of liver fibrosis in patients with chronic hepatitis B(CHB). However, the predictive performance of these established models remains inconclusive. We aimed to develop a novel predictive model for liver fibrosis in CHB based on routinely clinical parameters. Results Platelets(PLT), the standard deviation of red blood cell distribution width(RDW-SD), alkaline phosphatase(ALP) and globulin were independent predictors of significant fibrosis by multivariable analysis. Based on these parameters, a new predictive model namely APRG(ALP/PLT/RDW-SD/globulin) was proposed. The areas under the receiver-operating characteristic curves(AUROCs) of APRG index in predicting significant fibrosis(≥F2), advanced fibrosis(≥F3) and liver cirrhosis(≥F4) were 0.757(95%CI 0.699 to 0.816), 0.763(95%CI 0.711 to 0.816) and 0.781(95%CI 0.728 to 0.835), respectively. The AUROCs of the APRG were significantly higher than that of aspartate transaminase(AST) to PLT ratio index(APRI), RDW to PLT ratio(RPR) and AST to alanine aminotransferase ratio(AAR) to predict significant fibrosis, advanced fibrosis and cirrhosis. The AUROCs of the APRG were also significantly higher than fibrosis-4 score (FIB-4) (0.723, 95%CI 0.663 to 0.783) for cirrhosis(P=0.034) and better than gamma-glutamyl transpeptidase(GGT) to PLT ratio(GPR) (0.657, 95%CI 0.590 to 0.724) for significant fibrosis(P=0.001). Materials and Methods 308 CHB patients who underwent liver biopsy were enrolled. The diagnostic values of the APRG for liver fibrosis with other noninvasive models were compared. Conclusions The APRG has a better diagnostic value than conventionally predictive models to assess liver fibrosis in CHB patients. The application of APRG may reduce the need for liver biopsy in CHB patients in clinical practice.
Collapse
Affiliation(s)
- Jian Wang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaomin Yan
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yue Yang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Haiyan Chang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Bei Jia
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Xiang-An Zhao
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Guangmei Chen
- Department of Infectious Diseases, Affiliated Hospital of Nanjing, University of Traditional Chinese Medicine, Nanjing, Jiangsu, China
| | - Juan Xia
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yong Liu
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yuxin Chen
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Guiyang Wang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Li Wang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Zhaoping Zhang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Weimao Ding
- Department of Hepatology, Huai'an No. 4 People's Hospital, Huai'an, Jiangsu, China
| | - Rui Huang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Chao Wu
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China.,Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| |
Collapse
|
|
16
|
Brief Report: Elevated Red Cell Distribution Width Identifies Elevated Cardiovascular Disease Risk in Patients With HIV Infection. J Acquir Immune Defic Syndr 2017; 74:298-302. [PMID: 27828877 DOI: 10.1097/qai.0000000000001231] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Red cell distribution width (RDW) is linked to cardiovascular risk in the general population, an association that might be driven by inflammation. Whether this relationship holds for patients with HIV infection has not been previously studied. Using a large clinical registry, we show that elevated RDW (>14.5%) is independently associated with increased risk of coronary artery disease {odds ratio [OR] 1.39 [95% confidence interval (CI): 1.25 to 1.55]}, peripheral vascular disease [OR 1.41 (95% CI: 1.29 to 1.53)], myocardial infarction [1.43 (95% CI: 1.25 to 1.63)], heart failure [OR 2.23 (95% CI: 1.99 to 2.49)], and atrial fibrillation [OR 1.96 (95% CI: 1.64 to 2.33)]. In conclusion, in the context of the inflammatory milieu that accompanies HIV infection, RDW remains a powerful marker of cardiovascular disease.
Collapse
|
|
17
|
Roderick KV, Abelson AL, Nielsen L, Price LL, Quinn R. Evaluation of red blood cell distribution width as a prognostic indicator in cats with acquired heart disease, with and without congestive heart failure. J Feline Med Surg 2017; 19:648-656. [PMID: 27225272 PMCID: PMC11128818 DOI: 10.1177/1098612x16649988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives Congestive heart failure secondary to cardiomyopathy is a common manifestation of cardiac disease in cats, carrying a variable prognosis. The objective of this retrospective study was to evaluate the relationship between red blood cell distribution width (RDW) and survival time in feline patients with acquired heart disease with and without congestive heart failure (CHF). Methods Three hundred and forty-nine client-owned cats with echocardiograms and complete blood count, including RDW measurement, performed between March 2006 and December 2011, were included in the study. Patient characteristics, including signalment, hematocrit, RDW, echocardiographic parameters and survival, were recorded. Comparisons between RDW in cats with asymptomatic acquired heart disease and those with CHF were made. Survival was documented and compared at 30 days and 6 months. Results CHF was present in 80 cats and absent in 269 cats. Cats with CHF had an increase in mortality compared with cats without CHF at 30 days and 6 months ( P = 0.007 and P = 0.04, respectively). RDW was not significantly associated with survival in cats with or without CHF at 30 days or 6 months. A significant difference was found between median RDW values in cats with CHF vs cats without CHF (16.3% vs 15.8%; P = 0.02). The median RDW value was significantly higher in cats with unclassified cardiomyopathy compared with cats with other types of cardiomyopathy (16.3% vs 15.8%; P = 0.03). Conclusions and relevance Single RDW values did not predict mortality in cats with acquired heart disease but may be useful in determining if cats have decompensated heart disease and CHF. Human studies indicate that incremental increases in serial RDW measurements are associated with decreased survival; serial RDW measurements in cats may be an area of future study.
Collapse
Affiliation(s)
- Kursten V Roderick
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, USA
- Angell Animal Medical Center, MA, USA
| | - Amanda L Abelson
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, USA
| | | | - Lori Lyn Price
- The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, MA, USA
- Tufts Clinical and Translational Science Institute, Tufts University, MA, USA
| | | |
Collapse
|
|
18
|
Senthong V, Hudec T, Neale S, Wu Y, Hazen SL, Tang WHW. Relation of Red Cell Distribution Width to Left Ventricular End-Diastolic Pressure and Mortality in Patients With and Without Heart Failure. Am J Cardiol 2017; 119:1421-1427. [PMID: 28285713 DOI: 10.1016/j.amjcard.2017.01.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/05/2017] [Accepted: 01/05/2017] [Indexed: 01/06/2023]
Abstract
Higher red cell distribution width (RDW) has been associated with poor prognosis in patients with heart failure (HF). RDW is also closely associated with iron deficiency. However, the mechanism underlying this association is unclear. The relation between left ventricular end-diastolic pressure (LVEDP) and RDW has not been studied, especially in those without HF. We examined the relation between LVEDP and RDW in 1,084 consecutive stable patients who underwent elective coronary angiography. We observed that 38% had high LVEDP (>16 mm Hg) and 29% had history of HF. The median RDW was 13.4%, which was higher with increasing LVEDP (p <0.0001) and significantly higher in patients with HF (p <0.0001). Baseline RDW were independently associated with high LVEDP even after multivariable logistic regression analysis (adjusted odds ratio [OR] per unit change 1.14, 95% confidence interval [CI] 1.0 to 1.29, p = 0.044). Interestingly, result were stronger in non-HF cohort (adjusted OR per unit change 1.37, 95% CI 1.13 to 1.67, p = 0.001). In addition, elevated (third vs first tertiles) RDW levels were independently a predictor of high LVEDP and were associated with a 4.8-fold increased 5-year mortality risk (adjusted hazard ratio 4.11, 95% CI 2.12 to 7.96, p <0.0001), even with the addition of B-type natriuretic peptide to the model (adjusted OR for LVEDP 2.25, 95% CI 1.0 to 5.05, p = 0.05; adjusted hazard ratio for mortality 3.79, 95% CI 1.033 to 13.89, p = 0.044, respectively). In conclusion, high RDW levels were observed in patients with or without HF and independently associated with high LVEDP and with mortality.
