Relationship between First Values of Red Cell Distribution Width, Mean Platelet Volume, Platelet Distribution Width, and Hospital Mortality in Acute Deep Venous Thrombosis.
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP
OBJECTIVE:To determine the relationship between red cell distribution width (RDW), mean platelet volume (MPV), platelet distribution width (PDW) values and mortality in acute deep vein thrombosis (DVT). STUDY DESIGN:Descriptive study. PLACE AND DURATION OF STUDY:Canakkale Onsekiz Mart University Health Practice and Research Hospital, Turkey, from 2015 to 2020. METHODOLOGY:Hospitalised cases of acute DVT were detected. Discharged patients (externe group -EG), mortal course (mortality group - MG) and control group ( healthy persons without thrombosis - CG) were formed. Statistical significance of the first values of RDW, MPV and PDW between groups was evaluated. In addition, the difference between the groups was evaluated according to the age, gender, platelet count, and level of the thrombosis (proximal, distal). RESULTS:There was a significant increase in RDW values between CG and EG (13.63 ± 1.37 vs. 15.97 ± 3.20; p=0.012), CG and MG (13.63 ± 1.37 vs. 17.85 ± 3.73; p=0.003). There was a significant increase in PDW values between CG and MG (16.78 ± 0.41 vs. 18.05 ± 1.07; p<0.001) and between EG and MG (16.98 ± 0.51 vs. 18.05 ± 1.07; p<0.001). There was no significant difference in other variables. CONCLUSION:The results show that increased RDW values may be associated with deep venous thrombosis; and increased PDW values may be associated with mortality. Following RDW and PDW values, which are fast, inexpensive and widely available, can be useful as an early predictor of thrombosis and poor prognosis. Key Words: Red cell distribution width, Mean platelet volume, Platelet distribution width, Deep venous thrombosis, Predictor, Mortality, Poor prognosis.
Risk of venous thromboembolism among hospitalizations of adults with selected autoimmune diseases.
Yusuf Hussain R,Hooper W Craig,Beckman Michele G,Zhang Qing C,Tsai James,Ortel Thomas L
Journal of thrombosis and thrombolysis
Previous research has suggested autoimmune diseases are risk factors for developing venous thromboembolism (VTE). We assessed whether having diagnoses of selected autoimmune diseases associated with antiphospholipid antibodies--autoimmune hemolytic anemia (AIHA), immune thrombocytopenic purpura (ITP), rheumatoid arthritis (RA), and systemic lupus erythematosus (SLE)--were associated with having a VTE diagnosis among US adult hospitalizations. A cross-sectional study was conducted using the 2010 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. VTE and autoimmune diseases were identified using International Classification of Diseases, Ninth Revision, Clinical Modification coded diagnoses information. The percentages of hospitalizations with a VTE diagnosis among all non-maternal adult hospitalizations without any of the four autoimmune diseases of interest and among those with AIHA, ITP, RA, and SLE diagnoses were 2.28, 4.46, 3.35, 2.65 and 2.77%, respectively. The adjusted odds ratios (OR) for having a diagnosis of VTE among non-maternal adult hospitalizations with diagnoses of AIHA, ITP, RA, and SLE were 1.25 [95% confidence interval (CI) 1.05-1.49], 1.20 (95% CI 1.07-1.34), 1.17 (95% CI 1.13-1.21), and 1.23 (95% CI 1.15-1.32), respectively, when compared to those without the corresponding conditions. The adjusted OR for a diagnosis of VTE associated with a diagnosis of any of the four autoimmune diseases was 1.20 (95% CI 1.16-1.24). The presence of a diagnosis of AIHA, ITP, RA, and SLE was associated with an increased likelihood of having a VTE diagnosis among the group of all non-maternal adult hospitalizations.
Practical Utility of D-dimer Test for Venous Thromboembolism in Systemic Lupus Erythematosus Depends on Disease Activity: a Retrospective Cohort Study.
