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Caldo-Silva A, Furtado GE, Chupel MU, Letieri RV, Neves RS, Direto F, Barros MP, Bachi ALL, Matheu A, Martins F, Massart A, Teixeira AM. Empowering frail older adults: multicomponent elastic-band exercises and BCAA supplementation unleash physical health and preserve haematological biomarkers. Front Sports Act Living 2023; 5:1171220. [PMID: 37720080 PMCID: PMC10502309 DOI: 10.3389/fspor.2023.1171220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 08/03/2023] [Indexed: 09/19/2023] Open
Abstract
The effectiveness of Branched Chain Amino Acids (BCAAs) supplementation on enhancing exercise performance in both young and older adults remains a topic of debate. Recent research suggests that BCAAs combined with regular exercise might have an impact on human erythropoiesis, blood dynamics, and iron homeostasis. Given the increasing longevity of the global population, it is crucial to investigate the potential benefits of BCAA supplementation and regular exercise as non-pharmacological interventions for improving the overall health of frail older adults. To assess the influence of a 40-week multicomponent exercise intervention (MEP) combined BCCA supplementation on the haematological indicators of frail older adults (83-93 years old) residing in nursing homes. A prospective, naturalistic, controlled clinical trial employing an intervention-washout-intervention was conducted for this purpose. The study included four experimental groups: MEP plus BCAA supplementation (MEP + BCAA, n = 8), MEP only (n = 7), BCAA supplementation only (n = 7), and control group non exercising (CG, n = 13). Fried's physical frailty (PF) protocol was employed to stratify the participants. Additionally, the assessment included the evaluation of nutritional status, comorbidities, and anthropometric measurements. Among the several haematological markers examined, only mean cellular Haemoglobin Concentration (MCH) [F = 4.09; p < 0.03] and Mean Cell haemoglobin Concentration (MCHC) [F = 10, 323; p < 0,0001] showed significant effects of time group. Our findings demonstrate that a long-term intervention with BCAA plus MEP did not lead to significant alterations in the haematological profile. An 8-week withdrawal from interventions did not affect the frailty status in the MEP and MEP + BCAA groups, whereas the control group exhibited an increase in PF status. The findings, demonstrating the potential pro-immune effect and maintenance of MCH and MCHC levels, highlight the relevance of incorporating exercise and nutritional strategies to promote healthy aging. This study contributes to the achievement of the United Nations Sustainable Development Goals 3 (good health and well-being) and 10 (reduced Inequalities) for all.
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Affiliation(s)
- Adriana Caldo-Silva
- Research Centre for Sport and Physical Activity, CIDAF, Faculty of Sport Science and Physical Education, University of Coimbra, Coimbra, Portugal
| | - Guilherme E. Furtado
- Research Centre for Sport and Physical Activity, CIDAF, Faculty of Sport Science and Physical Education, University of Coimbra, Coimbra, Portugal
- Polytechnic Institute of Coimbra, Applied Research Institute, Rua da Misericórdia, Lagar dos Cortiços-S, Martinho do Bispo, Coimbra, Portugal
- Research Centre for Natural Resources Environment and Society (CERNAS), Polytechnic Institute of Coimbra, Bencanta, Coimbra, Portugal
| | - Matheus Uba Chupel
- Biological Sciences Platform- Hurvitz Brain Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Rubens Vinícius Letieri
- Multidisciplinary Research Nucleus in Physical Education (NIMEF), Physical Education Department, Avenida Nossa Senhora de Fátima, Federal University of North of Tocantins (UFNT), Tocantinópolis, Brazil
| | - Rafael Santos Neves
- Research Centre for Sport and Physical Activity, CIDAF, Faculty of Sport Science and Physical Education, University of Coimbra, Coimbra, Portugal
| | - Fábio Direto
- Research Centre for Sport and Physical Activity, CIDAF, Faculty of Sport Science and Physical Education, University of Coimbra, Coimbra, Portugal
