El ancho de distribución eritrocitaria en el pronóstico de corrección quirúrgica de cardiopatías congénitas / Red cell distribution width in the prognosis of surgical correction of congenital heart diseases

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.

Red blood cell distribution width values in erectile dysfunction / Valores del ancho de distribución eritrocitaria en la disfunción eréctil

Purpose: Erectile dysfunction (ED) has increased prevalence by age and significantly affects the quality of life of men and their partners. To investigate the relationship between ED and red blood cell distribution width (RDW) values.Materials and method: Between September 2019 and December 2019, a total of 192 individuals comprising those that were admitted to the urology outpatient clinic with ED complaints and healthy volunteers from among hospital staff were prospectively included in the study. The participants were divided into two groups according to the international erectile function index (IIEF-5) as ED group (n=148) and control group (n=44).Results: There was no statistically significant difference between the two groups in terms of age, smoking status, presence of hypertension, triglyceride, low-density lipoprotein, high-density lipoprotein, total cholesterol, total prostate-specific antigen and haematocrit values. Body mass index, fasting blood sugar, neutrophil–lymphocyte ratio (NLR), and platelet–lymphocyte ratio (PLR) were significantly higher in the ED group (28.5±27.4kg/m2 vs 26.8±26.5kg/m2, p=.021, 109.05±49.7mg/dl vs 93.39±10.2mg/dl, p<.001, 2.18±1.3 vs 1.74±0.3, p=.031, and 113.7±47 vs 92.4±24.1, p=.004, respectively). The mean RDW values were 13.7±1.1 in the ED group and 13±0.5 in the control group (p<.001). The multivariate analysis revealed PLR [1.02 OR (1–1.04), p=.007] and RDW [2.75 OR (1.56–4.85), p<.001] as independent predictors for an ED diagnosis.Conclusion: Based on the strong relationship between RDW and ED, we consider that RDW may be a new indicator in the diagnosis of ED. (AU)

Objetivo: Se ha incrementado la edad de prevalencia de la disfunción eréctil (DE), afectando significativamente a la calidad de vida de los varones y sus parejas. Estudiamos las relaciones entre DE y los valores del ancho de distribución eritrocitaria (RDW).Material y método: Entre septiembre y diciembre de 2019 se incluyó prospectivamente en el estudio a un total de 192 individuos, que comprendía tanto a los pacientes que acudieron a la clínica ambulatoria de urología con quejas de DE como a los voluntarios sanos del personal hospitalario. Se dividió a los participantes en dos grupos, grupo DE (n=148) conforme al índice internacional de función eréctil (IIEF-5) y grupo control (n=44).Resultados: No se encontraron diferencias estadísticamente significativas entre los dos grupos en términos de edad, estatus de tabaquismo, presencia de hipertensión, y valores de triglicéridos, lipoproteínas de baja densidad, lipoproteínas de alta densidad, colesterol total y antígeno prostático específico total. El índice de masa corporal, glucosa en sangre en ayunas, índice neutrófilos-linfocitos (INL) e índice plaquetas-linfocitos (IPL) fueron significativamente más altos en el grupo DE (28,5±27,4kg/m2 vs. 26,8±26,5kg/m2, p=0,021, 109,05±49,7mg/dl vs. 93,39±10,2mg/dl, p<0,001, 2,18±1,3 vs. 1,74±0,3, p=0,031, y 113,7±47 vs. 92,4±24,1, p=0,004, respectivamente). Los valores eritrocitarios medios fueron 13,7±1,1 en el grupo DE y 13±0,5 en el grupo control (p<0,001). El análisis multivariante reveló que los valores de IPL [OR 1,02 (1-1,04), p=0,007] y RDW [OR 2,75 (1,56-4,85), p<0,001] se comportaron como factores predictivos independientes del diagnóstico de DE.Conclusión: Basándonos en la fuerte relación entre RDW y DE, consideramos que RDW puede ser un nuevo indicador en el diagnóstico de DE. (AU)

Red blood cell distribution width values in erectile dysfunction.