Oh Yoon Jeong,Park Eun Hye,Park Jun Won,Song Yeong Wook,Lee Eun Bong
Journal of Korean medical science
BACKGROUND:The D-dimer test is a screening tool for venous thromboembolism (VTE); however, its utility for patients with systemic lupus erythematosus (SLE) remains unclear. Here, we examined the utility of the D-dimer test as a screening tool for VTE in SLE patients. METHODS:SLE patients (n = 276) and age- and sex-matched patients with non-rheumatic disease (n = 1,104), all of whom underwent D-dimer testing to screen for VTE, were enrolled. The sensitivity and specificity and receiver operating characteristics curve of the D-dimer test were compared in both groups. Then, subgroup of SLE patients in whom the D-dimer test can be useful was sought. RESULTS:The incidence of VTE was more common in SLE patients than controls (10.9% vs. 4.0%). Although the sensitivity of the D-dimer test was comparable between SLE patients and controls (93.3% vs. 90.9%), the specificity of the test was profoundly lower in SLE patients compared to controls (28.4% vs. 84.4%). The area under the curve (AUC) of the D-dimer for VTE was 0.669 in SLE patients and 0.90 in control group. Multiple linear regression analysis demonstrated that SLE disease activity index-2000 (SLEDAI-2K) was significantly associated with D-dimer levels in SLE patients (β = 0.155; = 0.022). Subgroup analysis showed that the AUC is moderate (0.768) with low disease activity, while it is low (0.518) with high SLEDAI-2K. CONCLUSION:The D-dimer test may not be a useful screening tool for VTE in patients with active SLE. D-dimer test for predicting VTE in SLE patients should be differentially applied according to disease activity of SLE.
The ratio of superoxide dismutase to standard deviation of erythrocyte distribution width as a predictor of systemic lupus erythematosus.
Yan Ling,Wang Bo,Chen Shizhi,Zhou Hua,Li Pu,Zhou Lijing,Zhao Qing,Wang Bo,Chen Weixian
Journal of clinical laboratory analysis
BACKGROUND:To explore the clinical value of the serum superoxide dismutase-to-standard deviation of erythrocyte distribution width ratio (SRSR) in systemic lupus erythematosus (SLE). METHODS:A total of 222 SLE patients from the Rheumatology and Immunology Department in the Second Affiliated Hospital of Chongqing Medical University from January 2017 to April 2019 were collected as the experimental group, and a total of 202 healthy physical examiners were extracted as the control group. Neutrophil-to-lymphocyte ratio (NLR), superoxide dismutase-to-standard deviation of erythrocyte distribution width ratio (SRSR), and platelet-to-lymphocyte ratio (PLR) were calculated from the collected data and then compared the level of the above three indexes between the two groups. In addition, we analyzed the association between SRSR and clinically relevant indicators. RESULTS:We found that the SRSR of SLE patients was significantly lower than healthy control group, by analyzing the receiver operating characteristic (ROC) curve; it revealed that the SRSR had higher specificity and sensitivity than either superoxide dismutase (SOD) or standard deviation of erythrocyte distribution width (RDW-SD) alone. The area under the curve (AUC) for SRSR was significantly larger than either SOD or RDW-SD alone, and the AUC for SRSR was also larger than NLR and PLR. And it was found that SRSR was independently correlated with SLE disease activity through multiple linear regression analysis. CONCLUSION:SRSR is a useful biomarker for the diagnosis of SLE, and it is of great significance in the clinical application.
Red cell distribution width correlates with fatigue levels in a diverse group of patients with systemic lupus erythematosus irrespective of anaemia status.
Wincup Chris,Parnell Chris,Cleanthous Sophie,Tejera Segura Beatriz,Nguyen Matthew H,Bryant Katherine,O'Neill Sean G,Richards Toby,Rahman Anisur
Clinical and experimental rheumatology
OBJECTIVES:Fatigue remains a debilitating feature of systemic lupus erythematosus (SLE). Although in some cases this may be the result of intercurrent fibromyalgia, mood disorder or untreated metabolic syndrome, in many cases the cause is unclear. The aim of this study was to investigate the relationship between fatigue and red cell distribution width (RDW), a measure of variability in erythrocyte size and volume. METHODS:A total of 225 patients were recruited from three clinics in England and Australia. Patients completed the Functional Assessment of Chronic Illness Therapy (FACIT) Fatigue Score or 12-item Short Form survey (SF-12) to measure fatigue, which was compared with RDW and haemoglobin. In a subgroup of 72 patients, markers of disease activity were also assessed for correlation with fatigue using univariate and multivariate analysis with fatigue as the dependent variable. RESULTS:In all three groups, significant correlations between fatigue and RDW were observed (p<0.001; p=0.02; p<0.001 respectively) and this was preserved in multivariate analysis. There was no correlation between fatigue and haemoglobin in two groups (with the correlation between RDW and fatigue remaining significant in non-anaemic patients in the third group). In subgroup analysis, fatigue was not associated with any measures of disease activity. CONCLUSIONS:We report a reproducible, statistically significant association between RDW and fatigue levels in a diverse population of patients with SLE. The findings of this study raise the possibility of a potential novel biological basis for fatigue in those in whom there is a lack of an alternate explanation.
