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BACKGROUND: Despite the established negative regulatory effects observed in various diseases like cardiovascular disease and diabetes, the distinct impact of red cell distribution width (RDW) to albumin ratio (RAR) on mortality within the realm of rheumatoid arthritis (RA) remains obscure. This study sought to explore the relationship between RAR and mortality in RA patients. METHODS: A cohort of 2151 adults with RA from the National Health and Nutrition Examination Survey (NHANES) spanning 2003-2016 was analyzed for RAR levels derived from red cell distribution width and albumin concentrations. Utilizing Cox regression analysis, Kaplan-Meier curves, and Restricted Cubic Spline (RCS) models, we assessed the association between RAR levels and RA mortality while adjusting for potential confounding variables. RESULTS: Participants with higher RAR had a twofold to threefold increased risk of all-cause (HR = 3.10, 95% CI: 2.26-4.24) and cardiovascular mortality (HR = 2.46, 95%CI: 1.26-4.79) versus lower RAR. Kaplan-Meier analysis revealed that the higher RAR group had a significantly lower survival rate compared to the lower RAR group for both all-cause and cardiovascular mortality (both p < .0001), with a more pronounced effect observed for all-cause mortality. Furthermore, the RCS-fitted Cox regression model illustrated a nonlinear positive correlation between RAR levels and RA mortality. CONCLUSION: Overall, a higher RAR was associated with an increased risk mortality in RA patients. These findings underscore the potential of RAR as a prognostic biomarker in predicting outcomes in RA.
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Artritis Reumatoide , Biomarcadores , Índices de Eritrocitos , Encuestas Nutricionales , Humanos , Artritis Reumatoide/sangre , Artritis Reumatoide/mortalidad , Artritis Reumatoide/diagnóstico , Masculino , Femenino , Persona de Mediana Edad , Estados Unidos/epidemiología , Medición de Riesgo , Biomarcadores/sangre , Factores de Riesgo , Adulto , Causas de Muerte , Pronóstico , Anciano , Albúmina Sérica Humana/análisis , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/sangre , Valor Predictivo de las Pruebas , Factores de TiempoRESUMEN
BACKGROUND: Abnormal red blood cell distribution width (RDW) is associated with poor cardiovascular, respiratory, and coronavirus disease 2019 (COVID-19) outcomes. However, whether RDW provides prognostic insights regarding COVID-19 patients admitted to the intensive care unit (ICU) was unknown. Here, we retrospectively investigated the association of RDW with 30-day and 90- day mortalities, duration of mechanical ventilation, and length of ICU and hospital stay in patients with COVID-19. METHODS: This study included 321 patients with COVID-19 aged >18 years who were admitted to the ICU between March 2020 and July 2022. The outcomes were mortality, duration of mechanical ventilation, and length of stay. RDW >14.5% was assessed in blood samples within 24 hours of admission. RESULTS: The mortality rate was 30.5%. Multivariable Cox regression analysis showed an association between increased RDW and 30-day mortality (hazard ratio [HR], 3.64; 95% CI, 1.54-8.65), 90-day mortality (HR, 3.66; 95% CI, 1.59-8.40), and shorter duration of invasive ventilation (2.7 ventilator-free days, P=0.033). CONCLUSIONS: Increased RDW in COVID-19 patients at ICU admission was associated with increased 30-day and 90-day mortalities, and shorter duration of invasive ventilation. Thus, RDW can be used as a surrogate biomarker for clinical outcomes in COVID-19 patients admitted to the ICU.
