N-terminal del péptido natriurético tipo B y la amplitud de distribución eritrocitaria como factor pronóstico de severidad en pacientes con insuficiencia cardiaca aguda descompensada

Introducción: El estudio de predictores de desenlaces negativos en pacientes con insuficiencia cardiaca ha incluido la combinación de péptidos natriuréticos y el ancho de distribución eritrocitaria (RDW). Objetivo: Evaluar el uso combinado de la porción N-terminal del propéptido natriurético tipo B (NT-proBNP) y el RDW como pronóstico de fallecimiento por cualquier causa, hospitalización prolongada y reingreso al año del alta en pacientes con insuficiencia cardiaca aguda (ICA) descompensada. Métodos: Realizamos un estudio observacional retrospectivo. Construimos un índice combinado = NT-proBNP x RDW/100. Elaboramos curvas ROC, se estimó la sensibilidad y especificidad en base a los puntos de corte y se estimó el riesgo relativo para desarrollar los desenlaces. Comparamos las áreas bajo las curvas del índice combinado versus el NT-proBNP y RDW, por separado. Resultados: Analizamos los datos de 471 pacientes. El índice combinado tuvo su mejor corte en 927,79 para pronosticar fallecimiento durante el primer año de ingreso. Aquellos con valores ≥ 927,79 tuvieron un riesgo relativo de 32,7 (IC95%: 4,8 - 222,3). Para hospitalización ≥7 días el punto de corte fue 752,67, aquellos con este valor o superiores tuvieron un riesgo relativo de 22,4 (IC95%: 9,7 - 51,8). Para pronosticar reingreso al año del alta el corte fue 858,47 y el riesgo relativo fue 4,7 (IC95%: 3,3 - 6,8). Conclusiones: El índice combinado generó riesgos relativos que muestran una fuerte fuerza de asociación para fallecimiento por cualquier causa, hospitalización ≥ 7 días y reingresos al año del alta. Sin embargo, la superioridad para discriminar no fue concluyente respecto a los componentes individuales.

Introduction: The study of predictors of negative outcomes in patients with heart failure has included the combination of natriuretic peptides and red cell distribution width (RDW). Objective: To evaluate the combined use of the amino-terminal pro-brain natriuretic peptide (NT-proBNP) and RDW as a prognostic factor for death from any cause, prolonged hospitalization, and readmission one year after discharge in patients with decompensated acute heart failure (AHF). Methods: We conducted a retrospective observational study. We constructed a combined index = NT-ProBNP x RDW/100. ROC curves were constructed, sensitivity and specificity were estimated based on the cut-off points, and the relative risk was estimated to develop the outcomes studied. We compared the area under curve of combined index versus NT-proBNP and RDW, separately. Results: We analyzed data from 471 patients. The combined index had its best cut of 927.79 to predict death during the first year of admission. Those with values ≥ 927,79 had a relative risk of 32.7 (95% CI: 4.8 - 222.3). To predict hospitalization ≥ 7 days, the cut-off point was 752.67; those with this value or higher had a relative risk of 22.4 (95% CI: 9.7 - 51.8). To predict readmission one year after discharge, the cutoff was 858.47 and the relative risk was 4.7 (95% CI: 3.3 - 6.8). Conclusions: The combined index used generate relative risks that show a strong strength of association for death from any cause, hospitalization ≥7 days, and readmissions one year after discharge. However, the superiority to discriminate was inconclusive with respect to the individual components.

Relationship between platelet indices and red cell distribution width and short-term mortality in traumatic brain injury with 30-day mortality

SUMMARY OBJECTIVE: This study aimed at investigating whether there is a relationship between 7- or 30-day mortality and mean platelet volume, platelet distribution width, platelet count-to-total lymphocyte count ratio, or red cell distribution width in patients with traumatic brain injury. METHODS: We retrospectively analyzed intensive care unit patients with traumatic brain injury. We recorded patients' ages; genders; diagnoses; Glasgow Coma Scale scores; length of intensive care unit stay (in days); mean platelet volume, platelet distribution width, platelet count-to-total lymphocyte count ratio, and red cell distribution width values upon hospital admission; and health on the 7th and 30th days of their stays. RESULTS: We analyzed data from 110 patients. Of these, 84 (76.4%) were male and 26 (23.6%) were female. On the 7- and 30-day mortality evaluations, compared to the living patients, the deceased patients had a significantly higher median age and a significantly lower median Glasgow Coma Scale. Thus, increased age and lower Glasgow Coma Scale scores were associated with increased 7- and 30-day mortality rates. mean platelet volume and platelet distribution width values were similar in living and deceased patients. platelet count-to-total lymphocyte count ratio values were lower in deceased patients, but this difference was not statistically significant. Within 30 days after traumatic brain injury, deceased patients' red cell distribution width values were significantly elevated in deceased patients compared to those of living patients. CONCLUSION: Mean platelet volume, platelet distribution width, and platelet count-to-total lymphocyte count ratio values were not associated with 7- and 30-day mortality, whereas only elevated red cell distribution width was associated with 30-day mortality.