Hematological factors associated with immunity, inflammation, and metabolism in patients with systemic lupus erythematosus: Data from a Zhuang cohort in Southwest China.
Lao Xiaoxia,Ma Liping,Ma Qingwei,Ma Qiaorong,Yang Zhige,Guo Lingxiao,Nong Wenzheng
Journal of clinical laboratory analysis
INTRODUCTION:Hematological parameters play important role in multiple diseases. This study was to investigate the possible association of the routine hematological parameters involved in immunity, inflammation, and metabolism with systemic lupus erythematosus (SLE) in patients of Zhuang ethnicity in Guangxi, southwest China. METHODS:The medical records of 195 Zhuang SLE patients between January 2013 and November 2018 were retrospectively reviewed. Random forest algorithm and multivariate logistic regression were used to identify the feature hematological parameters in patients with SLE. Association rules were explored between each parameter and immunity- (IgG, IgA, IgM, C3, and C4), inflammation- (ESR, hs-CRP, and CAR), and metabolism- (TG, TC, HDL-C, LDL-C, TP, PA, ALB, and UA) related indexes. RESULTS:Random forest algorithm and logistic regression analysis showed that neutrophil-to-lymphocyte ratio (NLR), red blood cell distribution width (RDW), and platelet-to-lymphocyte ratio (PLR) were the feature parameters for distinguishing SLE patients from healthy controls. According to the ROC curves, the optimal cutoff values to predict SLE were 1.98 for NLR, 13.35 for RDW, and 145.64 for PLR. Association rule analysis showed that NLR was strongly associated with C3, hs-CRP, TG, ALB, and UA; RDW was strongly associated with C3, C4, hs-CRP, TG, and ALB; PLR was strongly associated with IgG, hs-CRP, HDL-C, and UA. CONCLUSIONS:Neutrophil-to-lymphocyte ratio, RDW, and PLR may serve as effective predictors of dysregulation in immunity, inflammation, and metabolism. These three indicators may be potential for cardiovascular risk assessment in Zhuang SLE patients in southwest China.
Usefulness of the hemogram as a measure of clinical and serological activity in systemic lupus erythematosus.
Journal of translational autoimmunity
Background and objectives:Systemic Lupus Erythematosus (SLE) follow-up is based on clinical, and analytical parameters. We aimed to determine the differences between the Neutrophil-to-lymphocyte ratio (NLR), Platelet-to-lymphocyte ratio (PLR) and Red blood cell distribution width (RDW) between SLE patients and healthy controls and to assess their association with anemia status, classical inflammatory biomarkers and cytokines, disease activity, SLE related factors and treatment received for SLE. Methods:Seventy-seven patients with SLE according to 2012 SLICC criteria and 80 healthy controls were included. Patients with SLE were classified in SLE with anemia (SLE-a) and SLE without anemia (SLE-na). Statistical analysis between SLE patients and controls and the association of serological and clinical activity markers with proposed hematological indices among SLE patients were performed. Results:RDW, NLR and PLR, were significantly higher in SLE patients than in healthy control group (p < 0.001), in SLE-a patients as compared to SLE-na (p < 0.0001) and were significantly associated with hypocomplementemia (p < 0.05). PLR was higher in active patients measured by SLEDAI-2K score and with longer disease duration (p < 0.05). RDW was associated with serological activity of the patients (p < 0.05) and was correlated with SLEDAI-2K and SLICC/ACR scores, hsCRP, D-dimer, fibrinogen, IL-6 and TNF as well as with corticosteroids intake (p = 0.05). A logistic regression analysis confirmed that after adjustment by age and hemoglobin values, RDW presented linear correlation with IL-6 levels (Beta-coefficient = 0.369, p = 0.003). Conclusion:NLR, PLR and RDW values suggest SLE serological and clinical activity. Given their availability, these markers not only could be useful tools to identify and monitor active SLE patients but whose application should be considered in inflammatory pathologies orchestrated by IL-6 and TNF.