| | - Marcelo P. Barros
- Institute of Physical Activity Sciences and Sports (ICAFE), Interdisciplinary Program in Health Sciences, Cruzeiro do Sul University, São Paulo, Brazil
| | - André L. L. Bachi
- Post-Graduation Program in Health Sciences, Santo Amaro University (UNISA), São Paulo, Brazil
| | - Ander Matheu
- Group of Cellular Oncology, Biodonostia Health Research Institute, San Sebastian, Spain
- CIBER On Frailty and Healthy Aging (CIBERfes), Institute of Health Carlos III, Madrid, Spain
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
| | - Faber Martins
- Laboratory for the Evaluation of Sports Performance, Physical Exercise, and Health (LABMOV), Polytechnic of Guarda, Guarda, Portugal
| | - Alain Massart
- Research Centre for Sport and Physical Activity, CIDAF, Faculty of Sport Science and Physical Education, University of Coimbra, Coimbra, Portugal
| | - Ana Maria Teixeira
- Research Centre for Sport and Physical Activity, CIDAF, Faculty of Sport Science and Physical Education, University of Coimbra, Coimbra, Portugal
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Guo L, Chen D, Cheng B, Gong Y, Wang B. Prognostic Value of the Red Blood Cell Distribution Width-to-Albumin Ratio in Critically Ill Older Patients with Acute Kidney Injury: A Retrospective Database Study. Emerg Med Int 2023; 2023:3591243. [PMID: 37051465 PMCID: PMC10085652 DOI: 10.1155/2023/3591243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 03/10/2023] [Accepted: 03/23/2023] [Indexed: 04/05/2023] Open
Abstract
Background. There is no evidence suggesting that red blood cell distribution width-to-albumin ratio (RA) predicts outcomes in severely ill older individuals with acute kidney injury (AKI). We hypothesized that RA is associated with all-cause mortality in critically ill older patients with AKI. Methods. We recorded demographics, laboratory tests, comorbidities, vital signs, and other clinical information from the MIMIC-III V1.4 dataset. The primary endpoint was 90-day all-cause mortality, and the secondary endpoints were 30-day mortality, one-year mortality, renal replacement treatment (RRT), duration of stay in the intensive care unit (ICU), sepsis, and septic shock. We generated Cox proportional hazards and logistic regression models to determine RA’s prognostic values and subgroup analyses to determine the subgroups’ mortality. We conducted a Pearson correlation analysis on RA and C-reactive protein (CRP) in the cohort of patients from the Second Affiliated Hospital of Wenzhou Medical University. Results. A total of 6,361 patients were extracted from MIMIC-III based on the inclusion and exclusion criteria. RA levels directly and linearly correlated with 90-day all-cause mortality. After controlling for ethnicity, gender, age, and other confounding variables in multivariate analysis, higher RA was significantly associated with an increased risk of 30-day, 90-day, and one-year all-cause mortality as opposed to the reduced levels of RA (tertile 3 vs. tertile 1: hazard ratios (HRs), 95% confidence intervals (CIs): 1.70, 1.43–2.01; 1.90, 1.64–2.19; and 1.95, 1.72–2.20, respectively). These results suggested that elevated levels of RA were linked to an elevated risk of 30-day, 90-day, and one-year all-cause death. There was a similar trend between RA and the use of RRT, length of stay in ICUs, sepsis, and septic shock. The subgroup analysis did not reveal any considerable interplay among strata. When areas under the curve were compared, RA was a weaker predictor than the SAPS II score but a stronger predictor than red blood cell distribution width (RDW) or albumin alone (
); RA combined with SAPS II has better predictive power than SAPS II alone (
). The Second Affiliated Hospital of Wenzhou Medical University cohort showed that CRP positively correlated with RA, with a coefficient of 0.2607 (
). Conclusions. RA was an independent prognostic predictor in critically ill older patients with AKI, and greater RA was linked to a higher probability of death. The risk of AKI is complicated when RRT occurs; sepsis and septic shock increase with RA levels.