Alterações Hematológicas durante um Período de Sete Dias de Internação em Pacientes com Infarto Agudo do Miocárdio / Hematological Changes during Seven Days of Hospitalization in Patients with Acute Myocardial Infarction

Resumo Fundamento O infarto agudo do miocárdio é uma das principais causas de mortalidade em todo o mundo e a formação de placa aterosclerótica é o principal mecanismo fisiopatológico, que resulta em inflamação crônica e induz a maturação eritrocitária, podendo causar aumento no índice de amplitude de distribuição dos glóbulos vermelhos (RDW). Objetivo Avaliar o papel do índice de anisocitose em pacientes com infarto agudo do miocárdio em ambos os tipos de infarto como preditor de gravidade. Métodos Os pacientes foram incluídos no estudo de acordo com os critérios de inclusão e exclusão, seguindo a rotina hospitalar baseada na história clínica e laboratorial. As análises estatísticas foram realizadas de acordo com cada variável. Chegou-se a todas as conclusões considerando o nível de significância de 5%. Resultados Durante o período de acompanhamento, nos 349 pacientes analisados, a taxa de mortalidade esteve associada às variáveis RDW (CV) e RDW (SD). Nos pacientes que foram a óbito, notou-se aumento, conforme demonstrado no modelo multivariado, nos efeitos de um infarto agudo do miocárdio com supradesnivelamento do segmento ST e RDW, ajustado para fatores de confusão (valor-p = 0,03 e 0,04). Em contrapartida, o número total de eritrócitos (valor-p = 0,00) e hemoglobina (valor-p = 0,03) apresentou diminuição durante a internação de pacientes graves. Conclusão O índice de anisocitose foi fator preditivo de mortalidade e pode ser utilizado como indicador de pior prognóstico em pacientes com infarto agudo do miocárdio.

Abstract Background Acute myocardial infarction is a major cause of mortality worldwide, and atherosclerotic plaque formation is the main pathophysiological mechanism, which results in chronic inflammation that induces erythrocyte maturation and may cause an increase in the red cell distribution width (RDW) index. Objective Evaluate the role of the anisocytosis index in patients with acute myocardial infarction in both types of infarctions as a predictor of severity. Methods Patients were included in the study according to the inclusion/exclusion criteria, following the hospital routine based on their clinical and laboratory history. Statistical analyzes were performed according to each variable. All conclusions were drawn considering the significance level of 5%. Results During the follow-up period, in the 349 patients analyzed, the mortality rate was associated with the variables RDW (CV) and RDW (SD), in those patients who died, an increase was noted, as demonstrated in the multivariate model, for the effects of an acute ST elevation myocardial infarction and the RDW, adjusted for confounding factors (p-value = 0.03 and 0.04). In contrast, the total number of erythrocytes (p-value = 0.00) and hemoglobin (p-value = 0.03) showed a decrease during severe patients' hospitalization. Conclusion The anisocytosis index was a predictive factor of mortality and can be used as an indicator of worse prognosis in patients with acute myocardial infarction.

The preoperative CONUT score combined with HRR can help assess the prognosis of patients with UTUC undergoing radical nephroureterectomy / 现代泌尿外科杂志

【Objective】 To investigate the predictive value of preoperative controlled nutritional status (CONUT) score and ratio of hemoglobin to red cell distribution width (HRR) for survival of patients with upper urinary tract urothelial carcinoma (UTUC) after radical surgery. 【Methods】 A retrospective analysis was performed on 145 UTUC patients who underwent surgical treatment in the Affiliated Hospital of Xuzhou Medical University during May 2011 and Jun. 2017. Clinic opathologic data were collected, the best cut-off values of CONUT score and HRR were determined with receiver operating characteristic (ROC) curve, and the CONUT-HRR scoring system was established. The correlation between different CONUT-HRR scores and clinic opathological indicators of UTUC patients was compared. The application value of CONUT-HRR score in predicting the prognosis of UTUC patients was evaluated with Kaplan-Meier survival curve and Cox proportional risk regression model. 【Results】 The optimal cut-off values of preoperative CONUT score and HRR for predicting cancer specific survival (CSS) were 3 and 10.41, respectively. The patients were divided into three groups: CONUT-HRR 0 group (n=62, CONUT score <3 and HRR ≥10.41), CONUT-HRR 1 group (n=51, CONUT score <3 and HRR <10.41, or CONUT score ≥3 and HRR≥10.41), and CONUT-HRR 2 group (n=32, CONUT score ≥3 and HRR <10.41). CONUT-HRR score was correlated with age, surgical method, pathological T stage, lymph node metastasis and vascular invasion (all P<0.05). Kaplan-Meier survival curve results showed that the 5-year CSS of CONUT-HRR 0, 1 and 2 groups were 96.4%, 65.8% and 30.9%, respectively, with statistically significant differences (P<0.001). Cox regression model showed that CONUT-HRR score, pathological T stage, lymph node metastasis and vascular infiltration were independent factors of CSS. 【Conclusion】 Preoperative CONUT-HRR score can be used as a simple and reliable indicator to evaluate the prognosis of UTUC patients. Higher score indicates worse prognosis.

