The Prognostic Significance of Red Cell Distribution Width in Cardiac Surgery: A Systematic Review and Meta-Analysis.

RED CELL DISTRIBUTION WIDTH (RDW) is a routinely available biomarker of likely erythropoietic dysfunction, which may be associated with adverse outcomes after cardiac surgery. This systematic review and meta-analysis aimed to clarify the prognostic value of RDW in patients undergoing cardiac surgery. The authors searched MEDLINE, Embase, and the Cochrane Library from inception to May 10, 2022 for studies investigating the association between elevated RDW (as defined by the authors of included studies) and adverse outcomes after cardiac surgery. Herein, the authors extracted maximally adjusted hazard ratios (HRs) and odds ratios (ORs) with associated CIs, and pooled them using random-effects inverse- variance modeling. The authors explored interstudy heterogeneity using metaregression. The authors included 26 studies involving 48,092 patients who had undergone cardiac surgery. Elevated preoperative RDW was associated with long-term mortality (pooled HR 1.63, 95% CI 1.05-2.52), short-term mortality (pooled OR 2.16, 95% CI 1.21-3.87), acute kidney injury (AKI; pooled OR 1.30, 95% CI 1.19-1.41) and postoperative atrial fibrillation (POAF; pooled OR 1.44, 95% CI 1.05-1.96). Some studies suggested a significant association between preoperative RDW elevation and neurologic complications; however, their number was insufficient for meta-analysis. The postoperative RDW levels were less consistently reported and could not be meta-analyzed. In conclusion, the authors found that elevated preoperative RDW was associated with increased short- and long-term mortality, POAF, and AKI after cardiac surgery. Further research is needed to investigate its role in the risk stratification of patients undergoing cardiac surgery.

COVID-19 Biomarkers at the Crossroad between Patient Stratification and Targeted Therapy: The Role of Validated and Proposed Parameters.

Clinical knowledge about SARS-CoV-2 infection mechanisms and COVID-19 pathophysiology have enormously increased during the pandemic. Nevertheless, because of the great heterogeneity of disease manifestations, a precise patient stratification at admission is still difficult, thus rendering a rational allocation of limited medical resources as well as a tailored therapeutic approach challenging. To date, many hematologic biomarkers have been validated to support the early triage of SARS-CoV-2-positive patients and to monitor their disease progression. Among them, some indices have proven to be not only predictive parameters, but also direct or indirect pharmacological targets, thus allowing for a more tailored approach to single-patient symptoms, especially in those with severe progressive disease. While many blood test-derived parameters quickly entered routine clinical practice, other circulating biomarkers have been proposed by several researchers who have investigated their reliability in specific patient cohorts. Despite their usefulness in specific contexts as well as their potential interest as therapeutic targets, such experimental markers have not been implemented in routine clinical practice, mainly due to their higher costs and low availability in general hospital settings. This narrative review will present an overview of the most commonly adopted biomarkers in clinical practice and of the most promising ones emerging from specific population studies. Considering that each of the validated markers reflects a specific aspect of COVID-19 evolution, embedding new highly informative markers into routine clinical testing could help not only in early patient stratification, but also in guiding a timely and tailored method of therapeutic intervention.

Correlation between Red Cell Distribution Width and Glycaemic Control among Adults with Type II Diabetes Mellitus at Aminu Kano Teaching Hospital, North-Western Nigeria.

BACKGROUND: Red Blood Cell Distribution Width (RDW) measures the degree of variation in red blood cell size and it is a good predictor of complications in many conditions such as diabetes mellitus (DM). This study aimed to determine the relationship between RDW and glycaemic control in patients with type II DM. MATERIALS AND METHODS: It was a cross-sectional comparative study where patients with type II DM and apparently healthy non-DM volunteers were recruited. Blood samples were collected and analysed for RDW, Fasting Plasma Glucose (FPG) level and Glycated Haemoglobin (HbA1c). Data were analyzed using Statacorp version 13. RESULTS: A total of 180 participants were enrolled (90 cases, 90 controls). The mean (±SD) ages of cases and controls were 42 (± 11.94) and 34 (± 9.5) years, respectively. Females constituted the majority (49/90; 54.4%) in both groups. The cases had higher RDW than the controls (15.5 ± 1.0% versus 14.3 ± 1.7 %, p=0.630). The correlation between RDW and HbA1c revealed a weak statistically significant relationship (r=0.096, p=0.03) while a weak negative relationship was observed between the RDW and FPG (r = -0.006, p=0.956) which was not statistically significant. However, a negative finding showed a positive correlation between RDW and MCH (p-value = 0.003) and MCHC (p-value = 0.0002). CONCLUSION: Red cell distribution width has a direct relationship with HbA1c in patients with DM. Therefore, we recommend that clinicians pay attention to this detail while evaluating patients with DM.