Collapse
Affiliation(s)
- Vichai Senthong
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Ohio; Queen Sirikit Heart Center of the Northeast, Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand
| | - Timothy Hudec
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Ohio
| | - Sarah Neale
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Yuping Wu
- Department of Mathematics, Cleveland State University, Cleveland, Ohio
| | - Stanley L Hazen
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Ohio; Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Ohio; Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.
| |
Collapse
|
|
19
|
Akgedik R, Karamanli H, Kurt AB, Günaydın ZY. Usefulness of admission red blood cell distribution width as a predictor of severity of acute pulmonary embolism. CLINICAL RESPIRATORY JOURNAL 2017; 12:786-794. [PMID: 27925452 DOI: 10.1111/crj.12595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 11/10/2016] [Accepted: 11/23/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Previous researches have represented a considerable relation between acute pulmonary embolism (PE) and red blood cell distribution width (RDW). To the authors' knowledge no research has been informed in subjects with PE severity. Pulmonary arterial obstruction index (PAOI) is associated with the severity of acute PE. OBJECTIVES In our investigation, we purposed to assess the relation between PAOI and RDW and the benefit of these factors in the detection of PE severity. METHODS We retrospectively investigated the demographic information, probability of clinical scores, laboratory parameters, serum D-dimer levels, and echocardiographic findings of systolic pulmonary artery pressure (PAP) in Acute PE individuals who were diagnosed by computed tomography of pulmonary arterial angiography. Right ventricular dysfunction (RVD) on CT was assessed by calculating the right ventricular/left ventricular (RV/LV) diameter ratios on transverse (RV/LVtrans). RESULTS The information of 131 patients with acute PE and 51 (64.6%) female and 28 (35.4%) male healthy control were evaluated. Acute PE group's RDW values were higher than control subjects (P < .0001). RDW (%) level was remarkable higher in patients with massive PE than in patients with nonmassive PE. There were statistically considerable differences in terms of PAOI and systolic pulmonary arterial pressure (sPAP) between nonmassive and massive PE patients (P < .0001 for all). CONCLUSIONS PAOI was correlated with PE severity, D-dimer level, sPAP and clinical probability scores. PAOI was correlated with RDW levels. RDW levels, an inexpensive and easily measurable laboratory factor, were considerable associated with the severity and presence of PE.
Collapse
Affiliation(s)
- Recep Akgedik
- Department of Chest Diseases, Faculty of Medicine, Ordu University, Ordu, Turkey
| | - Harun Karamanli
- Department of Chest Diseases, Ataturk Chest Diseases and Chest Surgery Education and Research State Hospital, Ankara, Turkey
| | - Ali Bekir Kurt
- Department of Radiology, Faculty of Medicine, Ordu University, Ordu, Turkey
| | | |
Collapse
|
|
20
|
Bozorgi A, Mehrabi Nasab E, Khoshnevis M, Dogmehchi E, Hamze G, Goodarzynejad H. Red Cell Distribution Width and Severe Left Ventricular Dysfunction in Ischemic Heart Failure. Crit Pathw Cardiol 2016; 15:174-178. [PMID: 27846011 DOI: 10.1097/hpc.0000000000000094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The red cell distribution width (RDW), a simple and widely available marker, has been linked with an increased risk of adverse outcomes in patients with heart failure (HF) and risk of death, and cardiovascular events in those with previous myocardial infarction, but its relation with the severity of left ventricular (LV) dysfunction is not fully investigated. The aim of this study was to assess the prognostic value of the RDW in post myocardial infarction patients with typical signs and symptoms of HF and with reduced LV ejection fraction (EF). METHODS Patients (n = 350) came from an ongoing registry of consecutive patients who admitted for ischemic heart disease at our center. All patients were followed up 1 year after the initial hospitalization by telephone interviews. The outcomes studied were mortality and hospitalization because of decompensated HF. RESULTS RDW-coefficient of variation (express in percentage) was calculated from SD of mean corpuscular volume and mean corpuscular volume itself. Using logistic regression analysis, 3 variables consisting age, RDW level, and hemoglobin were identified as independent predictors of severe LV dysfunction (LVEF <30%). Levels of RDW were associated with the presence of severe LV dysfunction, with an accuracy of 61.4% (95% confidence interval: 56.2%-66.4%) and 66.9% (95% confidence interval: 61.8%-71.6%), using cut-off values of higher than 13.5 and 13.8, respectively. CONCLUSION Our results suggest that elevated RDW may be used as a prognostic tool among HF patients with the documented myocardial infarction because it is an inexpensive, rapidly calculated test that is already routinely in use in practice.
Collapse
Affiliation(s)
- Ali Bozorgi
- From the *Department of Electrophysiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran; †Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran; ‡Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran; §Department of Emergency Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran; and ¶Department of Clinical and Basic Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | | | | |
Collapse
|
|
21
|
Nishiyama Y, Niiyama H, Harada H, Katou A, Yoshida N, Ikeda H. Effect of Exercise Training on Red Blood Cell Distribution Width as a Marker of Impaired Exercise Tolerance in Patients With Coronary Artery Disease. Int Heart J 2016; 57:553-7. [PMID: 27581674 DOI: 10.1536/ihj.16-015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Red blood cell distribution width (RDW) can predict mortality in cardiovascular disease. However, the underlying mechanisms of the beneficial prognostic marker remain unknown. The purpose of this study was to investigate whether the RDW is related to impaired exercise tolerance and exercise training (ET) effect on RDW in patients with coronary artery disease (CAD).Seventy-eight patients who underwent ET by supervised bicycle ergometer during 3 weeks served as the ET group whereas 30 patients who did not undergo ET were the control group. Exercise stress test with cardiopulmonary analysis was performed in the ET group. Peak oxygen uptake (from 14.1 ± 4.0 to 15.1 ± 3.8 mL/kg/minute, P < 0.05) significantly increased in the ET group. Although RDW and serum erythropoietin concentration (EP) before the observation period did not differ between the ET and control groups, RDW (from 44.4 ± 4.7 to 43.4 ± 3.8 fL, P < 0.01) and EP (from 27.9 ± 15.8 to 22.9 ± 8.2 mIU/mL, P < 0.005) significantly decreased in the ET group, however, these parameters did not change in the control group. In the ET group, RDW was negatively correlated with peak oxygen uptake (r = -0.55, P < 0.01) and the changes in RDW before and after ET were positively correlated with the changes in EP (r = 0.39, P < 0.005).Thus, ET increases exercise tolerance and decreases RDW in association with increased oxygen uptake in patients with CAD.