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INTRODUCTION: Diabetes mellitus type 2 (T2DM) is a metabolic disorder, and its prevalence is rising worldwide. The objective of the study was to investigate the association between mean platelet volume (MPV) and red cell distribution width (RDW) and the glycemic control marker HbA1c. So MPV and RDW could be used as prognostic indicators of deterioration of gluco-regulation in diabetes mellitus type 2 and the associated microvascular complications. METHODOLOGY: A cross-sectional study was conducted on 216 type 2 diabetic patients, who were divided into two groups based on HbA1c values (<7% and >7%). Red blood cell distribution width, mean platelet volume, plasma glucose estimation, fasting lipid profile, spot urine albumin creatinine ratio (ACR), direct ophthalmoscopic examination, and nerve conduction study were tested in all the patients. RESULTS: Of the 216 individuals diagnosed with type 2 diabetes mellitus, 210 exhibited inadequate glycemic control, establishing a statistically significant correlation with triglyceride levels, mean platelet volume, and blood sugar levels. The study revealed a significant association between MPV and RDW and HbA1c levels. Additionally, microvascular complications such as retinopathy, proteinuria, and neuropathy exhibited strong correlations in this patient cohort, emphasizing the interconnectedness of glycemic control and various health indicators in individuals with T2DM. CONCLUSION: This study provides significant results that mean platelet volume and red cell distribution can be used as markers in the diagnosis of microvascular complications in type 2 diabetes mellitus.
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OBJECTIVE: Diabetic foot ulcers are common chronic complications of diabetes mellitus that can lead to amputation and death in severe cases. There is limited research on the relationship between the red cell distribution width/albumin ratio and diabetic lower-extremity ulcers. The few studies that have been conducted have been in single-center inpatient settings and there is limited research in outpatient settings. This study investigated this relationship in adult outpatient clinics in the United States. METHODS: A retrospective cross-sectional study was conducted with 1624 participants of the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004. Three logistic regression models were developed to assess the association between red cell distribution width/albumin ratio and diabetic lower-extremity ulcers. The ratio was analyzed as a continuous and categorical variable. Stratified analyses were performed based on age, sex, HbA1c level, and body mass index. RESULTS: The study included 1624 adults, with a mean age of 65.0 ± 12.0 years, of whom 58.8% were male. The prevalence of diabetic lower-extremity ulcers was 8.0% (n = 131). Compared with individuals with a lower red cell distribution width/albumin ratio in T1(2.32,2.93), the adjusted OR values for the ratio and ulcers in T2(2.94,3.26), T3(3.27,7.42), and 2.07 (95% CI = 1.19â¼3.61), 2.92 (95% CI = 1.63â¼5.23). The association between the ratio and ulcers exhibited a non-linear relationship (nonlinear, P = .028). CONCLUSION: These results support the hypothesis of an S-shaped relationship between red cell distribution width/albumin and diabetic lower-extremity ulcers. Monitoring the RDW/Albumin ratio could be crucial for preventing diabetic lower-extremity ulcers in outpatient settings. Regular assessments may help identify high-risk patients early, enabling timely interventions. Future studies should further assess these two factors and their underlying mechanisms.
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Aim: To explore the association of Hemoglobin-to-Red Cell Distribution Width Ratio (HRR) with the risk of three-month unfavorable outcomes in acute ischemic stroke (AIS). Methods: A secondary analysis was conducted based on a prospective cohort study. A total of 1,889 patients with AIS treated in South Korea from January 2010 to December 2016 were enrolled. Multivariable logistic regression was conducted to investigated the independent relationship between HRR and risk of three-month unfavorable outcomes in AIS. Fitted smoothing curves were used to determine non-linear correlations. The recursive method was employed to explore the turning point and build a two-piece linear regression model. In addition, a set of subgroup analyses were carried out to evaluate the relationship between HRR and risk of three-month unfavorable outcomes. Results: Multivariate analysis in which potential confounders were adjusted for indicated that the risk of unfavorable outcomes was reduced by 10% for each unit increased of HRR [OR = 0.90, 95% CI: 0.84-0.96, p = 0.0024]. In addition, a non-linear relationship was observed between HRR and risk of three-month unfavorable outcomes, which had an inflection point of HRR was 10.57. The effect sizes and the confidence intervals on the left side of the inflection point were 0.83 (0.75, 0.91), p = 0.0001. On the right side of the inflection point, no association was found between HRR and the risk of three-month unfavorable outcomes. Conclusion: This study demonstrates a negative association between HRR and risk of three-month unfavorable outcomes. The relationship between HRR and risk of three-month unfavorable outcomes is non-linear. The correlation is negative for HRR values less than 10.57. For, HRR higher than 10.57, HRR is not associated with the risk of three-month unfavorable outcomes.
