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Resumen Objetivo: Evaluar la capacidad del ancho de distribución eritrocitaria (ADE) para predecir la mortalidad en niños sometidos a cirugía cardiovascular en la Fundación Hospital Infantil Napoleón Franco Pareja, en Colombia. Método: Estudio analítico de corte transversal retrospectivo que incluyó 45 individuos de 0 a 17 años operados de cardiopatía congénita. Se aplicaron la escala RACHS-1 (Risk Adjustment in Congenital Heart Surgery) y variables de laboratorio, incluyendo el ADE. La asociación entre el ADE y la mortalidad se determinó mediante análisis por curva ROC y correlación rho de Spearman. Resultados: Un ADE superior al 15.52% representó 1.6 veces más riesgo, comparado con los individuos por debajo de ese valor (intervalo de confianza del 95%: 1.01-2.6; p = 0.034). Los valores del ADE no se correlacionaron con los días de estancia hospitalaria ni con las complicaciones. El ADE prequirúrgico y el puntaje RACHS-1 fueron significativamente mayores en el grupo de mortalidad. La relación entre el ADE prequirúrgico y el puntaje RACHS-1 fue significativa. Conclusiones: En nuestro estudio, el ADE prequirúrgico presentó un poder moderado para discriminar la mortalidad perioperatoria en la corrección quirúrgica de cardiopatías congénitas. Se precisan más estudios con mayor tamaño de muestra.
Abstract Objective: To evaluate the capacity of red cell distribution width (RDW) to predict mortality in children undergoing cardiovascular surgery at the Fundación Hospital Infantil Napoleón Franco Pareja, in Colombia. Method: Retrospective cross-sectional analytical study that included 45 individuals aged 0 to 17 years operated for congenital heart disease. The RACHS-1 (Risk Adjustment in Congenital Heart Surgery) scale and laboratory variables including the RDW were applied. The association between RDW and mortality was determined by ROC curve analysis and Spearman's rho correlation. Results: An RDW greater than 15.52% represented 1.6 times more risk, compared to individuals below that value (95% confidence interval: 1.01-2.6; p = 0.034). The RDW values did not correlate with days of hospital stay or complications. The preoperative RDW and RACHS-1 score were significantly higher in the mortality group. The relationship between presurgical RDW and the RACHS-1 score was significant. Conclusions: In our study, the preoperative RDW had moderate power to discriminate perioperative mortality in the surgical correction of congenital heart disease. More studies with a larger sample size are required.
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Objective:To explore the relationship between the standard deviation of red blood cell distribution width (RDW-SD), neutrophil/lymphocyte value (NLR), fibrinogen (FIB) and the prognosis of multiple myeloma (MM) patients and their predictive value.Methods:In this study, a retrospective study method was used to select 120 patients with MM who were initially diagnosed in the department of hematology of the Affiliated Hospital of Jining Medical College from January 2017 to October 2019. The follow-up time was 24 months, including 62 patients who survived (survival group) and 58 patients who died (death group). The RDW-SD, NLR and FIB values of the two groups were compared, and the value of the three indicators in predicting the follow-up outcome of MM patients was analyzed using the receiver operating characteristic (ROC) curve. Logistic regression model was used to analyze the related factors affecting the prognosis of MM patients.Results:Among 120 newly treated MM patients, the RDW-SD, NLR and FIB of the survival group were significantly lower than those of the death group (all P<0.05); The sensitivity, specificity and area under ROC curve (AUC) of RDW-SD+ NLR+ FIB in predicting adverse outcomes of MM patients were 88.96%, 84.50% and 0.919 respectively. Logistic multivariate regression analysis showed that ≥60 years old, International Staging System (ISS) Ⅲ, β2-microglobulin (β2-MG)≥3 500 ng/ml, increased RDW-SD, NLR, and FIB will increase the risk of poor prognosis in MM patients (all P<0.05). Conclusions:The RDW-SD, NLR and FIB have a close relationship with the poor prognosis of newly treated MM patients, and the combined application has certain value in predicting the prognosis of patients.
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ABSTRACT BACKGROUND: Red blood cell distribution width (RDW) is related to sepsis-related mortality. Hemophagocytic lymphohistiocytosis (HLH) is a syndrome caused by severe infection, tumors, or autoimmunity without a specific diagnosis. OBJECTIVE: To explore the correlation between RDW and mortality in patients with HLH. DESIGN AND SETTING: A retrospective study conducted in a hospital in China. METHODS: A total of 101 inpatients with HLH from January 1, 2017 to December 31, 2021 were divided into non-survivor (n = 52) and survivor (n = 49) groups. A non-parametric test was used to analyze demographic, clinical, and laboratory data between groups. Independent variables with P < 0.05 were analyzed using binary logistic regression to screen out mortality-related variables. Selected variables were subjected to multivariate logistic regression analysis, and those with strong correlations were screened. Receiver operating characteristic (ROC) curves of strongly correlated variables and area under curve (AUC) values were obtained. RESULTS: The APACHE II score, RDW, and platelet (PLT) and fibrinogen (FIB) levels (P < 0.05) different significantly. RDW, PLT, FIB were correlated with mortality. The AUC values of RDW, PLT, and FIB were 0.857, 0.797, and 0.726, respectively. RDW was associated with mortality in patients with HLH (P < 0.01, cut-off value: 16.9). The sensitivity and specificity of predicting mortality were 97.96% and 96.1%, respectively. CONCLUSION: Logistic regression analysis showed a correlation between RDW and patients' mortality. Therefore, RDW can be used to predict mortality in patients with HLH.