Collapse
|
|
22
|
Yılmaz N, Yılmaz M. The Relationship of Vitamin B12 Deficiency and Red Cell Distribution Width-Platelet Ratio. JOURNAL OF CLINICAL AND EXPERIMENTAL INVESTIGATIONS 2016. [DOI: 10.5799/jcei.328604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
|
23
|
Bozorgi A, Khaki S, Mortazavi SH, Sadeghian S, Khoshnevis M, Tofighi S, Khaki A. Effect of Baseline Red Blood Cell Distribution Width on Short- and Intermediate-term Mortality of Patients Under Primary Percutaneous Coronary Intervention: A Survival Analysis. Crit Pathw Cardiol 2016; 15:69-74. [PMID: 27183257 DOI: 10.1097/hpc.0000000000000063] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Considering the limited studies specifically evaluating the role of Red blood cell distribution width (RDW) in primary percutaneous coronary intervention (PCI), we aimed to investigate the role of baseline RDW in short- and intermediate-term cardiovascular events in ST-elevation myocardial infarction patients under primary PCI. METHODS This is a historical cohort registry analysis of 1161 patients with ST-elevation myocardial infarction under primary PCI. According to inclusion criteria, 838 patients were allocated for analysis. Patients with RDW levels of 13.6% or higher were considered as high RDW group (third tertile). All the individuals were followed up for in-hospital and 6-month mortality along with readmission and composite major adverse cardiac events. RESULTS In-hospital deaths occurred in 53 (6.3%) patients and at 6-month follow-up 79 (9.4%) cases of mortality were documented. In-hospital and 6-month mortalities showed a significant trend in favor of high RDW group (13.3% vs. 5.9%, P = 0.003; 19.7% vs. 7.9%, P < 0.001, respectively). Multivariate analysis showed that high RDW was significantly and independently associated with higher rates of 6-month mortality (hazard ratio: 2.909; 95% confidence interval: 1.166-7.257; P = 0.022). RDW was also a significant predictor for 6-month mortality independent of anemia (hazard ratio: 2.811; 95% confidence interval: 1.047-7.551; P = 0.040). CONCLUSIONS We found a significant association between high RDW and in-hospital and 6-month mortality as well as the occurrence of major adverse cardiac event. Meanwhile RDW was found to be a significant predictor for 6-month mortality independent of anemia. Thus, it would be beneficial to use RDW as a risk stratification index to identify high risk intent-to-treat patients.
Collapse
Affiliation(s)
- Ali Bozorgi
- From the *Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran; and †School of medicine, Hamedan University of Medical Sciences, Hamedan, Iran
| | | | | | | | | | | | | |
Collapse
|
|
24
|
Guglielmini C, Poser H, Pria AD, Drigo M, Mazzotta E, Berlanda M, Luciani A. Red blood cell distribution width in dogs with chronic degenerative valvular disease. J Am Vet Med Assoc 2016; 243:858-62. [PMID: 24004234 DOI: 10.2460/javma.243.6.858] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate RBC distribution width (RDW) in dogs with chronic degenerative valvular disease (CDVD) with compensated or decompensated heart failure. DESIGN Retrospective case-control study. ANIMALS 27 healthy dogs and 135 dogs with CDVD (87 dogs with compensated heart failure and 48 dogs with decompensated heart failure). PROCEDURES The RDW and various CBC and serum biochemical variables were compared among groups. Correlations between RDW and various echocardiographic variables were evaluated. RESULTS Mean ± SD RDW in dogs with CDVD (13.1% ± 1.0%) was not significantly different from that of healthy dogs (12.8% ± 0.8%). The RDW of dogs with CDVD and compensated heart failure (13.0% ± 1.0%) was not significantly different from that of dogs with CDVD and decompensated heart failure (13.2% ± 1.1%). The RDW had a significant, weak, negative correlation with Hct (correlation coefficient, -0.250), hemoglobin concentration (correlation coefficient, -0.219), and mean corpuscular volume (correlation coefficient, -0.211). The RDW had a significant, weak, positive correlation with 1 echocardiographic index of CDVD severity (ie, the left atrium-to-aorta ratio [correlation coefficient, 0.183]). CONCLUSIONS AND CLINICAL RELEVANCE In this study population, RDW did not seem to be associated with the presence of heart failure or CDVD.
Collapse
Affiliation(s)
- Carlo Guglielmini
- Department of Veterinary Clinical Sciences, University of Teramo, Italy.
| | | | | | | | | | | | | |
Collapse
|
|
25
|
Danese E, Lippi G, Montagnana M. Red blood cell distribution width and cardiovascular diseases. J Thorac Dis 2015; 7:E402-11. [PMID: 26623117 DOI: 10.3978/j.issn.2072-1439.2015.10.04] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The red blood cell distribution width (RDW) is a rather simple measure of red blood cell (RBC) size heterogeneity (i.e., anisocytosis), which is easily calculated by dividing the standard deviation (SD) of erythrocyte volumes for the mean corpuscular volume (MCV). Emerging evidence suggests that, besides RBC abnormalities, many human disorders may be frequently associated with a high degree of anisocytosis. METHODS In this narrative review, we analyzed the current scientific literature about the putative role and the potential epidemiologic association between RDW and cardiovascular diseases. The findings of the most representative epidemiological studies were summarized and discussed. RESULTS Overall, considerable and convincing evidence has been brought that an increased RDW value is associated with acute coronary syndrome (ACS) [including acute myocardial infarction (AMI)], ischemic cerebrovascular disease (including stroke), peripheral artery disease (PAD), as well as with atrial fibrillation (AF), heart failure (HF) and hypertension. Higher anisocytosis also significantly and independently predicts adverse outcomes in patients with these conditions. CONCLUSIONS Although the role of anisocytosis in the pathogenesis of cardiovascular diseases remains uncertain, the considerable evidence available so far suggests that the clinical use of RDW may be broadened beyond the conventional boundaries of erythrocyte disorders, in particular for assisting the diagnosis and prognostication of patients with ACS, ischemic cerebrovascular disease, PAD, HF and AF.
Collapse
Affiliation(s)
- Elisa Danese
- Clinical Biochemistry Section, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy
| | - Giuseppe Lippi
- Clinical Biochemistry Section, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy
| | - Martina Montagnana
- Clinical Biochemistry Section, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy
| |
Collapse
|
|
26
|
Pusuroglu H, Cakmak HA, Akgul O, Erturk M, Surgit O, Akkaya E, Bulut U, Yildirim A. The prognostic value of admission red cell distribution width-to-platelet ratio in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.repce.2015.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
|
27
|
Pusuroglu H, Cakmak HA, Akgul O, Erturk M, Surgit O, Akkaya E, Bulut U, Yildirim A. The prognostic value of admission red cell distribution width-to-platelet ratio in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Rev Port Cardiol 2015; 34:597-606. [PMID: 26387826 DOI: 10.1016/j.repc.2015.03.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 03/10/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Red cell distribution width (RDW) is a measure of variation in the size of circulating red blood cells. Recent studies have reported a strong independent relation between elevated RDW and short- and long-term prognosis in various disorders. The aim of the present study was to investigate the relationship between admission RDW-to-platelet ratio (RPR) and in-hospital and long-term prognosis in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). METHODS A total of 470 consecutive patients with a diagnosis of STEMI who underwent primary PCI were included in this prospective study. The patients were divided into two groups based on their admission RPR: high (>0.061) RPR group and low (≤0.061) RPR group. The patients were followed for adverse clinical outcomes in-hospital and for up to one year after discharge. RESULTS In-hospital cardiovascular mortality, major adverse cardiovascular events (MACE), advanced heart failure and cardiogenic shock were significantly higher in the high RPR group (p<0.05). All-cause and cardiovascular mortality, MACE, fatal reinfarction, advanced heart failure, and rehospitalization for cardiac cause were more frequent in the high RPR group in one-year follow-up (p<0.05). High RPR was found to be a significant independent predictor of one-year cardiovascular mortality in multivariate analysis (p=0.003, OR: 3.106, 95% CI: 1.456-6.623). CONCLUSION RPR is an inexpensive and readily available biomarker that provides an additional level of risk stratification beyond that provided by conventional risk parameters in predicting long-term MACE and cardiovascular mortality in STEMI.