CONTEXTE: La largeur de distribution des globules rouges (LDG) mesure le degré de variation de la taille des globules rouges et constitue un bon prédicteur des complications dans de nombreuses affections telles que le diabète sucré (DS). Cette étude visait à déterminer la relation entre la largeur de distribution des globules rouges et le contrôle de la glycémie chez les patients atteints de diabète de type II. MATÉRIELS ET MÉTHODES: Il s'agit d'une étude comparative transversale dans laquelle ont été recrutés des patients atteints de diabète de type II et des volontaires non diabétiques apparemment en bonne santé. Des échantillons de sang ont été prélevés et analysés pour déterminer le temps de travail quotidien, le taux de glucose plasmatique à jeun et l'hémoglobine glyquée (HbA1c). Les données ont été analysées à l'aide de la version 13 de Statacorp. RÉSULTATS: Au total, 180 participants ont été recrutés (90 cas, 90 témoins). Les âges moyens (±SD) des cas et des témoins étaient respectivement de 42 (± 11,94) et 34 (± 9,5) ans. Les femmes constituaient la majorité (49/90;54,4%) dans les deux groupes. Les cas avaient un TDR plus élevé que les témoins (15,5 ± 1,0 % contre 14,3 ± 1,7 %, p=0,630). La corrélation entre le TDR et l'HbA1c a révélé une faible relation statistiquement significative (r=0,096, p=0,03), tandis qu'une faible relation négative a été observée entre le TDR et la glycémie (r= -0,006, p=0,956), qui n'était pas statistiquement significative. Cependant, une corrélation positive a été observée entre le RDW et la MCH (valeur p=0,003) et la MCHC (valeur p=0,0002). CONCLUSION: La largeur de distribution des globules rouges a une relation directe avec l'HbA1c chez les patients atteints de diabète. Par conséquent, nous recommandons aux cliniciens de prêter attention à ce détail lors de l'évaluation des patients atteints de diabète. Mots clés: Largeur de distribution des globules rouges (RDW), Hémoglobine glyquée (HbA1c), Diabète sucré (DM).

Is RDW a clinically relevant prognostic factor for newly diagnosed multiple myeloma? A systematic review and meta-analysis.

BACKGROUND: Multiple myeloma (MM) is an incurable plasma cell malignancy. Red cell distribution width (RDW) is a prognostic marker in various diseases, solid tumors, and hematologic neoplasms, but its prognostic significance in MM is controversial. In this study, we aimed to assess the relationship between RDW and the clinical prognosis of MM patients through a meta-analysis. METHODS: Relevant literature were retrieved from PubMed, Embase, and Web of Science databases according to PRISMA guideline. All relevant parameters were extracted and combined for statistical analysis. The effect size was presented as hazard ratio (HR)/odds ratio (OR) and 95% confidence interval (CI). HR/OR > 1 in MM patients with high RDW suggested a worse prognosis. Heterogeneity test evaluation was performed using Cochran's Q test and I2 statistics. A Pheterogeneity < 0.10 or I2 > 50% suggested significant heterogeneity. P < 0.05 was considered statistically significant. Statistical analysis was performed using Stata 12.0 software. RESULTS: 8 articles involving 9 studies with 1165 patients were included in our meta-analysis. Our results suggested that elevated RDW is significantly associated with poor prognosis in MM (OS: HR = 1.91, 95%CI: 1.48-2.46; PFS: HR = 2.87, 95% CI: 2.02-4.07). A significant correlation was not found between RDW and International Staging System (ISS) staging (ISS III VS ISS I-II: OR:1.53; 95%CI:0.97-2.42). CONCLUSION: Our results suggested that RDW is a robust predictor of newly diagnosed MM outcomes.

Labile glycated hemoglobin: an underestimated laboratory marker of short term glycemia.