Baseline Red Blood Cell Distribution Width Correlates with Disease Activity and Therapeutic Outcomes in Patients with Systemic Lupus Erythematosus, Irrespective of Anemia Status.
Zou Xing-Li,Lin Xiao-Jing,Ni Xun,Wang Jing,Liu Wen,Wei Jin
BACKGROUND:Red blood cell distribution width (RDW) has been recently found to reflect systemic inflammation in addition to anisocytosis, and its value for assessing disease activity of systemic lupus erythematosus (SLE) has been addressed in two studies, but its correlation with therapeutic outcomes and disease flare has not been evaluated. METHODS:One hundred and ninety-six newly diagnosed patients with SLE (all-SLE), including 105 non-anemic patients (na-SLE) and 91 patients with anemia (a-SLE) were prospectively studied. Baseline RDW of SLE patients was compared with that of control subjects. Correlations between RDW and disease activity, traditional laboratory parameters, clinical features, therapeutic outcomes, and disease flare were examined. RESULTS:RDW was exclusively higher in all-SLE, na-SLE, a-SLE than in controls (p < 0.001), but no significant difference of RDW was found between na-SLE and a-SLE (p = 0.27). More active disease scored with SLE Disease Activity Index 2000 (SLEDAI-2K) was present in patients with elevated RDW (> 15%) than normal RDW (= 11 - 15%) irrespective of anemia status (p < 0.001), and positive correlation between RDW with SLEDAI-2K was also disclosed independent of anemia status (r = 0.576, 0.614, 0.542, respectively for all-, na- and a-SLE, all with p < 0.001). Additionally, RDW positively correlated with high-sensitivity C-reactive protein (hsCRP) in all-SLE (r = 0.352, p < 0.001), na-SLE (r = 0.430, p < 0.001), and a-SLE (r = 0.315, p = 0.002). Among all clinical features, only the incidence of pulmonary arterial hypertension (PAH) was likely to be higher in elevated-RDW SLE than in normal-RDW SLE (χ2 = 4.135, p < 0.05). Patients received stratified therapy of remission induction based on their disease activity. A significantly higher rate of response (complete and partial response) was observed in normal-RDW than in elevated-RDW patients (all-SLE: 92.2% vs. 74.1%, p = 0.001; na-SLE: 92.3% vs. 77.5%, p = 0.04; a-SLE: 92% vs. 70.7%, p = 0.012). During a 12-month follow-up of the 166 responders, significantly greater flare-free survival was observed in normal-RDW than in elevated-RDW patients (68.8% vs. 29.8%, p = 0.002; 53.6% vs. 28.1%, p = 0.027; 55.9% vs. 31.4%, p = 0.032, respectively, for all-, na- and a-SLE). CONCLUSIONS:Our findings suggest that baseline RDW is an easily available parameter not only capable of reflecting SLE overall activity, but also predicting therapeutic outcomes and the risk of disease flare irrespective of anemia status.
Evaluation of Disease Activity of Systemic Lupus Erythematosus by D-dimer Combined with Red Blood Cell Distribution Width.
Zheng Chun-Sheng,Qin Xue-Jun,Ni Hong,Chen Rong-Yan,Liu Ji-Lai,Wang Wen-Hua
BACKGROUND:To investigate the value of D-dimer combined with red blood cell distribution width (RDW) in evaluating the disease activity of systemic lupus erythematosus (SLE). METHODS:A total of 105 SLE patients confirmed in our hospital from July 2018 to September 2020 were collected as the SLE group, and 60 healthy persons matched in age and gender during the same period were collected as the control group. According to the SLEDAI score, SLE patients were divided into SLE active group and SLE inactive group, and RDW and D-Dimer levels were detected. RESULTS:The level of RDW in the SLE active group [14.8 (13.4, 16.8)] was significantly higher than that in the SLE inactive group [13.4 (12.6, 14.37)] and control group [12.3 (12, 12.7)], with statistically significant differences (p < 0.05). The D-dimer level in the SLE active group was 1.36 (0.9, 2.25) mg/L, which was significantly higher than that in SLE inactive group [0.34 (0.22, 0.52)] mg/L and control group [0.15 (0.08, 0.19)] mg/L, with statistically significant differences (p < 0.05). Both RDW and D-dimer were positively correlated with the SLEDAI score (r = 0.393, p = 0.000), (r = 0.483, p = 0.000). The results of receiver operating characteristic curve showed that the area under the curve of RDW and D-Dimer alone was 0.875 and 0.954, respectively, while the area under the curve of RDW combined with D-Dimer was the largest, 0.984. CONCLUSIONS:The levels of RDW and D-dimer are closely related to the disease activity of SLE patients, and RDW combined with D-dimer is more valuable in assessing the disease activity of SLE patients.