Red cell distribution width levels in patients with pseudoexfoliation syndrome and pseudoexfoliation glaucoma

Purpose: The purpose of this study was to assess the levels of red cell distribution width (RDW) in patients with pseudoexfoliation syndrome (PEX) and pseudoexfoliation glaucoma (PEXG), and to compare their RDW values with healthy controls. Methods: 40 patients with PEX, 40 with PEXG, and 80 control subjects were enrolled in this study. Complete ophthalmologic examination and complete blood count measurements were performed of all subjects. Complete blood counts were performed within one hour of blood collection. Results: RDW levels were significantly higher in patients with PEX and PEXG than in controls (P = 0.027 and P < 0.001, respectively). Furthermore, a significant difference was found in RDW values between PEXG and PEX groups (P = 0.016). RDW levels were gradually increased from control group to PEXG group (P < 0.001). Multivariate logistic regression analysis revealed that RDW was independently associated with the presence of PEX/PEXG (odds ratio 1.765, 95% confidence interval (CI) 1.095–2.867, P = 0.013). Conclusion: We conclude that RDW may be a useful marker for predicting the presence of PEX and progression to PEXG.

Practical Approach to the Interpretation of Complete Blood Count Reports and Histograms

Improvement in technology and inclusion of new parameters in automated hematology analyzers allows for better and faster detection of anemias. These parameters along with histograms provide details and clues that help to diagnose the etiology of anemia and help bridge the time lag in detection and treatment. Timely and expert interpretation of complete blood counts should not be limited to the pathologist but should also interest the clinician to allow for efficient patient care.

Amplitud de la distribución eritrocitaria en el segundo trimestre del embarazo como predictor de preeclampsia

Objetivo. Establecer la utilidad de la amplitud de distribución eritrocitaria en el segundo trimestre del embarazo como predictor del desarrollo de preeclampsia. Diseño. Estudio de casos-controles. Institución. Hospital Central "Dr. Urquinaona", Maracaibo, Venezuela. Participantes. Embarazadas entre 17 y 20 semanas que acudieron a la consulta prenatal y fueron seguidas hasta el término del embarazo. Métodos. Se tomaron muestras de sangre y fueron seguidas hasta el parto para establecer si desarrollaban preeclampsia. Principales medidas de resultado. Características generales, valores de la amplitud de la distribución eritrocitaria y eficacia pronóstica. Resultados. Los casos fueron 41 embarazadas que desarrollaron preeclampsia (grupo A) y 463 embarazadas fueron consideradas como controles (grupo B). No se encontraron diferencias estadísticamente significativas en la edad materna, edad gestacional y presión arterial sistólica y diastólica al momento de la realización de la ecografía (p = ns). La edad gestacional al momento del diagnóstico de preeclampsia en el grupo A fue de 35,0 +/- 3,2 semanas. Se encontraron diferencias significativas en los valores de amplitud de la distribución eritrocitaria entre las pacientes del grupo A (14,5 +/- 2,3%) y las pacientes del grupo B (13,8 +/- 1,8%; p = 0,039). Un valor de corte de 14% presentó un valor por debajo de la curva de 0,576 con sensibilidad del 63,4%, especificidad del 49,7%, valor predictivo positivo del 10,0% y valor predictivo negativo del 93,9%. Conclusión. Los valores de valores de la amplitud de la distribución eritrocitaria en el segundo trimestre no son útiles en la predicción de preeclampsia.

Objective: To establish the usefulness of red cell distribution width in the second trimester of pregnancy as a predictor of the development of preeclampsia. Design: Case-control study. Institution: Hospital Central "Dr. Urquinaona", Maracaibo, Venezuela. Participants: Pregnant women between 17 and 20 weeks who attended prenatal consultation and were followed up until to term. Methods: Blood samples were taken and followed up until delivery to establish if they developed preeclampsia. Main outcome measures: General characteristics, values of red cell distribution width and prognostic efficacy. Results: Cases were 41 pregnant women who developed preeclampsia (group A) and 463 pregnant women were considered as controls (group B). No statistically significant differences were found in maternal age, gestational age, and systolic and diastolic blood pressure at the time of ultrasound (p = ns). Gestational age at the time of diagnosis of preeclampsia in group A was 35.0 +/- 3.2 weeks. Significant differences were found in red cell distribution width values between patients in group A (14.5 +/- 2.3%) and patients in group B (13.8 +/- 1.8%; p = 0.039). A cut-off value of 14% presented a value under the curve of 0.576 with sensitivity of 63.4%, specificity of 49.7%, positive predictive value of 10.0% and negative predictive value of 93.9%. Conclusion: The values of red cell distribution width values in the second trimester are not useful in the prediction of preeclampsia.