OBJECTIVES: Diabetes mellitus is a major public health problem. Hemoglobin A1c (HbA1c) is a key laboratory parameter in the management of diabetes patients. However, in diabetes monitoring, interpretation of HbA1c results is hampered by the important interindividual variation in red blood cell (RBC) life span. Furthermore, HbA1c only slowly responds to changes in glucose metabolism. Besides HbA1c, there exists a labile HbA1c fraction (l-HbA1c), exhibiting much faster kinetics. As both HbA1c and l-HbA1c are measured by modern standard chromatography, we explored the possibilities of using the l-HbA1c fraction for monitoring glycemia. METHODS: l-HbA1c and HbA1c fractions were simultaneously assayed on a Tosoh G8 analyzer and expressed as %. l-HbA1c results were compared with serum glucose and HbA1c. Concomitantly, RBC distribution width (RDW) was determined on a Sysmex SN analyzer as a marker for erythrocyte life span. RESULTS: l-HbA1c could be measured with between-run coefficient of variations (CVs) between 2.2 and 2.3%. l-HbA1c correlated with both glycemia (r=0.80) and HbA1c results (r=0.73). In a multiple regression model (r2=0.752), glycemia and HbA1c were the most determining factors. To a lesser extent, RDW correlated with l-HbA1c (r=0.158). Furthermore, the l-HbA1c/HbA1c ratio weakly positively correlated with RDW (r=0.247). CONCLUSIONS: L-HBA1c represents an additional marker for monitoring the rapid occurrence of glycemic disorders that escape detection when using only HbA1c and blood glucose. RDW can be used as an indicator of atypical RBCs life span, in which the l-HbA1c fraction may be helpful.

CPAP Influence on Readily Available Inflammatory Markers in OSA-A Pilot Study.

Obstructive sleep apnea (OSA) is characterized by repetitive upper airway collapse, chronic hypoxia and a proinflammatory phenotype. The purpose of our study was to evaluate readily available inflammatory biomarkers (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell count (WBC), red cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), WBC-to-MPV ratio (WMR) and lymphocyte-to-C-reactive protein ratio (LCR)) before and after CPAP in patients with moderate-severe OSA. We performed a prospective study that included patients with newly-diagnosed moderate-severe OSA. The control groups (patients without OSA and with mild OSA) were selected from the hospital polygraphy database. All subjects underwent routine blood panel, which was repeated in moderate-severe OSA patients after 8 weeks of CPAP. Our final study group included 31 controls, 33 patients with mild, 22 patients with moderate and 37 patients with severe OSA. CRP, ESR, NLR and WMR were correlated with OSA severity. After 8-week CPAP therapy, we documented a decrease in weight status, which remained statistically significant in both CPAP-adherent and non-adherent subgroups. Readily available, inexpensive inflammatory parameters can predict the presence of moderate-severe OSA, but are not influenced by short-term CPAP.

Red Cell Distribution Width (RDW) and Complete Blood Cell Count-Derived Measures in Non-Arteritic Anterior Ischemic Optic Neuropathy.

Purpose: To assess the role of complete blood cell count (CBC) dimensional indices and CBC-derived measures in non-arteritic anterior ischemic optic neuropathy (NA-AION). Methods: In this retrospective case-control survey, 37 newly diagnosed NA-AION patients and 37 sex- and age-matched cataract controls were enrolled in 2017-2018. On the same day of NA-AION diagnosis, a blood sample was collected and CBC was determined using an automatic blood counter. CBC dimensional indices, such as mean platelet volume (MPV) and red cell distribution width (RDW), and CBC-combined indices, including neutrophil/lymphocyte ratio (NLR), derived NLR [dNLR = neutrophils/(white blood cells - neutrophils)], and platelet/lymphocyte ratio (PLR), were evaluated. Erythrocyte sedimentation rate (ESR) was also measured. Results: Mean platelet count, median MPV, RDW, NLR, and dNLR were 221±48 x 109/L, 8.2 fL (IQR=7.6-8.9), 13% (IQR=12-14.5), 2.50 (IQR=1.77-3.06), and 1.73 (IQR=1.31-2.07) in NA-AION patients and 248±56 x 109/L, 7.60 fL (IQR=7.05-8.25), 12% (IQR=11.6-13), 1.95 (IQR=1.43-2.49) and 1.36 (IQR=1.07-1.69) in controls. NA-AION patients showed significantly lower platelet count (p=0.03) and significantly higher median values of MPV (p=0.01), RDW (p=0.015), NLR (p=0.03), and dNLR (p=0.01). Multivariate logistic regression models disclosed a significant correlation only between higher levels of RDW and NA-AION (p≤0.05). The attributable risk of the association between NA-AION and RDW was 33%. Conclusions: Results suggest that RDW may be somehow involved in the pathogenesis of NA-AION. However, high-quality cohort studies are warranted to confirm whether, or not, an altered RDW may be considered a potential biomarker of this vascular disorder affecting the optic nerve.