PURPOSE: Erectile dysfunction (ED) has increased prevalence by age and significantly affects the quality of life of men and their partners. To investigate the relationship between ED and red blood cell distribution width (RDW) values. MATERIALS AND METHOD: Between September 2019 and December 2019, a total of 192 individuals comprising those that were admitted to the urology outpatient clinic with ED complaints and healthy volunteers from among hospital staff were prospectively included in the study. The participants were divided into two groups according to the international erectile function index (IIEF-5) as ED group (n=148) and control group (n=44). RESULTS: There was no statistically significant difference between the two groups in terms of age, smoking status, presence of hypertension, triglyceride, low-density lipoprotein, high-density lipoprotein, total cholesterol, total prostate-specific antigen and haematocrit values. Body mass index, fasting blood sugar, neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) were significantly higher in the ED group (28.5±27.4kg/m2 vs 26.8±26.5kg/m2, p=.021, 109.05±49.7mg/dl vs 93.39±10.2mg/dl, p<.001, 2.18±1.3 vs 1.74±0.3, p=.031, and 113.7±47 vs 92.4±24.1, p=.004, respectively). The mean RDW values were 13.7±1.1 in the ED group and 13±0.5 in the control group (p<.001). The multivariate analysis revealed PLR [1.02 OR (1-1.04), p=.007] and RDW [2.75 OR (1.56-4.85), p<.001] as independent predictors for an ED diagnosis. CONCLUSION: Based on the strong relationship between RDW and ED, we consider that RDW may be a new indicator in the diagnosis of ED.

Red Cell Distribution Width in Obstructive Sleep Apnea. / Ancho de distribución eritrocitaria en apnea obstructiva del sueño.

INTRODUCTION: Red cell distribution width (RDW) describes heterogeneity in the size of red blood cells. An increase in RDW has been associated with excess mortality in heart failure and other chronic diseases. Since there is an increased risk of cardiovascular morbidity and mortality in obstructive sleep apnea (OSA), it is possible that these patients have a high RDW. METHOD: We recruited subjects aged 18 to 60 years referred to the sleep-disordered breathing unit for suspected OSA. Subjects with any comorbidity were excluded. Apnea-hypopnea index (AHI) was calculated from the respiratory polygraphy. The RDW was obtained from the complete blood count. Changes in RDW after one year of treatment with continuous positive airway pressure (CPAP) were determined. RESULTS: We included 34 healthy subjects and 138 with OSA, aged 40.5±9.8 and 45.6±9.2 (P=.004) years, respectively. The RDW was higher in subjects with OSA compared to healthy subjects: 13.40 (12.40 to 14.40) vs. 13.15 (12.07 to 14.23) (P=.036). AHI showed a positive independent relationship with RDW in both the whole population (r=0.223; P=.002) and the OSA group (r=0.231; P=.005). No significant changes were found in RDW after one year of CPAP therapy. CONCLUSIONS: RDW increase in patients with OSA is directly associated with severity, although levels are not modified by the effective treatment of OSA with CPAP.

Red cell distribution width and additive risk prediction for major bleeding in non-ST-segment elevation acute coronary syndrome.

INTRODUCTION AND OBJECTIVES: Red cell distribution width has been linked to an increased risk for in-hospital bleeding in patients with non-ST-segment elevation acute coronary syndrome. However, its usefulness for predicting bleeding complications beyond the hospitalization period remains unknown. Our aim was to evaluate the complementary value of red cell distribution width and the CRUSADE scale to predict long-term bleeding risk in these patients. METHODS: Red cell distribution width was measured at admission in 293 patients with non-ST-segment elevation acute coronary syndrome. All patients were clinically followed up and major bleeding events were recorded (defined according to Bleeding Academic Research Consortium Definition criteria). RESULTS: During a follow-up of 782 days [interquartile range, 510-1112 days], events occurred in 30 (10.2%) patients. Quartile analyses showed an abrupt increase in major bleedings at the fourth red cell distribution width quartile (> 14.9%; P=.001). After multivariate adjustment, red cell distribution width >14.9% was associated with higher risk of events (hazard ratio=2.67; 95% confidence interval, 1.17-6.10; P=.02). Patients with values ≤ 14.9% and a CRUSADE score ≤ 40 had the lowest events rate, while patients with values >14.9% and a CRUSADE score >40 points (high and very high risk) had the highest rate of bleeding (log rank test, P<.001). Further, the addition of red cell distribution width to the CRUSADE score for the prediction of major bleeding had a significant integrated discrimination improvement of 5.2% (P<.001) and a net reclassification improvement of 10% (P=.001). CONCLUSIONS: In non-ST-segment elevation acute coronary syndrome patients, elevated red cell distribution width is predictive of increased major bleeding risk and provides additional information to the CRUSADE scale.