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BACKGROUND: Higher red blood cell distribution width (RDW) levels are associated with mortality in patients with chronic obstructive pulmonary disease (COPD). However, more convincing evidence is still lacking, and the relationship between hemoglobin-to-red blood cell distribution width ratio (HRR) and mortality in patients with COPD remains unclear. METHODS: This study is a prospective cohort study that includes 3,745 adult patients with COPD from the National Health and Nutrition Examination Survey (NHANES) database spanning from 1999 to 2018 in the United States. COX proportional hazards regression analysis, Kaplan-Meier survival curves and restricted cubic spline models were employed to investigate the association of RDW and HRR levels with mortality. Time-dependent receiver operating characteristic curve (ROC) analysis was conducted to evaluate the accuracy of RDW and HRR in predicting mortality in patients with COPD. RESULTS: Higher RDW level was positively associated with increased risk of all-cause mortality (HR = 1.16, 95% CI = 1.11-1.21, P < 0.001), cardiovascular disease (CVD) mortality (HR = 1.13, 95% CI = 1.06-1.21, P < 0.001), and chronic lower respiratory disease (CLRD) related mortality (HR = 1.15, 95% CI = 1.05-1.25, P = 0.003) after adjusting for various potential confounders. HRR was inversely associated with all-cause mortality (HR = 0.14, 95% CI = 0.08-0.25, P < 0.001), CVD mortality (HR = 0.12, 95% CI = 0.05-0.31, P < 0.001). HRR has no significant correlation with CLRD-related mortality. The time-dependent ROC curve showed that RDW exhibited area under the curves (AUCs) of the 5- and 10-year survival rates were 0.707 and 0.714 for all-cause mortality and 0.686 and 0.698, respectively, for CVD mortality. HRR yielded AUCs of the 5- and 10-year survival rates were 0.661 and 0.653 for all-cause mortality and 0.654 and 0.66, respectively, for CVD mortality. CONCLUSION: Higher RDW levels were positively associated with an increased risk of mortality in patients with COPD. HRR levels were negatively correlated with the risk of all-cause and CVD mortality. The predictive value of HRR for mortality in these patients is lower than that of RDW.
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Índices de Eritrocitos , Hemoglobinas , Encuestas Nutricionales , Enfermedad Pulmonar Obstructiva Crónica , Humanos , Enfermedad Pulmonar Obstructiva Crónica/sangre , Enfermedad Pulmonar Obstructiva Crónica/mortalidad , Masculino , Femenino , Persona de Mediana Edad , Anciano , Estudios Prospectivos , Estados Unidos/epidemiología , Hemoglobinas/análisis , Curva ROC , Modelos de Riesgos Proporcionales , Estimación de Kaplan-Meier , Valor Predictivo de las PruebasRESUMEN
The red cell distribution width (RDW) is a standard variable reported in the complete blood count. It has been found to have a consistent relationship to life expectancy in older individuals, prognosis in patients with cardiovascular disease, outcome in those with hematological and non-hematological neoplasms and in a variety of medical circumstances such as non-cardiovascular or cancer related critical illness and postoperative outcome from various procedures. This report reviews some of the key medical publications establishing these relationships with RDW. The precise pathobiological processes that explain the predictive value of the RDW in this wide array of circumstances or why an alteration in erythropoiesis (exaggerated red cell size variation) occurs is uncertain. The possible role of inflammation has been one hypothesis considered, but not established.