Evaluation of systemic lupus erythematosus disease activity using anti-α-enolase antibody and RDW.
Huang Yunxiu,Chen Linmu,Zhu Baofang,Han Hui,Hou Yanfang,Wang Weijia
Clinical and experimental medicine
The objective of the study was to investigate the value of anti-α-enolase antibody (Ab) combined with RDW in evaluating the activity of systemic lupus erythematosus (SLE). Levels of serum anti-α-enolase Ab and RDW were detected in 193 SLE patients and 98 healthy controls by ELISA and automatic blood cell counter (XN9000), respectively. Furthermore, the correlation between anti-α-enolase Ab and RDW in evaluating the activity of SLE was evaluated by correlation analysis. The level of anti-α-enolase Ab (9.16 ± 0.44 ng/mL in stable group and 10.26 ± 0.36 ng/mL in activity group) was significantly higher than that in the healthy control (7.05 ± 0.27 ng/mL). The level of RDW (12.92% ± 1.23% in stable group and 13.57% ± 2.12% in activity group) was significantly higher than that in the healthy control (12.46% ± 0.61%). The levels of anti-α-enolase Ab or RDW in SLE patients were positively correlated with SLEDAI-2 K score (r= 0.75, r = 0.73), respectively. Compared with the anti-α-enolase Ab (AUC: 78.0%) or RDW (AUC:80.0%) alone, anti-α-enolase Ab combined with RDW (AUC: 81.0%) had the best of the effectiveness of evaluating activity of SLE. These data suggested that combined anti-α-enolase Ab with RDW might be good biomarker to predict the activity of SLE in clinical.
The Utility of Rise in Red Cell Distribution Width in Determining the Risk of Renal Relapse in Lupus Nephritis.
You Huaizhou,Wang Tingting,Liu Shaojun,Zhu Xiaoye,Lu Jianda,Zhu Ying,Xue Jun,Hao Chuanming
BACKGROUND:We hypothesized that the levels of red cell distribution width (RDW) would correlate with lupus nephritis (LN) disease activity, therapeutic response after induction therapy, and its rise would be associated with future renal relapse in patients who had achieved clinical remission. METHODS:The associations of RDW and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), renal response, and renal relapse after induction therapy were examined in 172 biopsy-proven LN patients at the Division of Nephrology, Huashan Hospital Fudan University between 2007 and 2017. RESULTS:The median RDW of LN patients was significantly higher than that of healthy individuals (p < 0.001). Baseline RDW demonstrated positive correlation with baseline SLEDAI (r = 0.239, p = 0.004). Overall RDW after induction treatment was significantly decreased (p = 0.005), especially in the complete remission (CR) group (p = 0.02), and the partial remission (PR) group had a decreasing trend (p = 0.09), while the change of RDW in the no response (NR) group was not statistically significant (p = 0.70). Among the 153 patients who achieved remission after induction therapies, 37 (24.2%) patients developed 42 episodes of subsequent renal flare during a median follow-up of 36.0 (IQR, 20 - 66) months. The median time from remission to renal flare was 18.0 (IQR, 7.0 - 45.0) months. The overall renal flare rate was 0.065 relapse per patient-year. During follow up, 54 RDW rises (defined as more than 0.5% increase in RDW) were identified. There were 33 episodes (61.1%) of renal flares in patients with RDW rises, while there were only 9 renal flares (8.65%) in 104 patients without RDW rise (p < 0.001). Survival analysis showed that RDW rise was associated with a significantly higher risk of future renal relapse (adjusted HR, 14.03; 95% CI, 5.29 to 37.20; p < 0.001). CONCLUSIONS:In addition to correlating with disease activity and therapeutic response to induction therapy in patients with LN, RDW rise is a significant predictor of future renal relapse in patients who achieve remission.
Red cell distribution width and other red blood cell parameters in patients with cancer: association with risk of venous thromboembolism and mortality.