Red cell distribution width and prognosis in patients with cardiac arrest: A retrospective cohort study / 中华急诊医学杂志

Objective:To investigate the association between the initial red cell distribution width (RDW) and all-cause mortality in patients with cardiac arrest (CA) in intensive care unit (ICU).Methods:We conducted a retrospective cohort study and extracted the related clinical data in ICU among adult CA patients (age ≥18 years), using the Multiparameter Intelligent Monitoring Intensive Care III (MIMIC-Ⅲ, v1.4) database from 2001 to 2012. Based on whether they survived or not on 90 days, the patients were divided into the survival group and death group, and the clinical data of the two groups were compared. Meanwhile, the RDW values were divided into four parts according to quartile. The cumulative survival rate of 28-day and 90-day were estimated using the Kaplan-Meier method and compared using the log-rank test. Multivariate Cox proportional hazard models were also used to reveal the association between RDW and all-cause mortality.Results:Based on the inclusion and exclusion criteria, 853 adult CA patients were finally enrolled. The mean age was (67.26±15.84) years, and 534 (62.60%) patients were male. And the mean SOFA score was (6.13±3.70). Compared with the survival group ( n=410), the patients in the death group ( n=443) were older and had a higher SOFA score, RDW, anion gap, creatinine and blood phosphorus. Moreover, the proportion of chronic obstructive pulmonary disease, acute kidney injury and sepsis in the death group were higher than those in the survival group, and the length of stay in ICU in the death group was longer than that in the survival group (all P<0.05). However, the indicators of arterial blood oxygen partial pressure, hemoglobin and total blood calcium, as well as the proportion of coronary heart disease and acute myocardial infarction were lower than those in the survival group, and a shorter duration of hospitalization in the death group was noted (all P<0.05). Kaplan-Meier survival curves demonstrated that there was a significant difference in the cumulative survival rate of 28-day and 90-day (all P<0.001). In the multivariate Cox proportional hazard models, a higher RDW at ICU admission was an independent risk factor for 28-day ( HR=1.399, 95% CI: 1.014-1.930, P=0.041) and 90-day ( HR=1.433, 95% CI: 1.064-1.929, P=0.018) all-cause mortality among CA patients. Conclusions:An elevated RDW is an independent predictor for 28-day and 90-day all-cause mortality of CA patients. As a clinical indicators, it indicates a poor prognosis for adult CA patients.

Influence of the Ratio of Peripheral Hemoglobin-to-Red Cell Distribution width on the Prognosis of Patients with Diffuse Large B-cell Lymphoma / 中国实验血液学杂志

OBJECTIVE@#To investigate the influence of peripheral hemoglobin (Hb)-to-red cell distribution width (RDW) ratio (HRR) on the prognosis of patients with diffuse large B-cell lymphoma (DLBCL).@*METHODS@#Data of 265 patients with diffuse large B-cell lymphoma (DLBCL) at the Affiliated Hospital of Xuzhou Medical University from January 2014 to December 2019 were retrospectively analyzed. 132 healthy people in the same period were used as normal control group. The best cut-off points of HRR was determined by receiver operating characteristics (ROC) curve; the chi-square test was used to analyze the correlation of clinical characteristics with HRR; the Kaplan-Meier method was used to compare the overall survival (OS) and progression-free survival (PFS) of HRR patients in different groups; the Cox proportional risk model was used for univariate and multivariate analysis.@*RESULTS@#The best cut-off value of HRR was 0.936, which was divided into low HRR group and high HRR group. The low HRR group had a higher ECOG score, higher incidence of advanced Ann Arbor stage, higher NCCN-IPI score, and elevated LDH level. K-M survival analysis showed that OS (P<0.001) and PFS (P<0.001) in the low HRR group were significantly shorter than that in the higher HRR group. The multivariate analysis revealed that HRR was an independent predictor of OS（HR＝0.379，95％CI：0.237-0.605，P<0.001） and PFS （HR＝0.384，95％CI：0.241－0.614，P<0.001） in DLBCL patients.@*CONCLUSION@#Low HRR（<0.936） in patients with DLBCL indicates a poor prognosis, which is an independent prognosis risk factor.

Correlation Of Serum Albumin And Red Cell Distribution Width (RDW) With Deep Vein Thrombosis And Pulmonary Embolism A Retrospective Study

Background:Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is a severe and potentially lethal disease, with serious short and long?term complications and a potentially fatal outcome. Objective:To determine the correlation of Serum Albumin and Red cell Distribution Width( RDW),with deep vein thrombosis and pulmonary embolism.Materials & Methods: A retrospective study was carried out from the archive of patients with an event of VTE admitted in theGeneral Medicine ward, Jhalawar Medical College, Jhalawar, Rajasthan. Patients’ demographics, presenting symptoms, laboratory tests particularly RDW and Serum Albumin, medications, interventions, and outcomes were collected.Result:A total of 131 cases wereevaluated. Majority of the patients (48.8%) were in age group 45-64 years. The mean duration of hospitalization stay of venous thromboembolism (VTE) patients was 6.6 ± 1.4 days. Mean RDW (%) of the total study participants was 15.3 ± 1.4. Mean serum albumin of the total study participants was 3.3 ± 0.8.Conclusion:Majority of the patients were found with higher RDW and Low Serum Albumin.