Red cell distribution width and its association with retinopathy of prematurity.

OBJECTIVE: The aim of this study was to evaluate whether there is a relationship between red cell distribution width (RDW) values and the development of retinopathy of prematurity (ROP) in premature infants. METHODS: This retrospective study was conducted on a total of 159 infants with gestational age (GA) < 35 weeks including 77 infants diagnosed as ROP (patients' group) and 82 infants without ROP (control group) between September 2015 and January 2018. RDW values of the preterm infants were obtained from their medical records (routine postpartum cord blood sample and follow-up venous blood samples taken at first week, second week and first month). The possible relationship between RDW values and clinical features of ROP development was evaluated. RESULTS: The mean GA of all infants was 29.2 ± 2.4 (24-35) weeks, and the mean birth weight was 1268 ± 419 (550-2500) g. The RDW values measured in the first and the second weeks were significantly higher in infants with ROP compared with those wihout ROP (p < .001 for both). There was no statistically significant difference between the groups in terms of cord blood and first month RDW values (p = .719, p = .108, respectively). The first and second week's RDW values of infants with ROP requiring treatment (severe ROP) were significantly higher than those of infants with ROP not requiring treatment (mild ROP) (p = .005, p = .031, respectively), but no statistically significant difference was observed between the groups in terms of cord blood and first month values (p = .114 and p = .371, respectively). CONCLUSION: RDW is an easily accessible and inexpensive marker that may reflect the clinical risk factors for ROP. Follow-up measures of RDW have the potential to help clinicians for the prediction of ROP development in the first 2 weeks postnatally.

Red Cell Distribution Width and Mortality in Hemodialysis Patients.

BACKGROUND: Red cell distribution width (RDW) is an index of red blood cell volume variability that has historically been used as a marker of iron deficiency anemia. More recently, studies have shown that elevated RDW is associated with higher mortality risk in the general population. However, there is lack of data demonstrating the association between RDW and mortality risk in hemodialysis (HD) patients. We hypothesized that higher RDW is associated with higher mortality in HD patients. STUDY DESIGN: Retrospective observational study using a large HD patient cohort. SETTING & PARTICIPANTS: 109,675 adult maintenance HD patients treated in a large dialysis organization from January 1, 2007, to December 31, 2011. PREDICTOR: Baseline and time-varying RDW, grouped into 5 categories: <14.5%, 14.5% to <15.5%, 15.5% to <16.5%, 16.5% to <17.5%, and ≥17.5%. RDW of 15.5% to <16.5% was used as the reference category. OUTCOME: All-cause mortality. RESULTS: Mean age of study participants was 63±15 (SD) years and the study cohort was 44% women. In baseline and time-varying analyses, there was a graded association between higher RDW and incrementally higher mortality risk. Receiver operating characteristic, net reclassification analysis, and integrated discrimination improvement analyses demonstrated that RDW is a stronger predictor of mortality as compared with traditional markers of anemia, such as hemoglobin, ferritin, and iron saturation values. LIMITATIONS: Lack of comprehensive data that may be associated with both RDW and HD patient outcomes, such as blood transfusion data, socioeconomic status, and other unknown confounders; therefore, the possibility of residual confounding could not be excluded. Also, lack of information for cause of death; thus, cardiovascular mortality outcomes could not be examined. CONCLUSIONS: In HD patients, higher RDW is associated with incrementally higher mortality risk. RDW is also a stronger predictor of mortality than traditional laboratory markers of anemia. Further studies are needed to determine the mechanisms underlying the association between RDW and mortality.

Combination of red cell distribution width and American Society of Anesthesiologists score for hip fracture mortality prediction.