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Objective:To study the relationship between red blood cell distribution width(RDW)and short-term mortality in elderly patients with hip fragility fractures.Methods:The clinical data and blood routine test at admission of 205 elderly patients with brittle hip fractures who were admitted to our hospital from 2020 to 2021 and were followed up for one year were retrospectively analyzed.The comorbid conditions, RDW and cumulative mortality at 6 months and 1 year after fractures were counted, and the relationship between RDW and short-term mortality were analyzed.Results:The 6-month(6.7% and 20.8%, χ2=8.591, P=0.003)and 1-year(6.7% and 26.7%, χ2=14.818, P<0.001)mortality of patients with ≤1 comorbidity were significantly lower than those of patients with ≥2 comorbidities.Moreover, the 6-month and 1-year mortality in patients with RDW>13.5% were significantly higher than those of patients with RDW ≤ 13.5%.The proportion of RDW>13.5 % in patients with at least two comorbidities was significantly higher than that in patients with ≤1 comorbidity.Taking RDW=13.6% as the cut-off value of 6-month and 1-year mortality, the sensitivity and specificity for predicting 6-month mortality were 71.4 % and 59.9 %, respectively, and the sensitivity and specificity for predicting 1-year mortality were 64.7 % and 59.6 %, respectively. Conclusions:Red cell distribution width is associated with short-term mortality, and higher RDW is associated with a higher risk of mortality among elderly patients with brittle hip fractures.
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Objective:To identify the clinical characteristics and adverse events of patients with giant cell arteritis (GCA).Methods:Patients who were hospitalized and diagnosed with GCA in Zhongshan Hospital, Fudan University, from December 2009 to November 2020 were enrolled into a retrospective study analysis. Baseline data and follow-up data were collected. Adverse events were defined as one of the following events: relapses, ischemic complications and death. Patients with adverse events were analyzed in clinical features and risk factors by univariate and multivariate analysis. Associations with adverse events were assessed using ROC curve and survival curves.Results:A total of 69 patients with GCA were included in this study, with the male: female ratio of 1∶1.03. Fatigue and headache were common symptoms. Finally, 61 patients were followed up at the end of May in 2021. Over the mean follow-up time of (35±20) months, adverse events occurred in 16 cases (26.2%). Patients with adverse events had significantly lower levels of platelet and globulin at baseline than those without adverse events [(325±142)×10 9/L vs (238±112)×10 9/L, t=2.22, P=0.030]; [(31±6) g/L vs (26±6) g/L, t=2.74, P=0.008]. Red cell volume distribution width-coefficient of variation (RDW-CV) was considered an independent risk factor for adverse events [ OR (95% CI)=0.32 (0.14,0.74), P=0.008]. Further, patients especially with RDW-CV<14.75% were prone to have adverse events, which occurred in 2.6%, 20.5%, 25.6%, 33.3%, 41.00% in 1, 2, 3, 5, 10 years. Its risk increased significantly after 2 years ( P=0.042, P=0.021, P=0.002, P=0.001). The incidence of adverse events was much higher in patients with RDW-CV<14.75%(95% CI=0.002). Conclusion:Adverse events are common in patients with GCA. RDW-CV is an independent risk factor for having adverse events. Low level of RDW-CV predicts an increased risk of adverse events by the following years.
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Objective:To explore the predictive factors of secondary pulmonary hypertension (PH) in patients with chronic obstructive pulmonary disease (COPD).Methods:The patients who were hospitalized and diagnosed with COPD in Huai′an Hospital Affiliated to Xuzhou Medical University from September 2017 to December 2019 were enrolled, and the pulmonary systolic pressure were estimated by echocardiography. The patients were divided into simple COPD group and COPD combined with PH group. The general clinical data, hematology indexes, and pulmonary function indexes of each group were collected and analyzed to explore the predictive value of the above factors on the occurrence of PH in COPD.Results:The levels of average blood platelet volume (MPV), red blood cell distribution width (RDW), and logarithmic functionof amino-terminal brain natriuretic precursor (lgNT-proBNP) in the in the COPD combined with PH group were higher than those in the simple COPD group: (11.91 ± 2.60) fl vs. (10.39 ± 1.44) fl, (14.25 ± 2.49)% vs. (12.56 ± 1.12)%, (2.82 ± 0.54) ng/L vs. (2.22 ± 0.38) ng/L; the ratio of forced expiratory volume in the first second (FEV 1) and force vital capacity (FVC) and the percentage of FEV 1 to the predicted value (FEV 1%) were lower than those in the simple COPD group: (51.43 ± 8.07)% vs. (59.99 ± 8.33)%, (37.00 ± 12.62)% vs. (48.28 ± 15.10)%, the differences were statistically significant ( P<0.05). Logistic regression analysis showed that the changes of MPV( OR = 1.401, P = 0.015), RDW ( OR = 1.769, P = 0.013), lgNT-proBNP ( OR = 6.959, P<0.001), FEV 1/FVC( OR = 0.905, P<0.001) were closely related to the occurrence of PH in COPD. The receiver operating characteristic (ROC) curve analysis showed that the area under the curve of MPV, RDW, NT-proBNP combined detection in diagnosis of PH was the largest (0.873). Conclusions:The changes in NT-proBNP, RDW, MPV, FEV 1/FVC have a certain predictive value for COPD patients with PH. The combined detection of three hematological indicators can better predict the presence of PH in COPD patients than single detection or combined detection.