The prognostic value of preoperative red cell distribution width to platelet ratio on prostate cancer patients treated with endocrine therapy after radical prostatectomy / 中华泌尿外科杂志

Objective:To evaluate the prognostic value of preoperative red cell distribution width to platelet ratio on prostate cancer patients treated with endocrine therapy after radical prostatectomy.Methods:The clinical data of 349 prostate cancer patients treated with endocrine therapy after radical prostatectomy in our hospital from October 2007 to October 2018 were retrospectively analyzed.Among all the patients, the average age was 67 years old(ranged 42 to 84 years). The preoperative newly diagnosed PSA level was 4.2-499.2 ng/ml(average 30.6 ng/ml). 158 cases had a Gleason score of more than 8. 191 cases had a Gleason score of below than 8. According to tumorous staging, 151 patients were staged less than or equal to stage T 2b, 110 patients were staged as stage T 2c, 88 patients were staged equal or greater than stage T 3a. 295 patients were staged less than 1.15 ng/(ml·cm 3)of prostate specific antigen density, 54 patients were staged equal or greater than 1.15 ng/(ml·cm 3). There were 86 cases of seminal vesicle invasion and 263 cases of non-seminal vesicle invasion. There were 121 patients with low risk of prostate cancer, 83 patients with medium risk, and 145 patients with high risk. All patients received endocrine therapy after radical prostatectomy with androgen deprivation therapy (ADT). End point of observation was biochemical recurrence-free survival (RFS) with PCa patients treated with endocrine therapy after radical prostatectomy. Patients were categorized in two groups with high RPR and low RPR values using a cut-off point as calculated by the receiver-operating curve analysis.Correlations between RPR and clinical characteristics were analyzed.The prognostic analysis of preoperative RPR on prostate cancer patients treated with endocrine therapy after radical prostatectomy was estimated using Kaplan-Meier analysis and Cox proportional hazards models. Kaplan-Meier method was used to draw the survival curve. Meanwhile, univariate and multivariate Cox regression were used to explore factors influencing the prognosis of PCa patients. Results:of the 349 cases, ranging 4-132 months. Biochemical recurrence with PCa patients occurred in 93 cases, and 256 patients were not biochemical recurrence.The ideal cutoff value of preoperative RPR was 0.27(95% CI 0.502-0.653, P<0.05)determined by the ROC curve, by which the 349 patients was divided into the high RPR group of 66 patients(18.9 %) and the low RPR group of 283 patients(81.1 %). Preoperative RPR was significantly associated with Gleason score ( P=0.005), newly diagnosed tPSA value ( P=0.000), tumor T stage ( P=0.031), PCa risk scale ( P=0.037), positive margin ( P=0.030). The RFS in the high RPR group(26.0 months)was shorter than that in the low RPR group(35.0 months)( P<0.001). In univariate analysis, Gleason score ( HR=1.579, 95% CI 1.049-2.376, P=0.028), serum newly diagnosed tPSA ( HR=2.979, 95% CI 1.655-5.362, P=0.000), tumor T stage( HR=1.292, 95% CI 1.009-1.653, P=0.042), preoperative RPR value ( HR=3.555, 95% CI 2.339-5.401, P=0.000) were prognostic factors ( P<0.05). Cox multivariate analysis showed that higher newly diagnosed tPSA value( HR=1.917, 95% CI 1.033-3.558, P=0.039)and higher RPR value( HR=3.086, 95% CI 1.994-4.775, P=0.000) were independent predictors for endocrine therapy after radical prostatectomy of PCa( P<0.05). Conclusions:Preoperative RPR was an independent predictor for poor prognosis in PCa patients treated with endocrine therapy after radical prostatectomy.

Association Between Thyroid Hormone Status and Complete Blood Count Parameters in Anemic Patients

@#Introduction: Anemia and thyroid conditions effect each other in clinical practice. Anemia may induce alteration in thyroid hormone status and various thyroid conditions induce various types of anemia. In present study, we aimed to study the thyroid function tests of the anemic subjects and to compare characteristics and laboratory features of the three groups; hypothyroid, hyperthyroid, and euthyroid subjects. Methods: Anemic subjects divided into three groups according to the thyroid hormone status, either as hyperthyroid, hypothyroid and euthyroid groups. Hemogram indices and laboratory parameters compared between three groups. Results: Mean red cell distribution width (RDW) of hypothyroid anemic subjects was significantly lower than the RDW of euthyroid anemic subjects (p=0.003). White blood cell (WBC) count of hypothyroid anemic subjects was significantly reduced compared to the euthyroid (p<0.001) and hyperthyroid (p=0.047) anemic subjects. Significant inverse correlation between RDW and TSH (r=-0.25, p=0.001), between RDW and hemoglobin (r=-0.44, p<0.001), between RDW and hematocrit (r=-0.35, p<0.001) and between RDW and mean corpuscular volume (r=-0.53, p<0.001) were noted. Conclusions: Since anemia is common in thyroid conditions, besides its role in differential diagnosis of the anemia, RDW could also serve as an adjunct diagnostic tool in estimation of the thyroid hormone status in anemic subjects.