UNLABELLED: The prognostic value of red cell distribution width (RDW) and a combination of RDW and the American Society of Anesthesiologists (ASA) score for long-term hip fracture mortality remains unknown. Our data showed that both RDW and ASA were independent risk predictors. A combination of these two parameters may provide a more powerful strategy for the prediction of hip fracture mortality. INTRODUCTION: Red cell distribution width (RDW) has recently been suggested as an independent predictor of prognosis in a variety of disorders. The American Society of Anesthesiologists (ASA) system has been widely used to stratify patients for outcome evaluations. However, the prognostic value of RDW and a combination of RDW and the ASA score for long-term hip fracture mortality has yet to be studied. METHODS: This prospective cohort study included 1402 subjects from 2000 to 2011 with a follow-up study over a 2 year period. Cox proportional hazards models with a bootstrap validation were used to evaluate associations of RDW, ASA, and a combination of both with long-term mortality. The global fit and the area under the receiver operating characteristic (ROC) curve (AUC) for model discrimination were further analyzed. RESULTS: Both RDW and ASA exhibited as independent risk predictors of 2-year mortality. The population with elevation of either RDW or ASA increased the risk of mortality (bootstrap validated hazard ratio (HR) 1.971 95 % confidence interval (CI) [1.336-3.005] p < 0.01) while those with an increase in both assessments (bootstrap validated HR 2.667 95 % CI [1.526-4.515] p < 0.01) were at the highest risk for mortality. The addition of the combination of ASA and RDW improved the discrimination power of risk prediction models (AUC increased from 0.700 to 0.723, p < 0.05). CONCLUSION: Both RDW and ASA exhibited as independent risk predictors of 2-year hip fracture mortality. The combination of these two readily available parameters may provide a more powerful and effective strategy for the assessment of all-cause mortality in hip fracture patients.

Prognostic value of hematological parameters in patients undergoing esophagectomy for esophageal squamous cell carcinoma.

BACKGROUND: It is now widely recognized that outcomes in cancer patients are not determined by their tumor characteristics alone. In this study, we retrospectively analyzed the clinical data of esophageal cancer patients to evaluate the impact of red blood cell distribution width (RDW), platelet distribution width (PDW), and mean platelet volume (MPV) on cancer-specific survival (CSS). STUDY DESIGN: We retrospectively reviewed a database of 144 consecutive patients who underwent curative esophagectomy for esophageal squamous cell carcinoma at our institute between 2006 and 2014. RESULT: In multivariate analysis, pathological stage (pStage) (p = 0.0002) and a high RDW (p = 0.0300) were found to be independently associated with poor survival. Patients with a high RDW had a significantly poorer prognosis in terms of CSS than those with a low RDW (p = 0.004). Among non-elderly patients, multivariate analysis demonstrated that pStage (p = 0.0120), and a high RDW (p = 0.0092) were independent risk factors for a worse prognosis. In addition, non-elderly patients with a high RDW had a significantly poorer prognosis in terms of CSS than those with a low RDW (p = 0.0003). On the other hand, univariate analysis demonstrated that pStage (p = 0.0008) was the only significant risk factor for a poor prognosis in elderly patients. CONCLUSIONS: We confirmed that a high RDW was significantly associated with the CSS of esophageal cancer patients after curative esophagectomy. Furthermore, in non-elderly patients, a high RDW was a significant and independent predictor of poor survival.

The Role of New Morphological Parameters Provided by the BC 6800 Plus Analyzer in the Early Diagnosis of Sepsis.

BACKGROUND: Late diagnosis of sepsis is associated with adverse consequences and high mortality rate. The aim of this study was to evaluate the diagnostic value of hematologic research parameters, that reflect the cell morphology of blood cells, available on the BC 6800 plus automated analyzer (Mindray) for the early detection of sepsis. MATERIALS AND METHODS: A complete blood count (CBC) was performed by Mindray BC 6800 Plus Analyzer in 327 patients (223 with a confirmed diagnosis of sepsis following sepsis-3 criteria, 104 without sepsis), admitted at the Intensive Care Unit of the Novara's Hospital (Italy) and in 56 patients with localized infection. RESULTS: In univariate logistic regression, age, Hb, RDW, MO#, NMR, NeuX, NeuY, NeuZ, LymX, MonX, MonY, MonZ were associated with sepsis (p < 0.005). In multivariate analysis, only RDW, NeuX, NeuY, NeuZ, MonX and MonZ were found to be independent predictors of sepsis (p < 0.005). Morphological research parameters are confirmed to be predictors of sepsis even when analyzing the group with localized infection. CONCLUSIONS: In addition to already established biomarkers and basic CBC parameters, new morphological cell parameters can be a valuable aid in the early diagnosis of sepsis at no additional cost.