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Objective:To explore the influencing factors of severity of upper gastrointestinal bleeding (UGIB) and to establish the early warning evaluation model in the form of line chart, so as to provide a feasible basis for emergency nurses' triage.Methods:A total of 680 UGIB patients admitted to the Emergency Department of the First Affiliated Hospital of Wenzhou Medical University from January 2019 to January 2020 were retrospectively analyzed. They were divided into a modeling group ( n=510) and a validation group ( n=170) by random number table method, and were divided into a high-risk group and a low-risk group according to the expert Consensus on Emergency Diagnosis and Treatment Procedures for Acute Upper Gastrointestinal Bleeding in 2020. The differences of various indicators between groups were compared, the factors affecting the severity of the disease were analyzed by Logistic regression, and the nomogram was drawn and validated. Results:Multivariate logistic regression analysis showed that hematemesis ( OR=3.875, 95% CI: 2.212-6.79), diabetes ( OR=2.64, 95% CI: 1.184-5.883), syncope ( OR=10.57, 95% CI: 3.675-30.403), heart rate ( OR=3.262, 95% CI: 1.753-6.068), red blood cell distribution width ( OR=3.904, 95% CI: 2.176-7.007), prothrombin time ( OR=3.665, 95% CI: 1.625-8.269), lactic acid ( OR=3.498, 95% CI: 1.926-6.354) and hemoglobin ( OR=4.984, 95% CI: 2.78-8.938) were the influencing factors of the severity of UGIB patients ( P < 0.05). The nomogram model showed good consistency and differentiation (C-index=0.903, 95% CI: 0.875-0.931), and was verified internally (C-index=0.895) and Hosmer-Lemeshow goodness-of-fit test ( P=0.7936). Externally verified C-index was 0.899 (95% CI: 0.846-0.952). The calibration curve prompt warning evaluation model had good stability and the prediction efficiency was better than the modified early warning score ( P < 0.05). Conclusions:The early warning evaluation model has a reliable predictive value, which can provide a reference for emergency medical staff to screen high-risk patients and formulate targeted nursing interventions.
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Objective:To explore the value of neutrophil to lymphocyte rate (NLR) combined with red blood cell distribution width to platelet count ratio (RPR) in evaluating the condition and prognosis of emergency elderly sepsis patients.Methods:A prospective research method was conducted to select 169 elderly patients with sepsis who visited the emergency department of Xuanwu Hospital of Capital Medical University from January 2020 to February 2022.After admission, blood routine examination, chest computerized tomography, biochemical examination, procalcitonin, and pathogenic examination were given, and the scores of acute physiology and chronic health evaluation (APACHE Ⅱ) were scored according to worst value of 24 hours. After 28 days of follow-up, the patients were divided into the survival group(125 cases) and the death group(44 cases) according to the prognosis. The differences of white blood cell count(WBC), NLR, PCT, RPR and APACHE Ⅱ scores were compared between the two groups. The correlation between NLR,RPR and APACHE Ⅱ scores were analyzed. The difference of area under receiver operating characteristic curve (ROC) of RPR, NLR, their combination and PCT in predicting mortality were compared in elderly patients with sepsis. The independent sample t test was used to compare the measurement data with normal distribution, and the χ 2 test was used to compare the enumeration data. The risk factors were analyzed by multiple logistic regression analysis. Results:There was no significant difference in WBC between the survival group and the death group ( P=0.361). The APACHE Ⅱ scores ((18.52±2.41) points), RPR (0.17±0.03), NLR (10.64±3.48), PCT ((2.55±1.14) μg/L) in the death group were higher than those in the survival group ((14.17±2.71) points, (0.14±0.03), NLR (7.67±3.33), (1.19±0.81) μg/L), the difference was statistically significant ( t values were 9.44,7.32,4.92, and 7.32, respectively; all P<0.001). RPR and NLR were positively correlated with APACHE Ⅱ scores ( r=0.393,0.368;both P<0.001). Multivariate logistic regression analysis showed that increased NLR ( OR=1.174,95% CI 1.041-1.325), procalcitonin ( OR=4.353,95% CI 2.382-7.954), RPR ( OR=14.247,95% CI 2.635-77.025) were independent risk factors for the prognosis of sepsis patients ( P values were 0.009,<0.001, and 0.002, respectively).The area under receiver operating characteristic curve (AUC) of PCT in predicting mortality was 0.859 (95% CI:0.801-0.917), the AUC of RPR was 0.755 (95% CI:0.665-0.845), and the AUC of NLR was 0.727 (95% CI: 0.643-0.812). The AUC of RPR and NLR was smaller than that of PCT ( P=0.033, 0.015), but the AUC of RPR combined with NLR was 0.799, which had no significant difference compared with PCT ( P=0.195). Conclusion:Both NLR and RPR had a certain predictive value for the condition and prognosis of elderly sepsis patients in emergency, and their combined evaluation value was similar to that of PCT.