Riedl Julia,Posch Florian,Königsbrügge Oliver,Lötsch Felix,Reitter Eva-Maria,Eigenbauer Ernst,Marosi Christine,Schwarzinger Ilse,Zielinski Christoph,Pabinger Ingrid,Ay Cihan
BACKGROUND:Cancer patients are at high risk of developing venous thromboembolism (VTE). Red cell distribution width (RDW) has been reported to be associated with arterial and venous thrombosis and mortality in several diseases. Here, we analyzed the association between RDW and other red blood cell (RBC) parameters with risk of VTE and mortality in patients with cancer. METHODS:RBC parameters were measured in 1840 patients with cancers of the brain, breast, lung, stomach, colon, pancreas, prostate, kidney; lymphoma, multiple myeloma and other tumor sites, that were included in the Vienna Cancer and Thrombosis Study (CATS), which is an ongoing prospective, observational cohort study of patients with newly diagnosed or progressive cancer after remission. Primary study outcome is occurrence of symptomatic VTE and secondary outcome is death during a maximum follow-up of 2 years. RESULTS:During a median follow-up of 706 days, 131 (7.1%) patients developed VTE and 702 (38.2%) died. High RDW (>16%) was not associated with a higher risk of VTE in the total study cohort; in competing risk analysis accounting for death as competing variable the univariable subhazard ratio (SHR) was 1.34 (95% confidence interval [CI]: 0.80-2.23, p = 0.269). There was also no significant association between other RBC parameters and risk of VTE. High RDW was associated with an increased risk of mortality in the total study population (hazard ratio [HR, 95% CI]: 1.72 [1.39-2.12], p<0.001), and this association prevailed after adjustment for age, sex, hemoglobin, leukocyte and platelet count (HR [95% CI]: 1.34 [1.06-1.70], p = 0.016). CONCLUSIONS:RDW and other RBC parameters were not independently associated with risk of VTE in patients with cancer and might therefore not be of added value for estimating risk of VTE in patients with cancer. We could confirm that high RDW is an independent predictor of poor overall survival in cancer.
Red Cell Distribution Width Has a Predictable Value for Differentiation of Provoked and Unprovoked Venous Thromboembolism.
Ertop Sehmus,Bilici Muammer,Engin Huseyin,Buyukuysal Cagatay,Arslaner Muzeyyen,Toka Bilal,Tekin Ishak Ozel
Indian journal of hematology & blood transfusion : an official journal of Indian Society of Hematology and Blood Transfusion
Venous thromboembolism (VTE) is generally classified as provoked or unprovoked. This dichotomy is important for following patients, mortality rate, prognosis and whether more efficient therapy is needed. In VTE patients, during initial diagnosis, it is not known exactly whether red cell distribution width (RDW) have a predictable value for this differentiation and pathogenesis. In this study, 298 patients with VTE and 197 control subjects were included. Patients with VTE were defined as provoked or unprovoked with respect to physical examination findings and laboratory values. Changes in RDW were tested between VTE patients and control subjects, provoked and unprovoked VTE patients, and separately with control subjects. RDW was found to be high in provoked and unprovoked groups compared with control group ( < 0.001, = 0.003 respectively). RDW was significantly high in provoked VTE patients group compared with unprovoked patients ( < 0.001) and a cut-off value was found to be 13.6 %. In ROC analysis, sensitivity was 90.19 % and specificity was 82 % (95 % CI 85.4-93. 8 % and 95 % CI 72.3-89. 6 % respectively). RDW could be used as a simple, costeffective and a reliable test independent of age in differentiation of provoked and unprovoked VTE. In order to better understand its role, prospective large homogenized population studies in different regions are necessary.
A narrative review of red blood cell distribution width as a marker for pulmonary embolism.
Hammons Lindsay,Filopei Jason,Steiger David,Bondarsky Eric
Journal of thrombosis and thrombolysis
Red blood cell distribution width (RDW) is a marker of variability in red blood cell size, and is routinely reported as part of a patient's complete blood count. RDW has been shown to be associated with the prediction, severity and prognosis of pulmonary embolism (PE) in recent studies. The underlying biomolecular mechanism of the relationship of RDW to PE is largely unknown, but is thought to be due to the relationship of RDW with acute inflammatory markers and variations in blood viscosity. This review substantiates that a high RDW level, defined using either an arbitrary number or according to receiver operator curve statistics, is associated with a higher risk of acute PE, increased severity (massive vs. submassive) of PE and increased mortality in patients with PE. Nevertheless, the comparison of current studies is limited due to the definition of high RDW (each study uses a different RDW cutoff level), the broad range of exclusion criteria and the inclusion of differing modalities used to diagnose a PE (computed tomography angiogram, ventilation-perfusion study, or clinical diagnosis). Despite the above limitations, these studies provide a promising future clinical use for RDW as a marker of PE.