Predictive value of red cell distribution width for overlap syndrome in obstructive sleep apnea.

Purpose: Obstructive sleep apnea syndrome (OSAS) and chronic obstructive pulmonary disease (COPD) are prevalent disorders, and the concurrence so-called overlap syndrome (OVS) is not rare either. Early recognition of OVS is essential because this group is more prone to cardiovascular morbidities and requires effective multidisciplinary follow-up. This study aimed to evaluate RDW in patients with severe OSAS and investigate whether it can predict OVS. Patients and methods: 96 patients were retrospectively analyzed, of whom 66 were found to have severe OSAS alone and 30 OVS during diagnostic workups. Demographic, polysomnographic, and laboratory results, including RDW, were compared between groups. Multivariate logistic regression was used to determine independent associates of OVS. Results: Gender and body mass index (BMI) were similar, however, the mean age and RDW were higher in the OVS group (p:0.008, p:0.002). The increase in RDW remained significant after adjustment for age, BMI, and cardiovascular risk factors. An RDW value of >13.65% was shown to have a 78.3% sensitivity and 60% specificity for predicting OVS in severe OSAS (p:0.004). Conclusion: The results suggest that RDW can be a reliable indicator for diagnosing OVS in OSAS. It can help in identifying the subset of patients who would benefit from proper consultations and multidisciplinary follow-up, leading to appropriate treatment of each disease component and effective monitoring to prevent adverse cardiovascular outcomes.

Prognostic value of systemic inflammation response indexes obtained from the complete blood count in patients treated for advanced ovarian carcinoma in front line.

OBJECTIVE: Various systemic inflammation response indexes (SIRI) have repeatedly been described as prognostic factors in ovarian cancer. They have not been validated in prospective trials and published results are sometimes contradictory. We aimed to explore their role in a cohort of patients diagnosed with stage III and IV ovarian cancer treated at our institution. METHODS: We retrospectively examined the prognostic influence of the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the monocyte-to-lymphocyte ratio (MLR), the red cell distribution width (RDW), and the mean platelet volume (MPV). RESULTS: A total of 77 patients were analyzed. NLR > 2.243 at diagnosis, NLR before primary surgery, MLR at diagnosis, PLR > 289.1 at diagnosis, and PLR at diagnosis were significant in univariate Cox regression for progression-free survival, but none of them retained their significance in the multivariate Cox regression analysis. For overall survival, NLR > = 2.53 at diagnosis, MLR > = 0.245 at diagnosis, and PLR > = 198.3 at diagnosis resulted significant in univariate COX regression; only PLR > = 198.3 at diagnosis retained its significance in the multivariate analysis. CONCLUSION: In our cohort, PLR > = 198.3 was an independent prognostic factor for worse OS. The definitive role of SIRI in ovarian cancer has not yet been established. If their value as prognostic factors could finally be established, they would become a simple and economical method to predict prognosis in patients with advanced ovarian cancer. Therefore, it is time to conduct prospective, multicenter studies with larger samples to definitively establish its role in ovarian cancer, if any.

Association of red cell distribution width with the risk of 3-month readmission in patients with heart failure: A retrospective cohort study.

Background: In recent years, red cell distribution width (RDW) has been found to be associated with the prognosis of patients with heart failure (HF) in Western countries. However, evidence from Asia is limited. We aimed to investigate the relationship between RDW and the risk of 3-month readmission in hospitalized Chinese HF patients. Methods: We retrospectively analyzed HF data from the Fourth Hospital of Zigong, Sichuan, China, involving 1,978 patients admitted for HF between December 2016 and June 2019. The independent variable in our study was RDW, and the endpoint was the risk of readmission within 3 months. This study mainly used a multivariable Cox proportional hazards regression analysis. Smoothed curve fitting was then used to assess the dose-response relationship between RDW and the risk of 3-month readmission. Results: In the original cohort of 1,978 patients with HF (42% male and 73.1% aged ≥70 years), 495 patients (25.0%) were readmitted within 3 months after discharge. Smoothed curve fitting showed a linear correlation between RDW and the risk of readmission within 3 months. In the multivariable-adjusted model, every 1% increase in RDW was associated with a 9% increased risk of readmission within 3 months (hazard ratio = 1.09, 95% confidence interval: 1.00-1.15; P < 0.005). Conclusions: A higher RDW value was significantly associated with a greater risk of 3-months readmission in hospitalized patients with HF.