Collapse
Affiliation(s)
- Hamdi Pusuroglu
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | | | - Ozgur Akgul
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Mehmet Erturk
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Ozgur Surgit
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Emre Akkaya
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Umit Bulut
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Aydin Yildirim
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| |
Collapse
|
|
28
|
Alattar FT, Imran NB, Patel P, Usmani S, Shamoon FE. Red cell distribution width (RDW) correlates with markers of diastolic dysfunction in patients with impaired left ventricular systolic function. IJC HEART & VASCULATURE 2015; 10:13-16. [PMID: 28616510 PMCID: PMC5441324 DOI: 10.1016/j.ijcha.2015.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 08/06/2015] [Indexed: 11/29/2022]
Abstract
Objective Red-cell distribution width (RDW) has been identified as a novel prognostic marker in a heterogeneous group of heart failure patients. In this group, diastolic dysfunction is associated with worse outcome. As the evidence is limited, the aim of the present study was to assess the relationship of RDW to diastolic markers in patients with left ventricular dysfunction (LVD) diagnosed during cardiac catheterization. Methods Clinical and angiographic data were collected retrospectively on a total of 291 stable patients (mean age 62 years, 199 males) with systolic dysfunction documented during cardiac catheterization in a regional medical center between January 2006 and December 2010. Results Positive association was seen between RDW and Left ventricular end diastolic pressure (LVEDP), estimated systolic pulmonary arterial pressure(sPAP), and left atrial dimension (LAD) (r: 0.18, 0.24, 0.28, respectively; p:<0.05).Three year retrospective survival analysis for 108 patients admitted in the first 2 years showed a statistically significant decrease in survival patients with high RDW(> 14.5) vs. normal RDW (73%vs.88%;log rank p:0.03). This was seen even in the asymptomatic subgroup (71% vs. 94%; log rank p: 0.01). Conclusion RDW correlates with markers of diastolic dysfunction in patients with LVD. Additionally, in patients asymptomatic LVD, high RDW is still associated with lower survival.
Collapse
Affiliation(s)
- Fadi T. Alattar
- Cardiology department, Saint Michael's Medical Center, Newark, NJ, USA
| | - Nashat B. Imran
- Nephrology Division, Internal Medicine Department, Wayne State University, Detroit, Michigan, USA
- Corresponding author.
| | - Pooja Patel
- Internal medicine department, Trinitas Regional Medical Center, Elizabeth, NJ, USA
| | - Saad Usmani
- Internal medicine department, Trinitas Regional Medical Center, Elizabeth, NJ, USA
| | - Fayez E. Shamoon
- Cardiology department, Saint Michael's Medical Center, Newark, NJ, USA
| |
Collapse
|
|
29
|
Oh J, Kang SM, Song MK, Hong N, Youn JC, Han S, Jeon ES, Cho MC, Kim JJ, Yoo BS, Chae SC, Oh BH, Choi DJ, Lee MM, Ryu KH. Clinical benefit of spironolactone in patients with acute decompensated heart failure and severe renal dysfunction: Data from the Korean Heart Failure Registry. Am Heart J 2015; 169:713-720.e3. [PMID: 25965719 DOI: 10.1016/j.ahj.2015.01.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 01/17/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUNDS We investigated the relationship between spironolactone use and all-cause mortality in acute decompensated heart failure (ADHF) patients with severe renal dysfunction. The clinical benefit of spironolactone in the treatment of heart failure (HF) has been described in several large randomized clinical trials. However, its clinical benefits have not been studied in hospitalized ADHF patients with severe renal dysfunction (estimated glomerular filtration rate [eGFR] <45 mL/min per 1.73 m(2)). METHODS AND RESULTS We retrospectively analyzed data from the Korean Heart Failure Registry. We included 1,035 ADHF patients with severe renal dysfunction. In Kaplan-Meier survival analysis, all-cause mortality in the spironolactone-treated group was significantly lower than that in the nonspironolactone group (18.1% vs 24.9%, respectively, log rank P = .028). However, spironolactone use was not an independent predictor after adjusting other HF risk factors (hazard ratio 0.974, 95% CI 0.681-1.392, P = .884) and after propensity score matching (P = .115). In subgroup analysis, the clinical benefit of spironolactone use was preserved in women, prehospital spironolactone use, the chronic kidney disease stage 3b (eGFR 30-44 mL/min per 1.73 m(2)), and the appropriate spironolactone use (eGFR ≥30 mL/min per 1.73 m(2) and K ≤5.0 mmol/L). CONCLUSION The spironolactone therapy was not beneficial in ADHF patients with severe renal dysfunction after multivariable adjusting and propensity score matching. However, we reassured the current HF guidelines for spironolactone use and the clinical benefit in chronic kidney disease stage 3b should be assessed in future clinical trial.
Collapse
Affiliation(s)
- Jaewon Oh
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seok-Min Kang
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Mi Kyung Song
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Namki Hong
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong-Chan Youn
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seongwoo Han
- Cardiology Division, Hallym University Medical Center, Hwaseong, Korea
| | - Eun-Seok Jeon
- Cardiology Division, Sungkyunkwan University Samsung Medical Center, Seoul, Republic of Korea
| | - Myeong-Chan Cho
- Cardiology Division, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Jae-Joong Kim
- Cardiology Division, Ulsan University Asan Medical Center, Seoul, Republic of Korea
| | - Byung-Su Yoo
- Cardiology Division, Yonsei University Wonju Christian Hospital, Wonju, Republic of Korea
| | - Shung Chull Chae
- Cardiology Division, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Byung-Hee Oh
- Cardiology Division, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong-Ju Choi
- Cardiology Division, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Myung-Mook Lee
- Cardiology Division, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Kyu-Hyung Ryu
- Cardiology Division, Hallym University Medical Center, Hwaseong, Korea
| |
Collapse
|
|
30
|
Li W, Li X, Wang M, Ge X, Li F, Huang B, Peng J, Li G, Lu L, Yu Z, Ma J, Xu L, Jin M, Si H, Wan R. Association between red cell distribution width and the risk of heart events in patients with coronary artery disease. Exp Ther Med 2015; 9:1508-1514. [PMID: 25780460 PMCID: PMC4353804 DOI: 10.3892/etm.2015.2244] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 01/13/2015] [Indexed: 01/01/2023] Open
Abstract
Red cell distribution width (RDW) has been found to be a novel prognostic biomarker in patients with coronary artery disease (CAD); however, the association between RDW and the risk of heart events in patients with CAD is yet to be fully elucidated. Thus, the aim of the present study was to determine whether an elevated RDW was associated with the Framingham risk score (FRS) in patients with CAD. Data were retrospectively collected from Affiliated Dongyang Hospital of Wenzhou Medical University (Dongyang, China). The patients had undergone a coronary angiography and their clinical data were integrated. The patients (male, 260; female, 132) were divided into two groups based on the results of the coronary angiography, namely the CAD (n=283) and control groups (n=109). The FRS was calculated for all the subjects, and complete blood count testing with biochemical measurements was performed. The mean RDW level was 13.7±1.8% in the CAD group and 13.1±1.0% in the control group, while the mean FRS was 9.0±4.9 in the CAD group and 6.4±3.9 in the control group. The RDW and FRS were significantly higher in the CAD group compared with the control group (P<0.001). No statistically significant differences were observed between the groups with regard to the hematocrit, mean corpuscular volume, platelets, glucose, urea, albumin, aspartate aminotransferase, total cholesterol, triglycerides (TG), high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and N-terminal pro-brain natriuretic peptide (P>0.05). The RDW was shown to significantly correlate with the red blood cell (RBC) count (r=-0.133, P=0.029), hemoglobin level (r=-0.207, P=0.001) and TG level (r=0.226, P<0.001) within the laboratory parameters, as well as the FRS (r=0.206, P<0.001). In the stepwise multivariate linear regression, which included the RBC count, hemoglobin level, TG level and RDW, the FRS was predicted by hemoglobin (r2=0.034, P=0.001), TG (r2=0.059, P<0.001) and RDW (r2=0.030, P=0.003) parameters. Therefore, a novel association was revealed between higher levels of RDW and an elevated FRS in patients with CAD, which raises the possibility that a simple marker, RDW, may be associated with an increased risk of heart events in CAD patients.