Red cell distribution width and risk for venous thromboembolism: a population-based cohort study.
Zöller Bengt,Melander Olle,Svensson Peter,Engström Gunnar
INTRODUCTION:Red cell distribution width (RDW) has been associated with venous thromboembolism (VTE), but whether RDW is a predictor of first event of VTE is unknown. We investigated the association between RDW and incidence of first event of VTE in a population-based cohort. MATERIALS AND METHODS:RDW was measured in 27 042 subjects (aged 45-73 years, 60.6% women), without previous history of VTE or cancer within 5 years before follow-up, who participated in the Malmö Diet and Cancer study during 1991-1996. Incidence of VTE was identified from the patient register and the cause of death register during a mean follow-up of 13.8 years and studied in relation to RDW. RESULTS:During follow-up, 991 subjects (57.5% women) were affected by VTE (pulmonary embolism or deep venous thrombosis of the lower limbs). After adjustment for potential confounding factors the hazard ratios (HR) for VTE for the second, third and fourth RDW quartiles 1.15 (95% confidence interval 0.94-1.41), 1.41 (1.14-1.73), 1.74 (1.38-2.21), respectively, were compared with the bottom quartile of RDW. In the multivariate model subjects with the top 5% of RDW values compared with the bottom quartile had an even higher risk (HR=2.51, 1.78-2.54). In receiver operating characteristic (ROC) analysis, the male specific area under the ROC curve (AUC) for RDW was 0.57 (95% CI 0.54-0.59). The female specific AUC was 0.56 (95% CI 0.53-0.58). CONCLUSIONS:RDW was found to be associated with long-term incidence of first event of VTE among middle-aged subjects.
Association between red cell distribution width and risk of venous thromboembolism.
Bucciarelli Paolo,Maino Alberto,Felicetta Irene,Abbattista Maria,Passamonti Serena M,Artoni Andrea,Martinelli Ida
BACKGROUND:An association between high red cell distribution width (RDW) and venous thromboembolism (VTE) has been observed. However, it is not known whether this association differs within various manifestations of VTE, nor if there is an interaction between RDW and thrombophilia abnormalities on the risk of VTE. AIMS:To investigate whether RDW is a marker of the risk of VTE; to identify subgroups of patients in which the association between RDW and VTE is stronger; to investigate a possible interaction between RDW and thrombophilia abnormalities. METHODS:Case-control study on 730 patients with a first objectively-confirmed VTE episode (300 unprovoked and 430 provoked) consecutively referred to our Center between 2007 and 2013, and 352 healthy controls. Blood was taken for a thrombophilia work-up and a complete blood count, including RDW, at least three months after VTE. RESULTS:Individuals with RDW above the 90(th) percentile (>14.6%) had a 2.5-fold increased risk of VTE compared to those with RDW ≤90(th) percentile, independently of age, sex, body mass index, other hematological variables and renal function (adjusted odds ratio: 2.52 [95%CI:1.42-4.47]). The risk was similar for unprovoked and provoked VTE, and slightly higher in patients with pulmonary embolism (adjusted odds ratio 3.19 [95%CI:1.68-6.09]) than in those with deep vein thrombosis alone (2.29 [95%CI:1.22-4.30]). No interaction between high RDW and thrombophilia abnormalities on the risk of VTE was observed. CONCLUSION:Our findings confirm RDW as an independent and easily available marker for stratification of the risk of VTE.
Plasma hepcidin is associated with future risk of venous thromboembolism.