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Índices de Eritrocitos , Humanos , Pronóstico , Eritrocitos/patología , Eritrocitos/metabolismo , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/etiología , Neoplasias/sangre , Neoplasias/diagnóstico , EritropoyesisRESUMEN
BACKGROUND: Systemic inflammation impairs outcomes in acute ischemic stroke (AIS). There is limited knowledge regarding the prognostic value of inflammatory biomarkers derived from complete blood count in predicting in-hospital mortality (IHM) in AIS patients treated with recombinant tissue plasminogen activator (rt-PA). Our study aims to compare the predictive performance of various inflammatory biomarkers for predicting IHM in AIS patients. METHODS: This retrospective study included AIS patients treated with rt-PA between January 2015 and July 2022. We identified the following inflammatory biomarkers: white blood cell counts (WBCs), absolute neutrophil count, absolute lymphocyte count, neutrophil to lymphocyte count ratio, platelet to neutrophil ratio, platelet to lymphocyte ratio, red cell distribution width (RDW), RDW to platelet ratio (RPR), and hemoglobin to RDW (HB/RDW) at admission before rt-PA administration. We assessed the predictive value of these biomarkers for IHM by plotting receiver operating characteristic (ROC) curves. The associations between inflammatory biomarkers and IHM were analyzed using multivariable logistic regression (MVLR) analyses. RESULTS: Of 345 AIS patients, IHM occurred in 65 patients (18.84%). HB/RDW and RDW showed better predictive performance compared to other inflammatory biomarkers. In ROC curve analysis, HB/RDW and RDW had an area under ROC of 0.668. HB/RDW outperformed RDW in terms of the positive likelihood ratio (2.733 vs 1.575), accuracy (0.757 vs 0.585), specificity (0.814 vs 0.560), and positive predictive values (0.388 vs 0.267). In MVLR analysis, RDW, RPR, and HB/RDW remained significantly associated with IHM (per 1-unit increases: odds ratios (ORs) = 1.450, 95% CI: [1.178-1.784]; per 1-unit increases: ORs = 1.329, 95% CI [1.103-1.602]; and per 0.1-unit decreases: ORs = 1.412, 95% CI [1.089-1.831], respectively). CONCLUSIONS: The association between HB/RDW and IHM in AIS patients treated with rt-PA was significant. HB/RDW exhibited superior predictive performance compared to other inflammatory biomarkers in predicting IHM.
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Biomarcadores , Índices de Eritrocitos , Fibrinolíticos , Hemoglobinas , Mortalidad Hospitalaria , Accidente Cerebrovascular Isquémico , Valor Predictivo de las Pruebas , Terapia Trombolítica , Activador de Tejido Plasminógeno , Humanos , Masculino , Femenino , Estudios Retrospectivos , Accidente Cerebrovascular Isquémico/sangre , Accidente Cerebrovascular Isquémico/mortalidad , Accidente Cerebrovascular Isquémico/diagnóstico , Accidente Cerebrovascular Isquémico/tratamiento farmacológico , Anciano , Biomarcadores/sangre , Persona de Mediana Edad , Hemoglobinas/metabolismo , Hemoglobinas/análisis , Terapia Trombolítica/efectos adversos , Medición de Riesgo , Activador de Tejido Plasminógeno/efectos adversos , Activador de Tejido Plasminógeno/sangre , Activador de Tejido Plasminógeno/administración & dosificación , Resultado del Tratamiento , Factores de Riesgo , Fibrinolíticos/efectos adversos , Fibrinolíticos/administración & dosificación , Fibrinolíticos/uso terapéutico , Mediadores de Inflamación/sangre , Anciano de 80 o más Años , Factores de TiempoRESUMEN
BACKGROUND AND AIMS: This study aimed to quantify adverse perinatal outcomes (APO), including small/large for gestational age (SGA/LGA) and preterm birth (PTB), in pregnant women with abnormal red cell distribution width (RDW) and explore the related mechanisms. METHODS: This study included 11,659 pregnant women who delivered in a specialized hospital. At the time of admission, the lipid profiles and whole blood cell counts were assessed, and APO was analyzed. RESULTS: Women with high RDW (>18.5% [the 97.5th percentile]) in late pregnancy had a higher risk of LGA compared with those with low RDW (<12.3% [the 2.5th percentile]), whereas women with low RDW had a higher risk of SGA and PTB, compared with those with high RDW. A 1% increase in RDW was associated with an increased risk of LGA and a decreased risk of SGA and PTB. Consistent associations were observed in sensitivity analysis among pregnant women of non-advanced age, non-obesity, non-pregnancy complications, and non-PTB (for SGA/LGA only). Increased RDW was significantly associated with increased triglycerides and decreased high-density lipoprotein cholesterol (HDL-C). Triglycerides and HDL-C significantly mediated 10.63 and 15.8% of RDW-associated LGA, 9.51% and 9.40 of RDW-associated SGA, and 8.44 and -8.25% of RDW-associated PTB, respectively. CONCLUSION: Abnormal RDW was associated with an increased risk of APO, and the RDW-associated APO risk could be partially mediated by triglycerides and HDL-C, suggesting that RDW may be a promising APO predictor.