Collapse
Affiliation(s)
- Weimin Li
- Department of Cardiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China
| | - Xiaoting Li
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China
| | - Maofeng Wang
- Department of Clinical Laboratory Medicine, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China
| | - Xuan Ge
- Department of Cardiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China
| | - Feixiang Li
- Department of Cardiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China
| | - Bian Huang
- Department of Cardiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China
| | - Jiren Peng
- Department of Cardiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China
| | - Guohong Li
- Department of Cardiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China
| | - Liang Lu
- Department of Cardiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China
| | - Zhuoyuan Yu
- Department of Cardiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China
| | - Jiaojiao Ma
- Department of Cardiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China
| | - Liaohang Xu
- Department of Cardiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China
| | - Meijuan Jin
- Department of Cardiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China
| | - Hongping Si
- Department of Cardiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China
| | - Rugen Wan
- Department of Clinical Laboratory Medicine, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang 322100, P.R. China
| |
Collapse
|
|
31
|
Salvagno GL, Sanchis-Gomar F, Picanza A, Lippi G. Red blood cell distribution width: A simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci 2014; 52:86-105. [PMID: 25535770 DOI: 10.3109/10408363.2014.992064] [Citation(s) in RCA: 698] [Impact Index Per Article: 63.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The red blood cell distribution width (RDW) is a simple and inexpensive parameter, which reflects the degree of heterogeneity of erythrocyte volume (conventionally known as anisocytosis), and is traditionally used in laboratory hematology for differential diagnosis of anemias. Nonetheless, recent evidence attests that anisocytosis is commonplace in human disorders such as cardiovascular disease, venous thromboembolism, cancer, diabetes, community-acquired pneumonia, chronic obstructive pulmonary disease, liver and kidney failure, as well as in other acute or chronic conditions. Despite some demographic and analytical issues related to the routine assessment that may impair its clinical usefulness, an increased RDW has a high negative predictive value for diagnosing a variety of disorders, but also conveys important information for short- and long-term prognosis. Even more importantly, the value of RDW is now being regarded as a strong and independent risk factor for death in the general population. Although it has not been definitely established whether an increased value of RDW is a risk factor or should only be considered an epiphenomenon of an underlying biological and metabolic imbalance, it seems reasonable to suggest that the assessment of this parameter should be broadened far beyond the differential diagnosis of anemias. An increased RDW mirrors a profound deregulation of erythrocyte homeostasis involving both impaired erythropoiesis and abnormal red blood cell survival, which may be attributed to a variety of underlying metabolic abnormalities such as shortening of telomere length, oxidative stress, inflammation, poor nutritional status, dyslipidemia, hypertension, erythrocyte fragmentation and alteration of erythropoietin function. As such, the aim of this article is to provide general information about RDW and its routine assessment, to review the most relevant implications in health and disease and give some insights about its potential clinical applications.
Collapse
Affiliation(s)
- Gian Luca Salvagno
- Clinical Chemistry Section, Department of Life and Reproductive Sciences, Academic Hospital of Verona , Verona , Italy
| | | | | | | |
Collapse
|
|
32
|
Gromadziński L, Januszko-Giergielewicz B, Pruszczyk P. Red cell distribution width is an independent factor for left ventricular diastolic dysfunction in patients with chronic kidney disease. Clin Exp Nephrol 2014; 19:616-25. [PMID: 25248504 PMCID: PMC4543415 DOI: 10.1007/s10157-014-1033-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 09/15/2014] [Indexed: 01/14/2023]
Abstract
BACKGROUND The increased value of the red cell distribution width (RDW) was reported to indicate poor prognosis in patients with chronic heart failure. We evaluated the value of the RDW in the diagnosis of left ventricular diastolic dysfunction (LVDD) in patients without diastolic heart failure among the chronic kidney disease (CKD) population. METHODS The study group consisted of 73 ambulatory patients with CKD, stages 2-5. Standard echocardiography and tissue Doppler imaging (TDI) were performed, and the level of RDW was determined. Patients were divided into four groups according to the results of peak early diastolic velocity of mitral annulus (EmLV) and the stage of CKD: group with early stage CKD (eGFR > 30 ml/min/1.73 m(2)) without LVDD (EmLV ≥ 8 cm/s), early stage CKD with LVDD (EmLV < 8 cm/s), group with advanced stage CKD (eGFR ≤ 30 ml/min/1.73 m(2)) without LVDD, and group with advanced stage CKD with LVDD. RESULTS Patients with advanced stage CKD with LVDD were characterized by higher RDW levels than patients with advanced stage CKD without LVDD and with early stage CKD groups with and without LVDD [14.5 (13.8-19.5) % vs. 13.7 (11.4-15,4) %, p = 0.049, vs. 13.8(13.1-14.9) %, p = 0.031, vs. 13.7(12.1-16.2) %, p = 0.0007], respectively. The area under the receiver operating characteristic (ROC) curve of RDW level for the detection of LVDD was 0.649, 95 % confidence interval (CI) 0.528-0.758, p = 0.021, whereas ROC derived RDW value of >13.5 % was characterized by a sensitivity of 83.3 % and specificity of 45.2 % for predicting LVDD. The only independent factor of LVDD was RDW level >13.5 % with odds ratio (OR) = 3.92 (95 % CI 1.05-14.56), p = 0.037. CONCLUSION RDW can be used as an additional factor for the diagnosis of LVDD in patients with advanced stage of CKD.
Collapse
Affiliation(s)
- Leszek Gromadziński
- Department of Internal Diseases, Gastroenterology and Hepatology, University Clinical Hospital in Olsztyn, ul. Warszawska 30, 10-082, Olsztyn, Poland,
| | | | | |
Collapse
|
|
33
|
Booth RA, Hill SA, Don-Wauchope A, Santaguida PL, Oremus M, McKelvie R, Balion C, Brown JA, Ali U, Bustamam A, Sohel N, Raina P. Performance of BNP and NT-proBNP for diagnosis of heart failure in primary care patients: a systematic review. Heart Fail Rev 2014; 19:439-51. [PMID: 24969534 DOI: 10.1007/s10741-014-9445-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
National and international guidelines have been published recommending the use of natriuretic peptides as an aid to the diagnosis of heart failure (HF) in acute settings; however, few specific recommendations exist for governing the use of these peptides in primary care populations. To summarize the available data relevant to the diagnosis of HF in primary care patient population, we systematically reviewed the literature to identify original articles that investigated the diagnostic accuracy of B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) in primary care settings. The search yielded 25,864 articles in total: 12 investigating BNP and 20 investigating NT-proBNP were relevant to our objective and included in the review. QUADAS-2 and GRADE were used to assess the quality of the included articles. Diagnostic data were pooled based on three cutpoints: lowest and optimal, as chosen by study authors, and manufacturers' suggested. The effect of various determinants (e.g., age, gender, BMI, and renal function) on diagnostic performance was also investigated. Pooled sensitivity and specificity of BNP and NT-proBNP using the lowest [0.85 (sensitivity) and 0.54 (specificity)], optimal (0.80 and 0.61), and manufacturers' (0.74 and 0.67) cutpoints showed good performance for diagnosing HF. Similar performance was seen for NT-proBNP: lowest (0.90 and 0.50), optimal (0.86 and 0.58), and manufacturers' (0.82 and 0.58) cutpoints. Overall, we rated the strength of evidence as high because further studies will be unlikely to change the estimates diagnostic performance.