Red cell distribution width as a diagnostic marker in neonatal sepsis

Background: The early diagnosis of neonatal sepsis, a significant cause of neonatal morbidity and mortality still remains a challenge. Red-cell Distribution Width (RDW) vary significantly in conditions associated with inflammation and infection like sepsis. The study aims to find the normal range of RDW in healthy newborns and investigate the role of RDW in the early diagnosis of neonatal sepsis.Methods: This is a prospective observational study, 50 normal and 50 sepsis neonates were considered for the study. The neonatal sepsis group consisted of neonates with (i) Positive sepsis screen with/without clinical features of neonatal sepsis and/or (ii) Blood, urine or CSF culture positive or signs of pneumonia on chest x-ray. The mean RDW and the relationship between RDW and neonatal sepsis were analysed using appropriate statistical methods in SPSS-25 software.Results: Mean RDW (%) was significantly higher in sepsis neonates (18.59'1.28) than in normal newborns (16.21'1.35). RDW had statistical significance with CRP (C-Reactive Protein) in the sepsis group. RDW had significant relationship with the diagnosis of neonatal sepsis with a p value of 0.000. An RDW cut-off level of 17.25% had 86% sensitivity, 87% specificity, and 93.5% accuracy in diagnosing neonatal sepsis.Conclusions: RDW helps as a diagnostic test in the early diagnosis of neonatal sepsis.

Predictive values of routine blood test results for iron deficiency in children / 中华儿科杂志

Objective@#To explore the predictive values of routine blood test results for iron deficiency (ID) screening in children.@*Methods@#Routine blood test results and serum ferritin (SF) levels from 1 443 healthy children (862 boys, 581 girls) aged 6 months to 18 years, who were seen for well-child visits between June 2017 and May 2019 in Children′s Hospital, Zhejiang University School of Medicine, were retrospectively analyzed. ID was defined as SF<20 μg/L, iron deficiency anemia (IDA) as ID with anemia (hemoglobin(Hb)<110 g/L at 6 months-5 years of age, Hb<120 g/L at 6-18 years of age), non-anemia ID as ID without anemia, non-ID anemia as SF≥20 μg/L with anemia, and healthy control subjects as those with SF≥20 μg/L but without anemia. The blood test results including Hb, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), red blood cell distribution width (RDW), and the percentage of low hemoglobin density (LHD) of healthy control, non-anemia ID, non-ID anemia, and IDA groups were compared by analysis of variance (ANOVA) or non-parametric test, quantitative data were described as ±s or M(interquartile range), and receiver operating characteristic curve (ROC) analysis was applied to assess predictive values of routine blood test results and LHD for detecting IDA and ID.@*Results@#Among 1 443 children with median age of 2.1(3.3) years, 1 061 children were in healthy control group, 292 in non-anemia ID group, 43 in non-ID anemia group and 47 in IDA group. The prevalence of ID was much higher than that of anemia (23.5% (339/1 443) vs. 6.2% (90/1 443) , χ2=169.76, P<0.01). Compared with control group, non-anemia ID group showed higher LHD (0.088 (0.093) vs.0.073 (0.068), P<0.01) and RDW (0.131±0.013 vs. 0.126±0.008, P<0.01), lower MCV ((80±4) vs. (83±4) fl, P<0.01) and MCHC values ((326±9) vs. (329±8) g/L, P<0.01). IDA group showed higher LHD (0.322(0.544)) and RDW (0.151±0.018), lower MCV ((73±6) fl) and MCHC values((309±14) g/L) than non-anemia ID group (all P<0.01). The area under curve (AUC) values of MCHC, LHD, RDW and MCV for detecting ID were 0.63 (95%CI: 0.60-0.67), 0.63 (95%CI:0.60-0.67), 0.67 (95%CI: 0.63-0.70) and 0.73 (95%CI: 0.69-0.76) respectively. With cutoff limits (MCV<80.2 fl, RDW>0.131 or MCHC<322 g/L), MCV, RDW and MCHC showed higher sensitivity for screening ID than hemoglobin (0.540, 0.469 and 0.336 vs. 0.139, χ2=121.70, 87.47, 35.56, all P<0.01).@*Conclusion@#MCV, RDW and MCHC can be used to screen ID in primary health care settings.