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Background: Clinically useful predictors for risk stratification of long-term survival may assist in selecting patients for endovascular abdominal aortic aneurysm (EVAR) procedures. This study aimed to analyze the prognostic significance of peroperative novel systemic inflammatory markers (SIMs), including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), hemoglobin-to-red cell distribution width ratio (HRR), systemic immune-inflammatory index (SIII), and systemic inflammatory response index (SIRI), for long-term mortality in EVAR. Methods: A retrospective analysis was performed on 147 consecutive patients who underwent their first EVAR procedure at the Department of Vascular Surgery, Beijing Hospital. The patients were divided into the mortality group (n = 37) and the survival group (n = 110). The receiver operating characteristic curves were used to ascertain the threshold value demonstrating the most robust connection with mortality. The Kaplan-Meier survival analysis was performed between each SIM and mortality. The relationship between SIMs and survival was investigated using restricted cubic splines and multivariate Cox regression analysis. Results: The study included 147 patients, with an average follow-up duration of 34.28 ± 22.95 months. Deceased patients showed significantly higher NLR (p < 0.001) and reduced HRR (p < 0.001). The Kaplan-Meier estimates of mortality were considerably greater in the higher-NLR group (NLR > 2.77) and lower-HRR group (HRR < 10.64). The hazard ratio (HR) of 0.833 (95% confidence interval (95% CI): 0.71-0.97, p < 0.021) was determined to be statistically significant in predicting death in the multivariable analysis. Conclusions: Preoperative higher-NLR and lower-HRR have been associated with a lower long-term survival rate in abdominal aortic aneurysm (AAA) patients undergoing elective EVAR. Multivariate Cox regression showed that decreased preoperative HRR is an independent risk factor that increases mortality risk following EVAR. SIMs, such as the NLR and HRR, could be used in future clinical risk prediction methodologies for AAA patients undergoing EVAR. However, additional prospective cohort studies are needed to identify these findings.
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This letter addresses the study titled "Red cell distribution width: A predictor of the severity of hypertriglyceridemia-induced acute pancreatitis" by Lv et al published in the World Journal of Experimental Medicine. The study offers a valuable analysis of red cell distribution width (RDW) as a predictive marker for persistent organ failure in patients with hypertriglyceridemia-induced acute pancreatitis. The study results suggest that RDW, combined with the Bedside Index for Severity in Acute Pancreatitis score, could enhance the predictive accuracy for severe outcomes. Further investigation into the role of RDW in different severities of acute pancreatitis is recommended. Additionally, the need for large-scale and multicenter prospective studies to validate these findings is emphasized.
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OBJECTIVE: An elevated preoperative red cell distribution width (RDW) is associated with adverse prognostic outcomes in various diseases. However, the correlation between changes in RDW (ΔRDW) and the prognosis following brain tumor craniotomy remains unclear. Accordingly, this study aimed to investigate the prognostic significance of perioperative changes in RDW in patients undergoing brain tumor craniotomy. METHODS: This retrospective cohort study included patients undergoing craniotomy for brain tumors at West China Hospital, Sichuan University, from January 2011 to March 2021. We defined perioperative changes in RDW: group A (non-significant RDW changes, ΔRDW ≤0.4%), group B (drop in RDW, ΔRDW < -0.4%), and group C (rise in RDW, ΔRDW >0.4%). The relationship between the changes in RDW and all-cause mortality was analyzed by categorizing the patients according to perioperative ΔRDW (RDW at postoperative one week - RDW at admission). RESULTS: The present study included a total of 9589 patients who underwent craniotomy for the treatment of brain tumors. A rise in RDW was significantly associated with increased mortality, with an adjusted OR of 3.56 (95% CI: 2.56-4.95) for 30-day mortality and 1.57 (95% CI: 1.33-1.85) for one-year mortality compared to those with non-significant RDW changes (ΔRDW ≤0.4%). Conversely, a decrease in RDW showed no significant association with 30-day mortality (adjusted OR: 1.04, 95% CI: 0.53-2.04) and one-year mortality (adjusted OR: 1.18, 95% CI: 0.92-1.53). These findings were also supported by restricted cubic spline, which shows that increases in RDW were significantly associated with lower survival rates compared to stable RDW levels during the follow-up period. CONCLUSIONS: Among patients undergoing craniotomy for a brain tumor, a rise in RDW was associated with 30-day mortality and higher long-term mortality risks, even if patients' admissions for RDW values were within the normal range. It was worth noting that maintaining stable RDW levels during this period was associated with better survival.