Collapse
Affiliation(s)
- Ronald A Booth
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
34
|
Use of BNP and NT-proBNP for the diagnosis of heart failure in the emergency department: a systematic review of the evidence. Heart Fail Rev 2014; 19:421-38. [DOI: 10.1007/s10741-014-9447-6] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
|
35
|
Hong SJ, Youn JC, Oh J, Hong N, Lee HS, Park S, Lee SH, Choi D, Kang SM. Red cell distribution width as an independent predictor of exercise intolerance and ventilatory inefficiency in patients with chronic heart failure. Yonsei Med J 2014; 55:635-43. [PMID: 24719129 PMCID: PMC3990060 DOI: 10.3349/ymj.2014.55.3.635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 10/02/2013] [Accepted: 10/08/2013] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Peak 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 METHODS 85 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. RESULTS For 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. CONCLUSION Higher 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.
Collapse
Affiliation(s)
- Sung-Jin Hong
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jong-Chan Youn
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jaewon Oh
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Namki Hong
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Sun Lee
- Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea
| | - Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Hak Lee
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Seok-Min Kang
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
|
36
|
Braun E, Kheir J, Mashiach T, Naffaa M, Azzam ZS. Is elevated red cell distribution width a prognostic predictor in adult patients with community acquired pneumonia? BMC Infect Dis 2014; 14:129. [PMID: 24597687 PMCID: PMC3973886 DOI: 10.1186/1471-2334-14-129] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 02/25/2014] [Indexed: 11/22/2022] Open
Abstract
Background Community acquired pneumonia (CAP) is a major cause of morbidity and mortality. We recently demonstrated that among young patients (<60 years old) with CAP, elevated red blood cell distribution width (RDW) level on admission was associated with significant higher rates of mortality and severe morbidity. We aimed to investigate the prognostic predictive value of RDW among CAP patients in general population of internal wards. Methods The cohort included patients of 18 years old or older who were diagnosed with CAP (defined as pneumonia identified 48 hours or less from hospitalization) between January 1, 2005 and December 31, 2010. Patients were retrospectively analyzed for risk factors for a primary endpoint of 90-day mortality. Secondary endpoint was defined as complicated hospitalization (defined as at least one of the following: In- hospital mortality, length of stay of at least 10 days or ICU admission). Binary logistic regression analysis was used for the calculation of the odds ratios (OR) and p values in univariate and multivariate analysis to identify association between patient characteristic, 90-day mortality and complicated hospitalization. Results The cohort included 3815 patients. In univariate analysis, patients with co-morbid conditions tended to have a complicated course of CAP. In multivariate regression analysis, variables associated with an increased risk of 90-day mortality included age > 70 years, high Charlson comorbidity index (>2), Hb < 10 mg/dl, Na <130 meq/l, blood urea nitrogen (BUN) >30 mg/dl, systolic blood pressure < 90 mmHg and elevated RDW >15%. Variables associated with complicated hospitalization included high Charlson comorbidity index, BUN > 30 mg/dl, hemoglobin < 10 g/dl, heart rate >124 bpm, systolic blood pressure < 90 mmHg and elevated RDW. Mortality rate and complicated hospitalization were significantly higher among patients with increased RDW regardless of the white blood cell count or hemoglobin levels. Conclusions Elevated RDW levels on admission are associated with significant higher rates of mortality and severe morbidity in adult patients with CAP. RDW as a prognostic marker was unrelated with hemoglobin levels, WBC count, age or Charlson score.
Collapse
Affiliation(s)
- Eyal Braun
- Departments of Medicine H and B, Rambam Health Care Campus, P,O, Box 9602, 31096 Haifa, Israel.
| | | | | | | | | |
Collapse
|
|
37
|
Abul Y, Ozsu S, Korkmaz A, Bulbul Y, Orem A, Ozlu T. Red cell distribution width. Chron Respir Dis 2014; 11:73-81. [DOI: 10.1177/1479972314525057] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The most important long-term complication of pulmonary thromboembolism is chronic thromboembolic pulmonary hypertension (CTEPH) that is associated with considerable morbidity and mortality. It is uncertain why some patients with acute pulmonary embolism (PE) develop CTEPH and others do not. Elevated red cell distribution width (RDW) has been associated with adverse outcomes of heart failure, PE, and idiopathic pulmonary hypertension. The aim of the present study was to investigate whether RDW might be a predictor of CTEPH in PE patients or not. This study is a retrospective cohort study. A total of 203 consecutive patients with acute PE were included. The RDW was higher in the CTEPH patients than the patients without CTEPH (17.04 ± 3.46, 14.64 ± 1.82, respectively, p = 0.015). RDW was also higher in the CTEPH patients at the time of diagnosis of CTEPH during follow-up compared with the baseline RDW level at the time of PE diagnosis (18.63 ± 3.58, 17.02 ± 3.59, respectively, p = 0.014). The optimal cutoff value of the RDW for predicting CTEPH was 14.65. The area under the curve of RDW for the prediction of CTEPH was 0.735 (95% confidence interval (CI): 0.600–0.869); in cases with RDW levels >14.65%, the specificity, sensitivity, and negative predictive value for CTEPH were 62% (95% CI: 0.55–0.69), 75% (95% CI: 0.47–0.92), and 96.7% (95% CI: 0.91–0.99), respectively. A multivariate regression analysis showed that RDW, hazard ratio: 1.58 (95% CI: 1.09–2.30), was a predictor of CTEPH ( p = 0.016). High level of RDW was an independent predictor of CTEPH in PE patients. Therefore, RDW levels may provide a prediction for CTEPH in PE patients.
Collapse
Affiliation(s)
- Yasin Abul
- Department of Pulmonary Medicine, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Savas Ozsu
- Department of Pulmonary Medicine, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Ahmet Korkmaz
- Ministry of Health, Pulmonary Medicine Clinics, Rize State Hospital, Rize, Turkey
| | - Yilmaz Bulbul
- Department of Pulmonary Medicine, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Asim Orem
- Department of Biochemistry, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Tevfik Ozlu
- Department of Pulmonary Medicine, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| |
Collapse
|
|
38
|
Relation between Red Cell Distribution Width and Left Ventricular Function in Children with Heart Failure. ISRN PEDIATRICS 2014; 2014:234835. [PMID: 24660068 PMCID: PMC3934566 DOI: 10.1155/2014/234835] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 01/06/2014] [Indexed: 11/29/2022]
Abstract
Background. Most of the studies done on adults showed that red cell distribution width (RDW) can be used as a prognostic marker in patients with chronic heart failure. However, RDW has not been tested in children with heart failure. Methods and Results. 31 children with heart failure admitted to Cardiology Unit, Tanta University Hospital, during the period of January 2012 to December 2012 were included in this study, RDW as a component of routine blood count was evaluated and correlated to the echocardiographic parameters of left ventricle. The mean age of our cohort was 16.16 ± 14.97 months, congenital heart disease with left-to-right shunt represented 58.1% of the underlying causes of heart failure while dilated cardiomyopathy made 41.9%. The mean hemoglobin level was 9.14 ± 1.18 gm/dL; RDW level ranged from 10.7% to 27.7% with a mean of 16.01 ± 3.34. Hemoglobin was significantly correlated with RDW at any level. For the echo parameters, at cutoff point of 16.4%, RDW was significantly correlated with fraction shortening (FS), and A, E/A ratio, but it was not correlated with LVEDD, LVESD, and E/É at the same cutoff level. Conclusion. RDW, a simple, available test, can be used as a marker for the left ventricular function in children with heart failure until an echocardiography assessment for the patients is done.