Red cell distribution width-a potential prognostic indicator for colorectal cancer patients after radical resection in China.

Background: Red cell distribution width (RDW) can signal poor prognosis in inflammatory medical conditions. The purpose of the study was to investigate the relationship between preoperative RDW and colorectal cancer (CRC) in a large cohort of patients. Methods: A total of 6,224 CRC patients who underwent radical resection at the Fudan University Shanghai Cancer Center were evaluated retrospectively. The prognostic significance of RDW for overall survival (OS) and disease-free survival (DFS) was analyzed using Cox proportional hazards models and Kaplan-Meier method. Propensity score matching (PSM) was used based on survival confounding factors. Results: The mean age of the study participants was 59.5±12.0 years and the study cohort was 44% female. The overall median and mean RDW values were 13.3% and 14.0%, respectively. Patients were stratified into three groups based on their RDW value (≤13.3%, 13.4-14.0%, and >14.0%). OS and DFS were shown to significantly deteriorate with increasing RDW category. In the PSM population, OS and DFS were significantly lower in the high RDW group compared with matched controls. However, the differences vanished in the comparisons between the middle RDW group and the control group. Conclusions: Our findings demonstrate that preoperative RDW may represent a simple and powerful prognostic factor for CRC patients after radical resection. Integrating RDW into clinical practice may better inform the prognosis and optimize therapeutic approaches for patients with CRC.

Is red distribution width a valid tool to predict impaired iron transport in heart failure?

Background: Impaired iron transport (IIT) is a form of iron deficiency (ID) defined as transferrin saturation (TSAT) < 20% irrespective of serum ferritin levels. It is frequently observed in heart failure (HF) where it negatively affects prognosis irrespective of anaemia. Objectives: In this retrospective study we searched for a surrogate biomarker of IIT. Methods: We tested the predictive power of red distribution width (RDW), mean corpuscular volume (MCV) and mean corpuscular haemoglobin concentration (MCHC) to detect IIT in 797 non-anaemic HF patients. Results: At ROC analysis, RDW provided the best AUC (0.6928). An RDW cut-off value of 14.2% identified patients with IIT, with positive and negative predictive values of 48 and 80%, respectively. Comparison between the true and false negative groups showed that estimated glomerular filtration rate (eGFR) was significantly higher (p = 0.0092) in the true negative vs. false negative group. Therefore, we divided the study population according to eGFR value: 109 patients with eGFR ≥ 90 ml/min/1.73 m2, 318 patients with eGFR 60-89 ml/min/1.73 m2, 308 patients with eGFR 30-59 ml/min/1.73 m2 and 62 patients with eGFR < 30 ml/min/1.73 m2. In the first group, positive and negative predictive values were 48 and 81% respectively, 51 and 85% in the second group, 48 and 73% in the third group and 43 and 67% in the fourth group. Conclusion: RDW may be seen as a reliable marker to exclude IIT in non-anaemic HF patients with eGFR ≥60 ml/min/1.73 m2.

Role of Routine Blood Parameters in Predicting Mortality Among Surgical Patients With Sepsis.

BACKGROUND: Outcome prediction for surgical patients with sepsis may be conducive to early aggressive interventions. In several studies, changes in the level of numerous biomarkers like red cell distribution width (RDW), platelet count (PC), mean platelet volume (MPV), and platelet distribution width (PDW) have been demonstrated to be associated with mortality in critically ill patients. We aimed at investigating the prognostic significance of dynamic changes in RDW, PC, MPV, and PDW in surgical patients with sepsis. METHODS: We prospectively enrolled 110 surgical patients of sepsis in our study admitted to the surgical ward and ICU. We measured RDW, PC, MPV, and PDW on days 1, day 4, and day 8. Receiver operating characteristics (ROC) were generated for prognostic validation of these parameters and mortality in surgical patients with sepsis.  Results: We found that higher RDW and PDW on day 1 among non-survivors as compared to survivors on day 1 were significantly associated with mortality. ROC curves showed that RDW and PDW on day 1 could be used to predict mortality in surgical patients with sepsis and it was dynamic changes in PC on day 4 and day 8 along with a change in MPV on day 8, which was significantly associated with mortality. CONCLUSION: The major findings of our study were baseline value of RDW and PDW on day 1 and continuous decrease in PC and increase in MPV over one week were significantly associated with mortality. So, it is better to monitor dynamic changes in PC and MPV in combination with baseline RDW and PDW. So, these parameters can be promising markers to assess prognosis in surgical patients with sepsis.