Correlation between severity of obstructive sleep apnea syndrome and red cell distribution width in elderly patients / 南方医科大学学报

OBJECTIVE@#To investigate the correlation between the severity of obstructive sleep apnea syndrome (OSAS) and red cell distribution width (RDW) in elderly patients.@*METHODS@#A cross-sectional study was conducted among 311 elderly patients diagnosed with OSAS in the snoring clinic between January, 2015 and October, 2016 and 120 healthy controls without OSAS from physical examination populations in the General Hospital of PLA. The subjects were divided into control group with apnea-hypopnea index (AHI) <5 (=120), mild OSAS group (AHI of 5.0-14.9; =90), moderate OSAS group (AHI of 15.0-29.9; =113) and severe OSAS group (AHI ≥ 30; =108). The clinical characteristics and the results of polysomnography, routine blood tests and biochemical tests of the subjects were collected. Multiple linear regression analysis was used to examine the correlation between OSAS severity and RDW.@*RESULTS@#The levels of RDW and triglyceride were significantly higher in severe OSAS group than in the other groups ( < 0.01). The levels of fasting blood glucose and body mass index were significantly higher in severe and moderate OSAS groups than in mild OSAS group and control group ( < 0.05 or < 0.01). Multiple linear regression analysis showed that AHI was positively correlated with body mass index (β=0.111, =0.032) and RDW (β=0.106, =0.029). The area under ROC curve of RDW for predicting the severity of OSAS was 0.687 (=0.0001).@*CONCLUSIONS@#The RDW increases as OSAS worsens and may serve as a potential marker for evaluating the severity of OSAS.

The role of red cell distribution width in the locoregional recurrence of laryngeal cancer / O papel da amplitude de distribuição de eritrócitos na recorrência locorregional do câncer da laringe

Abstract Introduction: Although the red cell distribution width has been reported as a reliable predictor of prognosis in several types of cancer, to our knowledge few reports have focused on the prognostic value of red cell distribution width in laryngeal carcinoma. Objective: We aimed to explore whether the pretreatment red cell distribution width predicted recurrence in laryngeal cancer patients is a simple, reproducible, and inexpensive prognostic biomarker. Methods: All laryngeal cancer patients who underwent curative surgery (n = 132) over a 7 year study period were evaluated. Data on demographics, primary tumor site, T-stage, N-stage, histological features (differentiation; the presence of perineural/perivascular invasion), treatment group (total laryngectomy or partial laryngectomy) or adjuvant therapy (chemotherapy/radiotherapy); laboratory parameters (complete blood count, including the pre-operative red cell distribution width), and disease-free survival rates were retrospectively reviewed. All cases were divided into three groups by the red cell distribution width tertile [<13% (25th percentile) (n = 31), 13-14.4% (50th percentile) (n = 72), and >14.4% (75th percentile) (n = 29)]. Results: High-red cell distribution width group included more patients of advanced age, and more of those with recurrent and metastatic tumors (p = 0.005, 0.048, and 0.043, respectively). Individuals with red cell distribution width >14.4% (75th percentile) had lower disease free survival rates than did those with red cell distribution width <13% (25th percentile) (p = 0.014). Patients with red cell distribution width >14.4% at diagnosis were at a higher risk of locoregional recurrence (hazard ratio = 5.818, 95% confidence interval (95% CI) 1.25-26.97; p = 0.024) than patients with a normal red cell distribution width (<13%). Conclusion: We found that the pretreatment red cell distribution width was independently prognostic of disease free survival rate in patients with laryngeal cancer and may serve as a new, accurate, and reproducible means of identifying early-stage laryngeal cancer patients with poorer prognoses.

Resumo Introdução: Embora a amplitude de distribuição de eritrócitos tenha sido relatada como um preditor confiável de prognóstico em vários tipos de câncer, que seja de nosso conhecimento, poucos estudos se concentraram no valor prognóstico dessa medida no carcinoma laríngeo. Objetivo: Avaliar se a amplitude de distribuição de eritrócitos pré-tratamento prevê a recorrência em pacientes com câncer de laringe como um biomarcador prognóstico simples, reprodutível e não dispendioso. Método: Foram avaliados todos os pacientes com câncer de laringe submetidos à cirurgia curativa (n = 132) durante sete anos. Dados demográficos, local do tumor primário, estágio T, estágio N, características histológicas (diferenciação; presença de invasão perineural/perivascular), grupo de tratamento (laringectomia total ou laringectomia parcial) ou terapia adjuvante (quimioterapia/radioterapia); parâmetros laboratoriais (hemograma, inclusive a amplitude de distribuição de eritrócitos pré-operatório) e a sobrevida livre de doença foram revisados retrospectivamente. Todos os casos foram divididos em três grupos pelo tercil da amplitude de distribuição de eritrócitos [< 13% (percentil 25) (n = 31), 13%-14,4% (percentil 50) (n = 72) e > 14,4% (percentil 75) (n = 29)]. Resultados: O grupo com amplitude de distribuição de eritrócitos elevado incluiu um número maior de pacientes com idade avançada e mais pacientes com tumores recorrentes e metastáticos (p = 0,005, 0,048 e 0,043, respectivamente). Os indivíduos com a amplitude de distribuição de eritrócitos > 14,4% (percentil 75) apresentaram taxas de sobrevida livre de doença menores do que aqueles com a amplitude de distribuição de eritrócitos < 13% (percentil 25) (p = 0,014). Pacientes com a amplitude de distribuição de eritrócitos > 14,4% no diagnóstico apresentaram maior risco de recorrência locorregional [Hazard Ratio = 5,818, intervalo de confiança de 95% (IC 95%) 1,25-26,97; p = 0,024] do que pacientes com a amplitude de distribuição de eritrócitos normal (< 13%). Conclusão: Verificamos que a amplitude de distribuição de eritrócitos pré-tratamento foi um fator prognóstico independente de sobrevida livre de doença em pacientes com câncer de laringe e pode servir como um novo parâmetro, preciso e reprodutível, para identificar pacientes com câncer de laringe em estágio inicial com piores prognósticos.