Collapse
|
|
39
|
Naffaa M, Makhoul BF, Tobia A, Jarous M, Kaplan M, Aronson D, Saliba W, Azzam ZS. Brain natriuretic peptide at discharge as a predictor of 6-month mortality in acute decompensated heart failure. Am J Emerg Med 2014; 32:44-9. [DOI: 10.1016/j.ajem.2013.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 09/30/2013] [Accepted: 10/01/2013] [Indexed: 11/26/2022] Open
|
|
40
|
Oh J, Kang SM, Hong N, Youn JC, Park S, Lee SH, Choi D. Effect of High-Dose Statin Loading on Biomarkers Related to Inflammation and Renal Injury in Patients Hospitalized With Acute Heart Failure. Circ J 2014; 78:2447-54. [DOI: 10.1253/circj.cj-14-0670] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jaewon Oh
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine
| | - Seok-Min Kang
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine
| | - Namki Hong
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine
| | - Jong-Chan Youn
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine
| | - Sungha Park
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine
| | - Sang-Hak Lee
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine
| | - Donghoon Choi
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine
| |
Collapse
|
|
41
|
Oh J, Kang SM, Hong N, Youn JC, Han S, Jeon ES, Cho MC, Kim JJ, Yoo BS, Chae SC, Oh BH, Choi DJ, Lee MM, Ryu KH. Hemoconcentration is a good prognostic predictor for clinical outcomes in acute heart failure: data from the Korean Heart Failure (KorHF) Registry. Int J Cardiol 2013; 168:4739-43. [PMID: 23958420 DOI: 10.1016/j.ijcard.2013.07.241] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 07/17/2013] [Accepted: 07/25/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hemoconcentration is a surrogate marker of effective decongestion and diuresis therapy. Recently, hemoconcentration has been associated with decreased mortality and rehospitalization in heart failure (HF) patients. However, the prognostic power of hemoconcentration in a large sample-sized HF cohort was limited until now. METHODS AND RESULTS We analyzed data from hospitalized patients with acute heart failure (AHF) that were enrolled in the Korean Heart Failure Registry(n=2,357). The primary end point was a composite of all-cause mortality and HF rehospitalization during the follow-up period (median=347, interquartile range=78-744 days).Hemoconcentration, defined as an increased hemoglobin level between admission and discharge, was presented in 1,016 AHF patients (43.1%). In multivariable logistic regression, hemoglobin, total cholesterol, and serum glucose levels at admission, and ischemic HF, were significant determinants for hemoconcentration occurrence. The Kaplan-Meier curve showed that event-free survival was significantly higher in the hemoconcentration group compared to the non-hemoconcentration group (65.1% vs. 58.1%, log rank p<0.001). In multiple Cox proportional hazard analysis, hemoconcentration was an independent predictor of the primary end point after adjusting for other HF risk factors (hazard ratio=0.671, 95% confidence interval=0.564-0.798, p<0.001). CONCLUSIONS Hemoconcentration during hospitalization was a prognostic marker of fewer clinical events in the AHF cohort. Therefore, this novel surrogate marker will help in the risk stratification of AHF patients.
Collapse
Affiliation(s)
- Jaewon Oh
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Seoul, Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
42
|
Holmström A, Sigurjonsdottir R, Hammarsten O, Gustafsson D, Petzold M, Fu MLX. Red blood cell distribution width and its relation to cardiac function and biomarkers in a prospective hospital cohort referred for echocardiography. Eur J Intern Med 2012; 23:604-9. [PMID: 22939804 DOI: 10.1016/j.ejim.2012.05.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 04/10/2012] [Accepted: 05/06/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Red blood cell distribution width (RDW), a measure of anisocytosis, is a prognostic biomarker for heart failure (HF). However it is still unclear how RDW is associated with heart function and established cardiac biomarkers. METHODS AND RESULTS In a prospective hospital cohort of 296 patients referred for echocardiography because of suspected HF, blood sampling and clinical examination were performed within 24h after echocardiography. The patients were divided into four HF groups, including one group where the HF diagnosis was uncertain (gray zone). In the patients the mean age was 70 ± 11 years, 44% with systolic HF (SHF), 18% with heart failure with normal ejection fraction (HFNEF), 17% with gray zone and 21% without HF (non-HF). RDW was higher among patients with SHF and HFNEF, compared with gray zone and non-HF patients. The distribution of different variables over the RDW quartiles showed an inverse correlation between RDW levels and LVEF and a positive correlation between RDW and NT-proBNP levels. Further analysis with stepwise multiple linear regression demonstrated that NT-proBNP levels, but not LVEF, were independently correlated with RDW. CONCLUSION In patients referred for echocardiography because of suspected HF, RDW levels were higher in patients with SHF and HFNEF. Moreover, NT-proBNP levels were independently linked with elevated RDW.
Collapse
Affiliation(s)
- Alexandra Holmström
- Dept of Clinical and Molecular Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | | | | | | | | |
Collapse
|
|
43
|
Kim J, Kim K, Lee JH, Jo YH, Rhee JE, Kim TY, Kang KW, Kim YJ, Hwang SS, Jang HY. Red blood cell distribution width as an independent predictor of all-cause mortality in out of hospital cardiac arrest. Resuscitation 2012; 83:1248-52. [DOI: 10.1016/j.resuscitation.2012.01.038] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 01/25/2012] [Accepted: 01/29/2012] [Indexed: 11/29/2022]
|
|
44
|
Makhoul BF, Khourieh A, Kaplan M, Bahouth F, Aronson D, Azzam ZS. Relation between changes in red cell distribution width and clinical outcomes in acute decompensated heart failure. Int J Cardiol 2012; 167:1412-6. [PMID: 22560496 DOI: 10.1016/j.ijcard.2012.04.065] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Revised: 03/29/2012] [Accepted: 04/08/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Increased red blood cell distribution (RDW) has been associated with adverse outcomes in patients with heart failure. We studied the association between baseline RDW and changes in RDW during hospital course with clinical outcomes in acute decompensated heart failure (ADHF) patients. METHODS AND RESULTS We prospectively studied 614 patients with ADHF. Baseline RDW and RDW change during hospital course were determined. The relationship between RDW and clinical outcomes after hospital discharge was tested using Cox regression models, adjusting for clinical characteristics, echocardiographic findings and brain natriuretic peptide levels. During follow up (1 year), 286 patients (46.6%) died and 84 were readmitted for ADHF (13.7%). Median RDW was significantly higher among patients who died compared to patients who survived (15.6% interquartile range [14.5 to 17.1] vs. 14.9% mg/L interquartile range [14.1 to 16.1], P<0.0001). Compared with patients in the 1st RDW quartile, the adjusted hazard ratio [HR] for death or rehospitalization was 1.9 [95% CI 1.3-2.6] in patients in the 4th quartile. Changes in RDW during hospitalization were strongly associated with changes in mortality risk. Compared with patients with persistent normal RDW (<14.5%), the adjusted HR for mortality was 1.9 [95% CI 1.1-3.1] for patients in whom RDW increased above 14.5% during hospital course, similar to patients with persistent elevation of RDW (HR was 1.7, 95% CI 1.2-2.3). CONCLUSION In patients hospitalized with ADHF, RDW is a strong independent predictor of greater morbidity and mortality. An increase in RDW during hospitalization also portends adverse clinical outcome.