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Objective:To explore the value of red blood cell distribution width (RDW) in evaluating the severity of patients infected with novel coronavirus Delta variant.Methods:A total of 28 patients infected with novel coronavirus Delta variant in designated hospital treated by the First Affiliated Hospital of Xi'an Jiaotong University medical team from December 2021 to January 2022 were enrolled (23 cases of common type, 4 severe and 1 critical cases). The detailed clinical data of patients was collected. Then, Pearson's correlation analysis was used to identify the blood examination indexes which affected the arterial partial pressure of oxygen (PaO 2) and arterial partial pressure of carbon dioxide (PaCO 2). According to the median standard deviation of red blood cell distribution width (RDW-SD, 42.5 fL), 28 patients were divided into low RDW-SD group (≤ 42.5 fL, 16 cases) and high RDW-SD group (> 42.5 fL, 12 cases), and the immune related indexes of the two groups were compared. Receiver operator characteristic curve (ROC) was drawn to evaluate the predictive value of RDW-SD on the severity of illness of coronavirus disease 2019 (COVID-19). Results:Correlation analysis showed that RDW-SD was the only index related to PaO 2 and PaCO 2 on the first day of admission, which was negative correlation with PaO 2 ( r = -0.379, P = 0.047) and positive correlation with PaCO 2 ( r = 0.509, P = 0.006). The results of effects of different clinical characteristics on RDW-SD level showed that there was no statistically significant difference in RDW-SD between groups with different clinical characteristics (including male/female, ≥ 65 years old/< 65 years old, having/without hypertension, having/without diabetes, smoking/not smoking, having/without hyperpyrexia, with/without fever for 3 days, with/without respiratory symptoms, with/without digestive symptoms). It was suggested that RDW-SD be relatively stable and not affected by the patient's baseline level. The percentage of B cells in low RDW-SD group was higher than that in high RDW-SD group (23.01±3.01 vs. 15.34±5.34, P < 0.05), immunoglobulin G (IgG) level in low RDW-SD group was lower than that in high RDW-SD group (g/L: 11.43±3.20 vs. 15.42±1.54, P < 0.05). The area under ROC curve (AUC) of RDW-SD in evaluating severe cases was 0.83 [95% confidence interval (95% CI) was 0.59-1.06], which was close to multilobularinltration, hypo-lymphocytosis, bacterial coinfection, smoking history, hyper-tension and age (MuL BSTA score; AUC = 0.82, 95% CI was 0.51-1.12) and better than British Thoracic Society's modified pneumonia score (CURB-65 score; AUC = 0.70, 95% CI was 0.50-0.91). Conclusion:RDW-SD has significant evaluative effect on the severity of COVID-19 patients with Delta variants.
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Objective:To investigate the effects of blood interleukin-6 (IL-6), red blood cell distribution width (RDW) and C-reactive protein (CRP) levels in the evaluation of the condition and prognosis of patients with moderate to severe acute pancreatitis (AP) and pulmonary infection.Methods:A total of 90 patients with moderate to severe AP combined with lung infection diagnosed and treated in Anhui Wanbei Coal and Electricity Group General Hospital from January 2018 to December 2020 were selected as the observation group, and 90 patients with moderate to severe AP without lung infection during the same period were selected as the control group. The IL-6, RDW, and CRP levels of patients in the two groups were compared, and their correlation with the disease severity was analyzed; the predictive value of serum IL-6, RDW and CRP levels on the prognosis of patients were analyzed by receiver operating characteristic (ROC) curve.Results:The serum levels of IL-6, RDW and CRP in the observation group were higher than those in the control group: (35.35 ± 7.19) ng/L vs. (26.91 ± 5.23) ng/L, (15.14 ± 5.36)% vs. (11.27 ± 2.07)%, (146.22 ± 50.27) mg/L vs. (102.83 ± 40.25) mg/L, and as the severity of the disease in the observation group increased, the serum IL-6, RDW and CRP levels increased, and the differences were statistically significant ( P<0.05). Serum IL-6, RDW, CRP levels of patients with moderate to severe AP combined with pulmonary infection were positively correlated with the severity of the disease ( r = 0.445, 0.610, 0.580, P<0.05). The serum levels of IL-6, RDW and CRP were higher in patients with poor prognosis when they were admitted to the hospital and on the 3rd and 7th days of admission than those with good prognosis ( P<0.05). The results of Cox regression analysis showed that serum IL-6, RDW and CRP levels at admission and on the 3rd and 7th day of admission were the prognostic factors of patients with moderate to severe AP combined with lung infection ( P<0.05). The combined detection of serum IL-6, RDW and CRP levels on the 7th day of admission had the largest area under the curve for predicting prognosis, and the sensitivity and specificity were 89.47% and 83.10%, respectively. Conclusions:The levels of serum IL-6, RDW and CRP in patients with moderate to severe AP combined with pulmonary infection are elevated, and are positively correlated with the severity of the disease. Clinical monitoring of their levels can provide a reliable reference for the formulation of treatment plans and prognostic evaluation.