Study of hematological parameters in sepsis patients and its prognostic implications

Background: Septic response is a leading contributory factor for morbidity and mortality especially in intensive care settings. The current research aims to study the co-relation of various hematological parameters in sepsis patients with the objective to see their effects in prognosis of sepsis patients.Methods: The current study was a cross-sectional study with a sample size of 117 patients with sepsis. Various hematological parameters of all the patients were obtained on day of admission (day 1) and seventh day (day 7) using hemogram reports and the difference of their statistical mean and standard deviation was estimated.Results: There was a significant statistical difference in the mean and standard deviation of neutrophil lymphocyte count ratio (NLCR), red cell distribution width standard deviation (RDW SD), Platelet count (PLT) and Platelet crit (PCT) whereas Mean platelet volume (MPV), Platelet distribution width (PDW) and Platelet large cell ratio (PLCR) showed no significant changes on day 1 and day 7 of observation in patients taken for the study.Conclusions: The prognosis of sepsis can be important when we can clinch the hemogram markers early in the period of sepsis and evaluate them according to the etiology of the respective incidences. Targeted approach can be initiated early in the course of hospitalization and may be a specific index of hemogram could be established to further co relate sepsis and its form in particular diseases.

Investigation of neutrophil-to-lymphocyte ratio and red cell distribution width in sudden senseurineural hearing loss

Background: Sudden hearing loss (DHL) is a sudden sensorineural hearing loss effecting et least 3 or more frequencies more than 30 Decibel. The purpose of this study was to investigate the usefulness of the neutrophil to lymphocyte ratio (NLR) and Red Cell Distribution Width (RDW) in the first diagnosis of sudden sensorineural hearing loss (SSHL).Methods: Total 24 patients diagnosed with SSHL and 24 control patients included in the study. Serum samples were analyzed retrospectively on the initial presentation.Results: On admission, the NLR was 2.1±1.1 The mean absolute neutrophil count was 7100±400/mm3, and the mean complete lymphocyte count was 3400±1100/mm3. RDW was 11.9±0.6. Eight patients had total healing, 12 patients had partial cure, and two patients had no healing in the study. Statistically significant changes in NLR determined in the measurements between SSHL and control group (p<0.05). Significant differences were not observed in hemoglobin and hematocrit values, lymphocyte counts, RDW measurements between SSHL and control group (p <0.05).Conclusions: In lights of this information we recommend to screen NLR levels in SSHL patients. This may help us follow up patients recovery and if the patients recover from the disease higher level of NLR may create doubt for recurrence of the disease in risky patients.

Red cell distribution width may help to discriminate synthetic cannabinoid users in the emergency department

Background: Differentiating bonsai users from the suspected users is problematic. The aim was to determine whether bonsai using men and the others can be distinguished via the hemogram parameters such as mean corpuscular volume (MCV), mean platelet volume (MPV), red cell distribution width (RDW) and Plateletcrit (PCT).Methods: In this retrospective case-control study, a total of 138 men admitted to ED were investigated in Kanuni Sultan Suleyman Hospital, Istanbul, Turkey in 2014. The patients were divided into 2 groups which were the first group had included bonsai users whereas the second group was consist of men not using bonsai. Complete blood count tests were performed on all patients.Results: Among the suspected bonsai users, 68 were diagnosed to use bonsai. It was found that MCV, RDW and PCT levels were significantly higher in bonsai users compared to controls while MPV levels were lower in the users. Author put all these parameters to logistic regression analysis model using enter method. RDW (OR: 3.98, 95%CI:2.180-7.266, p<0.0001), MPV (OR:0.526, 95%CI:0.373-0.742, p<0.0001) and PCT (OR:<0.0001, 95%CI:0.000-0.058, p=0.007) were independent variables to discriminate bonsai users from that of suspected users. The most promising parameter to differentiate bonsai users from suspected users was RDW (AUC: 0.748, 95%CI: 0.668-0.828, p:<0.0001). The optimal cut-off value was found as 10.8 for RDW with a sensitivity, specificity, +LR and -LR as 66.2%, 64.3%, 1.85, 0.53, respectively.Conclusions: RDW marker can be a reliable parameter to discriminate bonsai users from that of suspected users with moderate sensitivity and specificity.