Collapse
Affiliation(s)
- Badira F Makhoul
- Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel
| | | | | | | | | | | |
Collapse
|
|
45
|
Hong N, Oh J, Kang SM, Kim SY, Won H, Youn JC, Park S, Jang Y, Chung N. Red blood cell distribution width predicts early mortality in patients with acute dyspnea. Clin Chim Acta 2012; 413:992-7. [PMID: 22406179 DOI: 10.1016/j.cca.2012.02.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Revised: 02/02/2012] [Accepted: 02/21/2012] [Indexed: 01/08/2023]
Abstract
BACKGROUND Red blood cell distribution width (RDW) has been shown to predict clinical outcomes in cardiovascular diseases. We studied whether RDW is useful to predict early mortality in patients with acute dyspnea at an emergency department (ED). METHODS We retrospectively analyzed 907 patients with acute dyspnea who visited the ED from January 2009 to May 2009. Primary outcome was 30-day mortality. RESULTS Acute decompensated heart failure (29.9%) was the most common adjudicated discharge diagnosis followed by cancer (14.8%) and pneumonia (12.5%). There was a stepwise increase of 30-day mortality risk from lowest (RDW<12.9%) to highest (RDW>14.3%) RDW tertiles (1.4% vs. 8.3% vs. 18.3%; log-rank P<0.001). In multivariate Cox hazard analysis, RDW was an independent predictor of 30-day mortality after adjusting for other risk factors (HR 1.23; 95% CI 1.11-1.36; P<0.001). Adding RDW to conventional clinical predictors significantly improved prediction for 30-day mortality as measured by the area under the ROC curve (AUC, from 0.873 to 0.885; P=0.023) and the net reclassification improvement (NRI=14.1%; P<0.001)/integrated discrimination improvement (IDI=0.038; P=0.006). CONCLUSIONS Our findings suggest that RDW measured at ED is an independent and additive predictor of early mortality in patients with acute dyspnea.
Collapse
Affiliation(s)
- Namki Hong
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Seoul, Republic of Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
|
46
|
Celik A, Koc F, Kadi H, Ceyhan K, Erkorkmaz U, Burucu T, Karayakali M, Onalan O. Relationship between red cell distribution width and echocardiographic parameters in patients with diastolic heart failure. Kaohsiung J Med Sci 2012; 28:165-72. [DOI: 10.1016/j.kjms.2011.06.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 03/29/2011] [Indexed: 11/26/2022] Open
|
|
47
|
Zorlu A, Bektasoglu G, Kukul Guven FM, Dogan OT, Gucuk E, Refiker Ege M, Altay H, Cınar Z, Tandogan I, Yilmaz MB. Usefulness of admission red cell distribution width as a predictor of early mortality in patients with acute pulmonary embolism. Am J Cardiol 2012; 109:128-34. [PMID: 21958741 DOI: 10.1016/j.amjcard.2011.08.015] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 08/04/2011] [Accepted: 08/04/2011] [Indexed: 10/17/2022]
Abstract
Red cell distribution width (RDW) is strongly associated with prognosis in cardiopulmonary disorders such as coronary artery disease, acute myocardial infarction, acute and chronic heart failure, and pulmonary hypertension. However, its prognostic significance in acute pulmonary embolism (PE) is unknown. The aim of this study was to investigate the relation between admission RDW and early mortality in patients with acute PE. One hundred sixty-five patients with confirmed acute PE were included. Patients with previous treatment for anemia, malignancy, or chronic liver disease, those with dialysis treatment for chronic renal failure, and those who received erythrocyte suspension for any reason were excluded. A total of 136 consecutive patients with acute PE were evaluated prospectively. According to receiver-operating characteristic curve analysis, the optimal cut-off value of RDW to predict early mortality was >14.6%, with 95.2% sensitivity and 53% specificity. Patients were categorized prospectively as having unchanged (group 1) or increased (group 2) RDW on the basis of a cut-off value of 14.6%. The mean age of patients was 63 ± 15 years. The mean follow-up duration was 11 ± 7 days, and 21 patients died. Among these 21 patients, 1 (1.6%) was in group 1 and 20 (27%) were in group 2 (p <0.001). Increased RDW >14.6% on admission, age, presence of shock, heart rate, oxygen saturation, and creatinine level were found to have prognostic significance in univariate Cox proportional-hazards analysis. Only increased RDW >14.6% on admission (hazard ratio 15.465, p = 0.012) and the presence of shock (hazard ratio 9.354, p <0.001) remained associated with increased risk for acute PE-related early mortality in a multivariate Cox proportional-hazards model. In conclusion, high RDW was associated with worse hemodynamic parameters, and RDW seems to aid in the risk stratification of patients with acute PE.
Collapse
|
|
48
|
Oh J, Kang SM, Won H, Hong N, Kim SY, Park S, Lee SH, Jang Y, Chung N. Prognostic Value of Change in Red Cell Distribution Width 1 Month After Discharge in Acute Decompensated Heart Failure Patients. Circ J 2012; 76:109-16. [DOI: 10.1253/circj.cj-11-0664] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jaewon Oh
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine
| | - Seok-Min Kang
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine
- Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine
| | - Hoyoun Won
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine
| | - Namki Hong
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine
| | - Soo-Young Kim
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine
| | - Sungha Park
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine
| | - Sang-Hak Lee
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine
| | - Yangsoo Jang
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine
- Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine
| | - Namsik Chung
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine
- Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine
| |
Collapse
|
|
49
|
Elevated red cell distribution width predicts poor outcome in young patients with community acquired pneumonia. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:R194. [PMID: 21835005 PMCID: PMC3387636 DOI: 10.1186/cc10355] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2011] [Revised: 06/29/2011] [Accepted: 08/11/2011] [Indexed: 12/11/2022]
Abstract
Introduction Community acquired pneumonia (CAP) is a major cause of morbidity and mortality. While there is much data about risk factors for severe outcome in the general population, there is less focus on younger group of patients. Therefore, we aimed to detect simple prognostic factors for severe morbidity and mortality in young patients with CAP. Methods Patients of 60 years old or younger, who were diagnosed with CAP (defined as pneumonia identified 48 hours or less from hospitalization) between March 1, 2005 and December 31, 2008 were retrospectively analyzed for risk factors for complicated hospitalization and 90-day mortality. Results The cohort included 637 patients. 90-day mortality rate was 6.6% and the median length of stay was 5 days. In univariate analysis, male patients and those with co-morbid conditions tended to have complicated disease. In multivariate analysis, variables associated with complicated hospitalization included post chest radiation state, prior neurologic damage, blood urea nitrogen (BUN) > 10.7 mmol/L and red cell distribution width (RDW) > 14.5%; whereas, variables associated with an increased risk of 90-day mortality included age ≥ 51 years, prior neurologic damage, immunosuppression, and the combination of abnormal white blood cells (WBC) and elevated RDW. Complicated hospitalization and mortality rate were significantly higher among patients with increased RDW regardless of the white blood cell count. Elevated RDW was associated with a significant increase in complicated hospitalization and 90-day mortality rates irrespective to hemoglobin levels. Conclusions In young patients with CAP, elevated RDW levels are associated with significantly higher rates of mortality and severe morbidity. RDW as a prognostic marker was unrelated with hemoglobin levels. Trial registration ClinicalTrials.Gov NCT00845312
Collapse
|
|
50
|
Means RT. Free and Easy? Red Cell Distribution Width (RDW) and Prognosis in Cardiac Disease. J Card Fail 2011; 17:299-300. [DOI: 10.1016/j.cardfail.2011.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Indexed: 12/24/2022]
|