Red Blood Cell Deformation and Progressive Anemia Following Therapeutic Intervention in Patients With Adult T-Cell Leukemia/Lymphoma.

OBJECTIVES: During therapeutic intervention for adult T-cell leukemia-lymphoma (ATLL), transient red blood cell (RBC) deformations and rapid anemia progression are often observed. These RBC responses are characteristically observed during the treatment of ATLL, and we examined the details and significance of these RBC responses. METHODS: Seventeen patients with ATLL were enrolled. Peripheral blood smears and laboratory findings were collected during the first two weeks after treatment intervention. We examined the transition of erythrocyte morphology and the factors associated with the induction of anemia. RESULTS: RBC abnormalities (i.e., elliptocytes, anisocytosis, and schistocytes) rapidly progressed following therapeutic intervention in five of the six cases for whom evaluable consecutive blood smears were available, with significant improvement evident after two weeks. Changes in RBC morphology were significantly associated with the red cell distribution width (RDW). Laboratory findings from all 17 patients showed various levels of anemia progression. A transient increase in RDW values was observed in 11 cases after therapeutic intervention. The degree of progressive anemia during the two-week period was significantly correlated with increased lactate dehydrogenase and soluble interleukin-2 receptor levels and an increase in RDW (P <0.01). CONCLUSIONS: In cases of ATLL, transient progression of RBC morphological abnormalities and RDW value were observed early after therapeutic intervention. These RBC responses may be associated with tumor and tissue destruction. RBC morphology or RDW values may provide important information about the tumor dynamics and general condition of the patients.

Red Blood Cell Distribution Width as a Predictive Biomarker for Postoperative Infections in Children Who Underwent Cardiac Surgery: A Single-Center Retrospective Study.

Background It has been investigated that red blood cell distribution width (RDW) is associated with the clinical outcomes of patients following surgeries and is used as a prognostic biomarker for postsurgical complications. In this study, we aimed to assess the value of RDW as a predictor of postoperative complications in children after cardiac surgeries. Methods Three hundred fifty-five pediatric patients who underwent cardiac surgery between 2017 and 2018 were enrolled, and preoperative and postoperative RDW values were determined. Data collected included demographics; incidence of postsurgical complications, including sepsis, surgical site infections (SSIs), urinary tract infections (UTIs), and ventilator-associated pneumonia (VAP); length of hospital and pediatric cardiac intensive care unit (PCICU) stay; and ventilator duration. Results Among children who underwent cardiac surgery, 29 (8.2%) of the cases developed bloodstream infections (BSIs), while urinary tract infections (UTIs) were observed in 32 (9.0%) of the cases, and ventilator-associated pneumonia (VAP) was observed in 36 of the cases (10.1%). Of all cases, surgical site infections (SSIs) were reported in 13 patients (3.7%). Significantly higher postoperative RDW levels were observed on days three (p-value=0.028), five (p-value=0.041), and seven (p-value=0.042) in cases of BSI. For UTI cases, only preoperative RDW levels (p<0.001) and postoperative day three RDW levels (p<0.049) were significantly higher than their counterparts. VAP cases had significantly higher RDW levels pre-operatively (p-value=0.002), which was also observed in postoperative RDW levels on days three (p-value=0.033), five (p-value=0.031), and seven (p-value=0.021) in comparison to their analogs (p-values<0.05). Furthermore, a significant relationship was found between preoperative RDW and length of intensive care unit (ICU) stay (95% CI 0.685-3.221, p-value=0.003, R2=0.104) and duration of mechanical ventilation (95% CI 0.549-1.938, p-value=0.001, R2=0.102). Conclusion RDW is a significant factor in predicting complications in pediatric patients' post-cardiac surgeries, including BSI, UTI, and VAP, which would consequently anticipate patients' clinical state after cardiac procedures.