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Neoplasias Encefálicas , Craneotomía , Índices de Eritrocitos , Humanos , Craneotomía/mortalidad , Estudios Retrospectivos , Femenino , Persona de Mediana Edad , Masculino , Neoplasias Encefálicas/cirugía , Neoplasias Encefálicas/mortalidad , Neoplasias Encefálicas/sangre , Adulto , Anciano , Pronóstico , China/epidemiología , Periodo PerioperatorioRESUMEN
BACKGROUND: Previous studies have shown that the red cell distribution width (RDW)/serum albumin ratio (RA) is an integrative and new inflammatory marker. RA is associated with clinical outcomes in a variety of diseases, but the clinical value of RDW/RA in the assessment of diabetic kidney disease (DKD) has not been elucidated. We examined the link between diabetic RA and DKD while controlling for a wide variety of possible confounders. METHODS: Retrospective cohort analysis of the National Health and Nutrition Examination Survey (NHANES: 2009-2018) database from the Second Affiliated Hospital and Yuying Children's Hospital and the Wenzhou Medical University (WMU) database was conducted. Multivariate logistic regression analysis was used to assess the association between RA and DKD. RESULTS: Overall, 4513 diabetic patients from the NHANES database (n = 2839) and the WMU (n = 1412) were included in this study; 974 patients were diagnosed with DKD in NHANES and 462 in WMU. In the NHANES cohort, diabetes mellitus (DM) patients with higher RA level had a higher risk of DKD (odds ratio = 1.461, 95% confidence interval: 1.250-1.707, p < 0.00001). After adjusting for confounders and propensity score-matched (PSM) analysis, both shown RA levels were independently linked to DKD (pAdjust = 0.00994, pPSM = 0.02889). Similar results were also observed in the WMU cohort (p < 0.00001). CONCLUSIONS: The study observes that the RA was an independent predictor of DKD in DM patients. The RA, a biomarker that is cost-effective and easy-to-access, may have potential for risk stratification of DKD.
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Biomarcadores , Nefropatías Diabéticas , Índices de Eritrocitos , Albúmina Sérica , Humanos , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Nefropatías Diabéticas/sangre , Nefropatías Diabéticas/diagnóstico , Nefropatías Diabéticas/etiología , Biomarcadores/sangre , Albúmina Sérica/análisis , Encuestas Nutricionales , Adulto , Anciano , Factores de RiesgoRESUMEN
Despite advancements in artificial intelligence-based decision-making, transitioning patients from intensive care units (ICUs) to low-acuity wards is challenging, especially in resource-limited settings. This study aimed to develop a simple scoring system to predict ICU discharge safety. We retrospectively analyzed patients admitted to a tertiary hospital's medical ICU (MICU) between July 2016 and December 2021. This period was divided into two phases for model development and validation. We identified risk factors associated with unexpected death within 14 days of MICU discharge and developed a predictive scoring system that incorporated these factors. We verified the system's performance using validation data. In the development cohort, 522 patients were discharged from the MICU, and 42 (8.04%) died unexpectedly. In multivariate analysis, the Sequential Organ Failure Assessment (SOFA) score (odds ratio [OR] 1.26, 95% confidence interval [CI] 1.13-1.41), red blood cell distribution width (RDW) (OR 1.20, 95% CI 1.07-1.36), and albumin (OR 0.37, 95% CI 0.16-0.84) were predictors of unexpected death. Each variable was assigned a weighted point in the scoring system, and the area under the curve (AUC) was 0.788 (95% CI 0.714-0.855). The scoring system was performed using an AUC of 0.738 (95% CI 0.653-0.822) in the validation cohort of 343 patients with 9.62% of unexpected deaths. When a cut-off of 0.032 was applied, a sensitivity and a specificity of 81.8% and 55.2%, respectively, were achieved. This simple bedside predictive score for ICU discharge uses the SOFA score, albumin level, and RDW to aid in timely decision-making and optimize critical care facility allocation in resource-limited settings.