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Objective To investigate the value of neutrophil-to-lymphocyte ratio (NLR), red blood cell distribution width-to-lymphocyte ratio (RLR), and lymphocyte-to-monocyte ratio (LMR) in predicting the prognosis of early small hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA). Methods A retrospective analysis was performed for 132 patients newly diagnosed with early HCC who underwent RFA in Tianjin Second People's Hospital from September 2011 to December 2020. Preoperative data were collected and the patients were followed up to observe recurrence and overall survival (OS). The X-tile tool was used to determine the optimal cut-off values of NLR, RLR, and LMR based on 5-year survival rate and recurrence-free survival (RFS) rate, and then the patients were divided into N-R-L 0 group with 92 patients, N-R-L 1 group with 29 patients, and N-R-L 2 group with 11 patients. The chi-square test was used for comparison of categorical data between the three groups. The Kaplan-Meier method was used to plot the survival curve, and the log-rank test was used to compare RFS and OS rates between groups. The factors with statistical significance in the log-rank test were included in the multivariate Cox regression analysis to determine the risk factors for RFS and OS rates. Results There were significant differences in Child-Pugh class and albumin between the N-R-L 0, N-R-L 1, and N-R-L 2 groups ( χ 2 2=10.992 and 5.699, both P < 0.05). The 1-, 3-, and 5-year OS rates of the three groups were 100%/96.3%/90.7%, 96.6%/60.4%/41.3%, and 81.8%/46.8%/15.6%, respectively ( χ 2 =38.46, P < 0.000 1), and the 1-, 3-, and 5-year RFS rates of the three groups were 76.9%/52.5%/33.3%, 42.9%/13.1%/0, and 11.1%/0/0, respectively ( χ 2 =35.345, P < 0.000 1). The multivariate Cox regression analysis showed that tumor diameter ≥ 2 cm (hazard ratio[ HR ]=2.10, 95% confidence interval[ CI ]: 1.28-3.43, P =0.003; HR =3.67, 95% CI : 1.58-8.52, P =0.002), N-R-L score of 1 point ( HR =3.14, 95% CI : 1.81-5.46, P < 0.000 1; HR =8.27, 95% CI : 3.15-21.71, P < 0.000 1), and N-R-L score of 2 points ( HR =2.61, 95% CI : 1.06-6.42, P =0.037; HR =14.59, 95% CI : 3.96-53.78, P < 0.000 1) were independent predictive factors for RFS and OS. Conclusion N-R-L, a systemic inflammatory response marker composed of NLR, RLR, and LMR, is an independent risk factor for recurrence and survival of early small HCC after RFA, and it can be used as a useful noninvasive biomarker in combination with tumor features to predict the recurrence and survival of early HCC after RFA.
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Objective To investigate the clinical significance of red blood cell distribution width-to-platelet ratio (RPR index) in evaluating the severity of metabolic-associated fatty liver disease and predicting fatty liver-associated cirrhosis. Methods A total of 192 patients with metabolic-associated fatty liver disease and 210 patients with fatty liver-associated cirrhosis who were admitted to Shengjing Hospital of China Medical University from January 2019 to June 2020 were enrolled as group A and group B, respectively, and 206 individuals who underwent physical examination in our hospital during the same period of time were enrolled as control group (group C). All subjects underwent general measurement, blood cell analysis, blood biochemical test, and abdominal CT examination, and related formulas were used to calculate RPR, aspartate aminotransferase-to-platelet ratio index (APRI), and fibrosis-4 (FIB-4) index. A one-way analysis of variance was used for comparison of continuous data with homogeneity of variance between groups, and the SNK method was used for comparison between two groups; the Kruskal-Wallis H test was used for comparison of continuous data with heterogeneity of variance between groups, and the Mann-Whitney U test was used for comparison between two groups; the chi-square test was used for comparison of categorical data between groups; the receiver operating characteristic (ROC) curve was used to analyze the accuracy of the prediction of liver cirrhosis. Results There were significant differences in red blood cell distribution width-standard deviation, albumin, creatinine, body mass index, RPR, and APRI between any two groups (all P < 0.001), and there were significant differences in white blood cell count, platelet count, alanine aminotransferase, aspartate aminotransferase, direct bilirubin, blood urea nitrogen, and FIB-4 between group A and group B (all P < 0.05). There were significant differences in waist circumference and fasting blood glucose between groups A and B and between groups A and C (all P < 0.001). There was a significant difference in RPR between any two groups of the mild, moderate, and severe metabolic-associated fatty liver disease groups (all P < 0.05). In terms of diagnostic efficiency, the three noninvasive models RPR, APRI, and FIB-4 had an area under the ROC curve of 0.932, 0.815, and 0.877, respectively, in predicting fatty liver-associated cirrhosis. Conclusion There is a difference in RPR index between different stages of liver disease, and RPR index gradually increases with the aggravation of metabolic-associated fatty liver disease. RPR index has a higher value than APRI and FIB-4 in the warning of fatty liver-associated cirrhosis.