Ellingsen Trygve S,Lappegård Jostein,Ueland Thor,Aukrust Pål,Brækkan Sigrid K,Hansen John-Bjarne
Red cell distribution width (RDW) is associated with venous thromboembolism (VTE), but the underlying mechanism(s) is unclear. Iron deficiency is associated with high RDW, and studies suggest an association between iron deficiency and VTE. To assess whether iron deficiency is a risk factor for VTE that explains the association between RDW and VTE, we conducted a nested case-control study of 390 patients with VTE and 802 age- and sex-matched controls selected from the population-based cohort of the Tromsø Study. Physical measurements and blood samples were collected from 1994 to 1995. Logistic regression models were used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for VTE by RDW, hepcidin, and ferritin light chain (FtL). RDW was inversely associated with hepcidin, FtL, and hemoglobin. The risk of VTE increased linearly across categories of higher plasma hepcidin levels. Participants with hepcidin in the highest quartile had an OR for VTE of 1.32 (95% CI, 1.00-2.42), and those in the >90% percentile had an OR for VTE of 1.66 (95% CI, 1.14-2.42) compared with the reference group (quartiles 2 and 3). The risk estimates remained similar after adjustment for C-reactive protein. The risk of VTE increased by categories of higher RDW and was strengthened after inclusion of hepcidin and FtL in the multivariable model. Our findings reject the hypothesis that iron deficiency explains the association between RDW and VTE and suggest, in contrast, that high body iron levels might increase the risk of VTE.
The association between red cell distribution width and venous thromboembolism is not explained by myocardial infarction, stroke, or cancer.
Ellingsen Trygve S,Lappegård Jostein,Skjelbakken Tove,Mathiesen Ellisiv B,Njølstad Inger,Brækkan Sigrid K,Hansen John-Bjarne
Research and practice in thrombosis and haemostasis
BACKGROUND:Red cell distribution width (RDW) is a risk marker of venous thromboembolism (VTE), myocardial infarction (MI), stroke, and cancer. Due to interrelations between these diseases, the association between RDW and VTE may be explained by MI, stroke, or cancer. OBJECTIVE:To investigate whether the effect of RDW on VTE could be explained by intermediate development of MI, stroke, or cancer. METHODS:RDW was measured in 24 363 participants of the Tromsø Study in 1994-1995. Incident VTE, MI, stroke, and cancer were registered until December 31, 2010. Conventional and cause-specific Cox-regression models were used to estimate hazard ratios (HR) for VTE with 95% confidence intervals (CI) across categories of RDW. RESULTS:There were 502 first VTEs during a median follow-up of 16 years. In conventional Cox regression analysis, RDW in the highest quartile was associated with a 71% (HR 1.71, 95% CI 1.09-2.67) and 27% (HR 1.27, 95% CI 0.88-1.85) higher risk of VTE in men and women, respectively, compared to subjects in the lowest quartiles. The risk of VTE among subjects with RDW in the highest quartile was similar for men and women of postmenopausal age. In cause-specific analysis, where each individual contributed with person-time until the first occurring event only, the risk estimates were similar to those of the conventional Cox-regression analysis. CONCLUSION:Our findings suggest that the association between RDW and future risk of VTE is not explained by intermediate development of MI, stroke, or cancer.
Red cell distribution width is associated with incident venous thromboembolism (VTE) and case-fatality after VTE in a general population.
Ellingsen Trygve S,Lappegård Jostein,Skjelbakken Tove,Brækkan Sigrid K,Hansen John-Bjarne
Thrombosis and haemostasis
Recent studies suggest an association between red cell distribution width (RDW) and incident venous thromboembolism (VTE). We aimed to investigate the impact of RDW on risk of incident and recurrent VTE, and case-fatality, in a general population. RDW was measured in 26,223 participants enrolled in the Tromsø Study in 1994-1995. Incident and recurrent VTE events and deaths during follow-up were registered until January 1, 2012. Multivariate Cox proportional hazards regression models were used to calculate hazard ratios (HR) with 95% confidence intervals (CI). There were 647 incident VTE events during a median of 16.8 years of follow-up. Individuals with RDW in the highest quartile (RDW≥13.3%) had 50% higher risk of an incident VTE than those in the lowest quartile (RDW≤12.3%). The association was strongest for unprovoked deep-vein thrombosis (HR highest vs lowest quartile of RDW: 1.8, 95% CI 1.1-3.1). VTE patients with baseline RDW≥13.3% had 30% higher risk of all-cause mortality after the initial VTE event than VTE patients with RDW<13.3%. There were no association between RDW and risk of recurrent VTE. Our findings suggest that high RDW is a risk factor of incident VTE, and that RDW is a predictor of all-cause mortality in VTE patients.