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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.
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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.
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Background: Red blood cell distribution width (RDW) is being actively studied as a biomarker in various cardiovascular diseases (CVDs). The aim of this study was to conduct a comparative analysis of RDW in patients with carotid atherosclerosis, comparing it with an assessment of the severity of carotid artery stenosis (CAS). Methods: The Duplex registry database was used to conduct this retrospective cross-sectional study. The study participants underwent a complete blood count test, analysis for lipid profile, and carotid ultrasound. The patients were divided into 5 groups depending on CAS degree: none; 20%-49%; 50%-69%; 70%-99%; and occlusion. Results: Data from 2548 patients were included in the final analysis (mean age: 57.9 ± 12.3 years; 51% males [n = 1301]). The analysis confirmed the relationship between the increase in the RDW index and CAS gradation increase in men (Kr-W H = 16.43; P = 0.0009), but was not confirmed in women (Kr-W H = 4.32; P = 0.22). Significantly higher levels of high-density lipoprotein cholesterol and platelets and lower levels of red blood cell and white blood cells were registered in female patients without CAS and with CAS < 50% compared with men (P < 0.001). Conclusion: The results of the present study showed that RDW is an indicator whose increase is associated with an increase in the degree of carotid atherosclerosis in men, but not in women. This allows to discuss the role of the RDW index as a possible new laboratory biomarker of inflammation and progression of atherosclerosis, which can make an additional contribution to the formation of increased morbidity and mortality in men from atherosclerotic CVD.
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We evaluated RDW in a single-center series of 61 consecutive patients with primary and secondary MF at diagnosis and during treatment with ruxolitinib (RUX) and examined any possible prognostic impact. Elevated RDW values were present in all but 4 patients at diagnosis with a median RDW of 18.9%. RDW was higher in subjects with palpable splenomegaly (p = 0.02), higher ferritin, as well as among those cases who did not receive any cytoreduction before RUX (p = 0.04). Interestingly, higher RDW at diagnosis also correlated with a shorter time from MF diagnosis to RUX start (-4.1 months per one RDW unit; p = 0.03). We observed a modest increase (< 1%) in RDW during the first 6 months of RUX treatment. In a multivariable random-intercept model that considered all time points and contained the covariates time and RUX dose, we also observed a clear decrease in RDW with increasing hemoglobin (Hb) during RUX (slope: -0.4% per g/dL of Hb; p < 0.001). The median RDW at diagnosis of 18.9% was used as a cut-off to identify two subgroups of patients [Group 1: RDW 19.0-25.7%; Group 2: RDW 13.1-18.7%], showing a difference in mortality [Group 1 vs. 2: crude HR 2.88; p = 0.01]. Using continuous RDW at diagnosis, the crude HR was 1.21 per RDW unit (p = 0.002). In a Cox model adjusted for gender, age and Hb at diagnosis, the HR was 1.13 per RDW unit (p = 0.07). RDW may have prognostic significance at MF diagnosis and during RUX, helping in the rapid detection of patients with poor prognosis.