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Objective:To explore the value of red blood cell distribution width to platelet ratio (RPR), C-reactive protein to albumin ratio (CAR) combined with bedside index for severity in acute pancreatitis (BISAP) score in assessing the severity of acute pancreatitis (AP).Methods:The AP patients in the First Affiliated Hospital of Jinzhou Medical University from January to December 2020 were respectively collected. According to the severity of the disease, the patients were divided into the mild acute pancreatitis (MAP) group, moderate severe acute pancreatitis (MSAP) group, and severe acute pancreatitis (SAP) group. The general information and laboratory indicators of the patients were collected and scored according to the BISAP scoring standard. Spearman correlation analysis was used to explore the correlation of RPR, CAR and BISAP score in three groups of patients and their correlation with AP severity. Model 1 [MAP group and non-MAP group (MSAP group + SAP group)] and model 2 [non-SAP group (MAP group + MSAP group) and SAP group] were constructed. Multivariate binary logistic regression was used to analyze the independent factors of the non-MAP group and SAP group. The receiver operating characteristic (ROC) curve was used to calculate the area under the curve (AUC) to analyze the value of RPR, CAR, and BISAP score alone and in combination to judge the severity of AP patients.Results:A total of 197 AP patients who met the criteria were included, including 102 MAP patients, 56 MSAP patients, and 39 SAP patients. There were significant differences in RPR, CAR and BISAP score among patients with different AP severity ( P<0.001). RPR, CAR and BISAP score were positively correlated, and all three were positively correlated with AP severity ( r=0.435, 0.490, 0.628, P<0.001). RPR and CAR were independent factors for the severity of AP, and the combination of RPR, CAR and BISAP score was better than a single indicator in judging the severity of AP patients. The AUC of the three combined in Model 1 and Model 2 were 0.868 and 0.889, respectively. Conclusions:RPR, CAR combined with BISAP score has a good application value in the evaluation of AP, and is suitable for clinical promotion.
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Objective:To explore the predictive value of Red Blood Cell Distribution Width (RDW) in predicting the prognosis of patients with Extracorporeal Membrane Oxygenation (ECMO).Methods:The clinical data of patients undergoing ECMO admitted to Intensive Care Unit of Sichuan Provincial People’s Hospital from January 2015 to January 2020 were retrospectively analyzed. Patients were divided into the survival group and death group according to the prognosis during ICU hospitalization. The patients' basic data , acute physiology and chronic health score system Ⅱ (APACHE Ⅱ), RDW and activated partial thromboplastin time (APTT) at 72 hours after treatment with ECMO were compared between the two groups. Univariate and Logistic regression multivariate analyses were used to analyze the prognostic factors of patients with ECMO, predictive models and death warning scores were established. The receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic efficacy of RDW and death warning scores for the prognosis of patients with ECMO.Results:A total of 71 patients with ECMO who met the inclusion criteria were included, including 38 patients in the death group and 33 patients in the survival group. The age, APACHE-Ⅱscore, 72 h RDW and 72 h APTT in the death group were higher than those in the survival group. Respectively, the hospitalization time of ICU in the death group was significantly lower than that in the survival group ( P< 0.05). Logistic regression analysis showed that APACHE-Ⅱscore ( OR=1.117, P=0.047)、72 h RDW( OR=1.102, P=0.029) and 72 h APTT ( OR=1.049, P=0.029) were independent risk factors for death in patients with ECMO. ROC curve analysis showed that the area under ROC curve (AUC) of the APACHE-Ⅱ, score 、72 h RDW and 72 h APTT were 0.691, 0.691 and 0.632( P<0.05), Respectively, the combined AUC was 0.764, the sensitivity was 0.526, and the specificity was 0.909. The death warning score of patients with ECMO was established according to the Predictive model , which is less than 2 points with low risk of death and more than 2 points with high risk of death. The area under the ROC curve of death warning score is 0.8, the sensitivity is 0.607 and the specificity is 0.923. Conclusions:The RDW at 72 hours after treatment with ECMO has a good value in predicting the prognosis of patients with ECMO. Besides, a greater predictive value for the prognosis of patients with ECMO by combining 72 hours RDW, 72 hours APTT with APACHE-Ⅱscore than that of any separate indicator.
