Changes in Red Blood Cell Distribution Width is Associated with Liver Function Parameters and Prognosis in Patients with Chronic HBV Liver Disease.

BACKGROUND: Hepatitis B virus (HBV) infection represents a major threat to global public health, especially in China. The clear pathogenesis of chronic HBV infection (CHB) has not been fully elucidated, but inflammation is widely accepted to play an important role. Emerging evidence suggests that red blood cell distribution (RDW) is a novel potential marker of inflammatory responses. The present study aimed to investigate the clinical relevance of elevated RDW in the patients with chronic HBV liver disease ICP. METHODS: A total of 731 individuals with chronic HBV liver disease, comprising 92 CHB patients, 606 patients with HBV-related liver cirrhosis (LC), and 33 patients with hepatocellular carcinoma (HCC). Fifty volunteers represented the healthy controls (HC). Alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), total bilirubin (Tbil), albumin (Alb), prothrombin time (PT), and RDW were tested. Correlations between RDW and other clinical parameters were analyzed. A multivariable logistic regression model and the receiver operating characteristic (ROC) curve were used in the analysis of RDW as a predictor of 3-month mortality in the patients with decompensated liver cirrhosis. RESULTS: Our results showed that RDW was significantly increased in patients with chronic HBV liver disease, except for CHB patients. Moreover, RDW was positively correlated with ALP and PT and negatively correlated with Alb in patients with chronic HBV liver disease. A multivariable logistic regression model showed that RDW was an independent predictor of 3-month mortality in the patients with decompensated liver cirrhosis (odds ratio [OR]: 1.345, 95% confidence interval [CI]: 1.200 - 1.506, p= 0.000). Based on the receiver operating characteristic (ROC) curve, use of RDW as an independent predictor of 3-month mortality was projected to be 17.15%, and yielded a sensitivity and specificity of 92.16% and 66.49%, respectively, with an area under the curve of 0.799 (95% CI: 0.746 - 0.838). CONCLUSIONS: These data suggest that RDW may be a useful indicator to assess the liver function in patients with chronic HBV liver disease and help to predict mortality in hospitalized patients with decompensated cirrhosis in patients.

Differential Expression of CD52, CD14 and HLA-DR on CD4+ Monocytes in Three Types of Acquired Bone Marrow Failure Syndromes.

BACKGROUND: Aplastic anemia (AA), paroxysmal nocturnal hemoglobinuria (PNH), and myelodysplastic syndrome (MDS) are the common spectrums of acquired bone marrow failure syndromes (BMFs). Accurate and timely diagnosis is a significant clinical challenge because of the overlapping features. The pathogenesis is not fully understood, but several studies have suggested that defective monocyte functions play an important role. We aimed to find whether the different expressions of CD52, CD14 and HLA-DR on CD4+ monocytes would be helpful in the preliminary diagnosis of acquired BMFs. METHODS: This study included 45 patients (21 AA patients, 13 MDS patients, 11 PNH patients). The control group was composed of 33 healthy adults. Flow cytometry was performed to determine the fluorochrome conjugated antibodies, including CD52, CD14 and HLA-DR. RESULTS: In this study, we found the expression of CD52 on CD4+ monocytes in AA patients was significant lower than MDS [15.90% (2.39 - 25.70) vs. 60.63% (26.0 - 94.98), p < 0.001] and healthy controls [15.90% (2.39 - 25.70) vs. 67.19% (25.5 - 88.4)%, p < 0.001], and a little higher than PNH patients [15.90% (2.39 - 25.70) vs. 4.55% (3.1 - 6.0), p < 0.05]. While comparing the levels of HLA-DR on CD4+ monocytes, AA patients were lower than PNH [40.05% (17.2 - 73.3) vs. 83.14% (80.7 - 94.3), p < 0.001] and MDS patients [40.05% (17.2 - 73.3) vs. 82.37% (69.1 - 91.2), p < 0.001]. CONCLUSIONS: According to our knowledge, this is a new clinical diagnostic method that uses surface markers for CD4+ monocytes such as CD52, CD14, and HLA-DR to make differential diagnoses within AA, PNH, and MDS patients in clinical practice. In addition, CD52 in patients shows that CD52 represents the most valuable molecular marker for differential diagnosis of three types of acquired BMFs.