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Índices de Eritrocitos , Nitrilos , Mielofibrosis Primaria , Pirazoles , Pirimidinas , Humanos , Nitrilos/uso terapéutico , Pirazoles/uso terapéutico , Masculino , Femenino , Pirimidinas/uso terapéutico , Persona de Mediana Edad , Mielofibrosis Primaria/tratamiento farmacológico , Mielofibrosis Primaria/sangre , Mielofibrosis Primaria/mortalidad , Anciano , Pronóstico , Anciano de 80 o más Años , AdultoRESUMEN
BACKGROUND: Red cell distribution width (RDW) has been recognized as a potential inflammatory biomarker, with elevated levels associated with adverse outcomes in various diseases. However, its role in predicting outcomes after brain tumor craniotomy remains unclear. We aimed to assess whether preoperative RDW influences mortality and postoperative complications in patients undergoing brain tumor craniotomy. METHODS: This retrospective cohort study analyzed serum RDW levels in patients undergoing brain tumor craniotomy at West China Hospital. RDW was evaluated in two forms: RDW-CV and RDW-SD, and was categorized into four quartiles for analysis by using logistic regression and multivariate analysis to adjust for confounding. RESULTS: The study encompassed 10,978 patients undergoing brain tumor craniotomy. our analysis revealed no significant difference in 30-day mortality across various RDW-CV levels. However, we observed a dose-response relationship with preoperative RDW-CV levels in assessing long-term mortality risks. Specifically, patients with RDW-CV levels of 12.6-13.2% (HR 1.04, 95% CI 1.01-1.18), 13.2-13.9% (HR 1.12, 95% CI 1.04-1.26), and > 13.9% (HR 1.34, 95% CI 1.18-1.51) exhibited a significantly higher hazard of long-term mortality compared to those with RDW-CV < 12.6%. When preoperative RDW-CV was analyzed as a continuous variable, for each 10% increase in RDW-CV, the adjusted OR of long-term mortality was 1.09 (95% CI 1.05-1.13). we also observed significant associations between preoperative higher RDW-CV levels and certain postoperative complications including acute kidney injury (OR 1.46, 95% CI: 1.10-1.94), pneumonia infection (OR 1.19 95% CI: 1.05-1.36), myocardial infarction (OR 1.32, 95% CI: 1.05-1.66), readmission (OR 1.15, 95% CI: 1.01-1.30), and a prolonged length of hospital stay (OR 1.11, 95% CI: 1.02-1.21). For RDW-SD levels, there was no significant correlation for short-term mortality, long-term mortality, and postoperative complications. CONCLUSIONS: Our study showed elevated preoperative RDW-CV is significantly associated with increased long-term mortality and multiple postoperative complications, but no such association is observed with RDW-SD. These findings show the prognostic importance of RDW-CV, reinforcing its potential as a valuable tool for risk stratification in the preoperative evaluation of brain tumor craniotomy patients.
Asunto(s)
Neoplasias Encefálicas , Craneotomía , Índices de Eritrocitos , Complicaciones Posoperatorias , Humanos , Femenino , Masculino , Persona de Mediana Edad , Craneotomía/efectos adversos , Neoplasias Encefálicas/cirugía , Neoplasias Encefálicas/mortalidad , Estudios Retrospectivos , Complicaciones Posoperatorias/epidemiología , Adulto , AncianoRESUMEN
BACKGROUND: Hematoma expansion is a critical factor associated with increased mortality and adverse outcomes in patients with intracerebral hemorrhage (ICH). Identifying and preventing hematoma expansion early on is crucial for effective therapeutic intervention. This study aimed to investigate the potential association between the Red cell distribution width to lymphocyte ratio (RDWLR) and hematoma expansion in ICH patients. METHODS: We conducted a retrospective analysis of clinical data from 303 ICH patients treated at our department between May 2018 and May 2023. Demographic, clinical, radiological, and laboratory data, including RDWLR upon admission, were assessed. Binary logistic regression analysis was employed to determine independent associations between various variables and hematoma expansion. RESULTS: The study included 303 ICH patients, comprising 167 (55.1%) males and 136 (44.9%) females, with a mean age of 65.25 ± 7.32 years at admission. Hematoma expansion occurred in 73 (24.1%) cases. Multivariate analysis revealed correlations between hematoma volume at baseline (OR, 2.73; 95% CI: 1.45 -4,78; P < 0.001), admission systolic blood pressure (OR, 2.98 ; 95% CI: 1.54-4.98; P < 0.001), Glasgow Coma Scale (GCS) (OR, 1.58; 95% CI: 1.25-2.46; P = 0.017), and RDWLR (OR, 1.58; 95% CI: 1.13-2.85; P = 0.022) and hematoma expansion in these patients. CONCLUSIONS: Our findings suggest that RDWLR could serve as a new inflammatory biomarker for hematoma expansion in ICH patients. This cost-effective and readily available biomarker has the potential for early prediction of hematoma expansion in these patients.