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Objective:To investigate the correlation of red blood cell distribution width-to-platelet ratio (RPR) with clinical features and prognosis of patients with multiple myeloma (MM).Methods:The clinical data of 137 patients with MM who were admitted to the Affiliated Hospital of Xuzhou Medical University from April 2013 to July 2019 were collected. The receiver operating characteristic (ROC) curve was used to determine the best cut-off value of RPR. According to the best cut-off value of RPR, the patients were divided into high RPR group and low RPR group, and the differences in clinical characteristics and prognosis between the two groups were analyzed.Results:The best cut-off value of RPR was 0.10, and according to the best cut-off value, the patients were divided into high RPR group (RPR ≥ 0.10, 52 cases) and low RPR group (RPR < 0.10, 85 cases). There were statistical differences between the high RPR group and low RPR group in the proportion of patients between different stratification of Durie-Salmon (DS) staging ( χ2 = 17.110, P < 0.01), International Staging System (ISS) staging ( χ2 = 10.817, P = 0.001), red blood cell distribution width standard deviation(RDW-SD) ( χ2 = 26.937, P < 0.01), hemoglobin ( χ2 = 17.140, P < 0.01), lactate dehydrogenase (LDH) ( χ2 = 7.926, P = 0.005), erythrocyte sedimentation rate (ESR) ( χ2 = 9.513, P = 0.002), β 2-microglobulin (β 2-MG) ( χ2 = 7.726, P = 0.005), and bone marrow plasma cell ratio (BMPC) ( χ2 = 6.621, P = 0.010). The overall response rate (ORR) in the low RPR group was higher than that in the high RPR group [82.4% (70/85) vs. 71.2% (37/52)], but the difference was not statistically significant ( χ2 = 2.366, P = 0.124). The deep remission rate in the low RPR group was higher than that in the high RPR group [56.5% (48/85) vs. 19.2% (10/52)], and the difference was statistically significant ( χ2 = 18.327, P < 0.01). The results of multivariate analysis showed that the albumin, RPR and degree of remission were independent influencing factors for the overall survival (OS) of newly treated MM patients (all P < 0.05). Conclusion:MM patients with elevated peripheral blood RPR have shorter OS time, and RPR may be one of the indicators for evaluating the prognosis of MM.
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Objective@#To study the related factors of heart failure in patients with non-valvular atrial fibrillation.@*Methods@#Eighty patients with non-valvular atrial fibrillation were selected from the First People′s Hospital of Wucheng District of Jinhua City from August 2015 to April 2019. Patients with atrial fibrillation were divided into non-heart failure group (56 patients) and heart failure group (24 patients) according to the presence or absence of heart failure. The general characteristics of the two groups were compared with univariate analysis and Logistic analysis.@*Results@#There was no significant difference in average age, sex, body mass index, hypertension, hypercholesterolemia, diabetes mellitus, coronary heart disease, stroke, hemoglobin, white blood cell and red blood cell volume between the two groups (P>0.05). There were significant differences in the classification of atrial fibrillation, red blood cell distribution width (RDW) and serum creatinine (P<0.05).Multivariate Logistic regression analysis showed that RDW and serum creatinine were independent predictors of heart failure in patients with non-valvular atrial fibrillation (OR=3.08 and 1.03, P<0.05). The probability of heart failure in persistent atrial fibrillation, long-term persistent atrial fibrillation or permanent atrial fibrillation was 3.87 and 4.10 times higher than that of paroxysmal atrial fibrillation (P<0.05). Receptor operation character (ROC) curve analysis showed that the maximum Youden index of RDW was 14.00%, and the sensitivity and specificity for predicting heart failure were 55.7% and 87.7%, respectively.@*Conclusions@#Classification of atrial fibrillation, RDW and serum creatinine may be independent predictors of heart failure in patients with non-valvular atrial fibrillation. RDW>14.00% has certain value in predicting heart failure in patients with non-valvular atrial fibrillation.
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Objective To study the related factors of heart failure in patients with non-valvular atrial fibrillation.Methods Eighty patients with non-valvular atrial fibrillation were selected from the First People's Hospital of Wucheng District of Jinhua City from August 2015 to April 2019.Patients with atrial fibrillation were divided into non-heart failure group (56 patients) and heart failure group (24patients) according to the presence or absence of heart failure.The general characteristics of the two groups were compared with univariate analysis and Logistic analysis.Results There was no significant difference in average age,sex,body mass index,hypertension,hypercholesterolemia,diabetes mellitus,coronary heart disease,stroke,hemoglobin,white blood cell and red blood cell volume between the two groups (P ＞ 0.05).There were significant differences in the classification of atrial fibrillation,red blood cell distribution width (RDW) and serum creatinine (P ＜ 0.05).Multivariate Logistic regression analysis showed that RDW and serum creatinine were independent predictors of heart failure in patients with nonvalvular atrial fibrillation (OR =3.08 and 1.03,P ＜ 0.05).The probability of heart failure in persistent atrial fibrillation,long-term persistent atrial fibrillation or permanent atrial fibrillation was 3.87 and 4.10times higher than that of paroxysmal atrial fibrillation (P ＜ 0.05).Receptor operation character (ROC)curve analysis showed that the maximum Youden index of RDW was 14.00％,and the sensitivity and specificity for predicting heart failure were 55.7％ and 87.7％,respectively.Conclusions Classification of atrial fibrillation,RDW and serum creatinine may be independent predictors of heart failure in patients with non-valvular atrial fibrillation.RDW ＞ 14.00％ has certain value in predicting heart failure in patients with non-valvular atrial fibrillation.
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ObjectiveAt present, there are few studies on prognostic indicators for patients with severe traumatic brain injury (STBI). This paper aims to explore its significance by analyzing the demographic characteristics of patients with STBI, as well as parameters such as clinical laboratory test indicators.MethodsA retrospective analysis was performed on 139 STBI patients admitted to the Department of Emergency Medicine, General Hospital of Eastern Theater Command from January 2017 to December 2018. According to the 28-day death event, the participants were divided into the survival group (n=108) and the death group (n=31). Indicators such as Glasgow Coma Score (GCS), red blood cell distribution width (RDW), platelet distribution width (PDW) and clot-related indicators were collected. Univariate and multivariate logistic regression were used to analyze the risk factors related to death, and receiver operating characteristic (ROC) curve was adopted to determine their prognostic values.ResultsThere were significant differences in GCS, RDW and PDW between the two groups. RDW (OR=4.577, 95% CI: 1.704-12.291), PDW (OR=1.346, 95% CI: 1.093-1.657) and GCS (OR=0.469, 95% CI: 0.301-0.730) were risk factors for death of STBI patients. The area under the curve (AUC) of RDW, PDW and GCS scores were 0.735 (0.640-0.840), 0.675 (0.553-0.796) and 0.737 (0.638-0.837), respectively, and the AUC of the combination of the three was 0.840 (0.748-0.932), which was significantly better than that of single diagnosis.ConclusionRDW, PDW combined with GCS can effectively evaluate the prognosis of patients with STBI, which has important guiding value for clinicians′ diagnosis and treatment.
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@#Objective To explore the relation of preoperative red blood cell distribution width (RDW) with prognosis in esophageal cancer. Methods The PubMed, EMbase, Web of Science, Cochrane Library, VIP, Wanfang, CNKI and SinoMed databases were searched to identify potential studies assessing the correlation between preoperative RDW and prognosis of esophageal cancer patients from establishment of databases to February 2019. The endpoint events included the overall survival (OS), cancer-specific survival (CSS) and disease-free survival (DFS). The Stata 12.0 software was applied for the meta-analysis and the hazard ratio (HR) and 95% confidence interval (CI) were calculated. Results A total of 10 retrospective studies involving 4 260 esophageal cancer patients from China or Japan were included. The score of Newcastle-Ottawa scale (NOS) of the included studies was more than 6 points. The results demonstrated that elevated preoperative RDW was significantly associated with poor CSS (HR=1.50, 95% CI 1.14 to 1.99, P=0.004) and DFS (HR=1.45, 95% CI 1.14 to 1.85, P=0.002), while no significant association between preoperative RDW and OS in esophageal cancer was observed (HR=1.17, 95% CI 0.95 to 1.45, P=0.143). Subgroup analysis based on the pathology revealed that preoperative RDW had high prognostic value in esophageal squamous carcinoma (ESCC) (HR=1.37, 95% CI 1.05 to 1.77, P=0.018). Conclusion Preoperative RDW may be an independent prognostic factor for Chinese and Japanese esophageal cancer patients, especially for ESCC patients. However, more prospective studies with bigger sample sizes from other countries are still needed to verify our findings.
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Objective@#To estimate the correlation between red cell distribution width (RDW) level and left atrial appendage thrombogenic milieu (LAATM) in elderly patients with non-valvular atrial fibrillation (NVAF).@*Methods@#This was a retrospective case-control study. A total of 782 NVAF patients (age>60 years old) who finished transesophageal echocardiography (TEE) from January 2010 to December 2016 at Chaoyang Hospital was retrospectively screened, and diveded into LAATM group (n=65) and non LAATM group (n=717). RDW level was compared between the two groups. Potential association between RDW and LAATM was analyzed using multivariate logistic regression analysis. The accuracy of RDW for detecting LAATM was evaluated through receiver operating curve (ROC) analysis.@*Results@#There were significant differences in age, history of heart failure, course of atrial fibrillation (AF), type of AF, NT-proBNP level, RDW level, left ventricular end systolic diameter, left ventricular end diastolic diameter, left ventricular ejection fraction (LVEF), left atrial diameter, CHADS2 score and CHA2DS2-VASc score between the two groups (P<0.05). RDW level in LAATM group was significant higher than non LAATM group (13.4% (12.6%, 14.1%) vs. 12.1% (11.2%,13.0%), P<0.001). Multivariate logistic regression showed that RDW level associated with LAATM (OR=4.07, 95%CI 2.09-7.91, P<0.001). In ROC analysis, area under the curve was 0.81 (95%CI 0.74-0.88, P<0.001). When RDW level was 13.1%, LAATM could be diagnosed (sensitivity was 73.1% and specificity was 80.5%).@*Conclusions@#RDW value is associated with the presence of LAATM in elderly NVAF patients. The RDW level has a certain reference value for predicting LAATM.