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Affiliation(s)
- Lei Guo
- Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Dezhun Chen
- Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Bihuan Cheng
- Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Yuqiang Gong
- Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
| | - Benji Wang
- Department of Anesthesiology, Critical Care and Pain Medicine, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
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Whitfield JB, Seth D, Morgan TR, Atkinson SR, Bataller R, Botwin G, Chalasani NP, Cordell HJ, Daly AK, Darlay R, Day CP, Eyer F, Foroud T, Gleeson D, Goldman D, Haber PS, Jacquet J, Liang T, Liangpunsakul S, Masson S, Mathurin P, Moirand R, Moreno C, Morgan TR, Morgan M, Mueller S, Müllhaupt B, Nagy LE, Nahon P, Nalpas B, Naveau S, Perney P, Pirmohamed M, Schwantes‐An T, Seitz HK, Seth D, Soyka M, Stickel F, Thompson A, Thursz MR, Trepo E, Whitfield JB. All-cause and liver-related mortality risk factors in excessive drinkers: Analysis of data from the UK biobank. Alcohol Clin Exp Res 2022; 46:2245-2257. [PMID: 36317527 PMCID: PMC10098765 DOI: 10.1111/acer.14968] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND High alcohol intake is associated with increased mortality. We aimed to identify factors affecting mortality in people drinking extreme amounts of alcohol. METHODS We obtained information from the UK Biobank on approximately 500,000 participants aged 40-70 years at baseline assessment in 2006-2010. Habitual alcohol intake, lifestyle and physiological data, laboratory test results, and hospital diagnoses and death certificate data (to June 2020) for 5136 men (2.20% of male participants) and 1504 women (0.60%) who reported consuming ≥80 or ≥50 g/day, respectively, were used in survival analysis. RESULTS Mortality hazard ratios for these excessive drinkers, compared to all other participants, were 2.02 (95% CI 1.89-2.17) for all causes, 1.89 (1.69-2.12) for any cancer, 1.87 (1.61-2.17) for any circulatory disease, and 9.40 (7.00-12.64) for any liver disease. Liver disease diagnosis or abnormal liver function tests predicted not only deaths attributed to liver disease but also those from cancers or circulatory diseases. Mortality among excessive drinkers was also associated with quantitative alcohol intake; diagnosed alcohol dependence, harmful use, or withdrawal syndrome; and current smoking at assessment. CONCLUSIONS People with chronic excessive alcohol intake experience decreased average survival, but there is substantial variation in their mortality, with liver abnormality and alcohol dependence or other alcohol use disorders associated with a worse prognosis. Clinically, patients with these risk factors and high alcohol intake should be considered for early or intensive management. Research can usefully focus on the factors predisposing to dependence or liver abnormality.
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Affiliation(s)
- John B Whitfield
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Devanshi Seth
- Drug Health Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Centenary Institute of Cancer Medicine and Cell Biology, University of Sydney, Sydney, New South Wales, Australia
| | - Timothy R Morgan
- Department of Veterans Affairs, VA Long Beach Healthcare System, Long Beach, California, USA.,Department of Medicine, University of California, Irvine, California, USA
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Jurin I, Trkulja V, Lucijanić M, Pejić J, Letilović T, Radonić V, Manola Š, Rudan D, Hadžibegović I. Red Cell Distribution Width in Acute Pulmonary Embolism Patients Improves 30-Day Mortality Risk Stratification Based on the Pulmonary Embolism Severity Index. Heart Lung Circ 2022; 31:859-866. [PMID: 35074262 DOI: 10.1016/j.hlc.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 11/24/2021] [Accepted: 12/05/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To validate red cell distribution width (RDW) as an improvement in 30-day mortality risk stratification based on the Pulmonary Embolism Severity Index (PESI) in acute pulmonary embolism (PE). PATIENTS AND METHODS Prospective observational analysis of consecutive adult acute PE patients. RESULTS Among 731 patients, 30-day mortality was 11.9%. With adjustment for the PESI score and number of covariates, higher RDW was associated with higher mortality (RDW continuous: OR 1.21, 95% CI 1.06-1.38; Bayesian OR 1.22, 1.07-1.40; RDW 'high' [>14.5% in men >16.1% in women] vs normal: OR 3.83, 1.98-7.46; Bayesian OR 3.98, 2.04-7.68]. Crude mortality was 3.6% if PESI 86-105 (intermediate risk), but 1.2% if RDW normal and 7.1% if RDW high; 11.8% if PESI 106-125 (high risk), but 3.6% if RDW normal and 18.8% if RDW high. Adjusted probabilities showed higher mortality (ORs between 3.5-5.8) if RDW was high in any PESI risk subgroup. Crude mortality rates in two random-split subsets (n=365 and n=366) again showed the same patterns. CONCLUSIONS On-admission RDW above the normal range improves 30-day mortality risk stratification based on PESI score in acute PE. Particularly, it corrects PESI-based intermediate-risk or high-risk allocation by reclassification into very low-risk (<3.5%) or very high-risk (>11.0%).
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Affiliation(s)
- Ivana Jurin
- Department for Cardiovascular Diseases, University Hospital Dubrava, Zagreb, Croatia
| | | | - Marko Lucijanić
- Hematology Department, University Hospital Dubrava, Zagreb, Croatia
| | - Josip Pejić
- Department for Thoracic Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Tomislav Letilović
- Zagreb University School of Medicine, Zagreb, Croatia; Cardiology Department, University Hospital Merkur, Zagreb, Croatia
| | - Vedran Radonić
- Cardiology Department, University Hospital Merkur, Zagreb, Croatia
| | - Šime Manola
- Department for Cardiovascular Diseases, University Hospital Dubrava, Zagreb, Croatia
| | - Diana Rudan
- Department for Cardiovascular Diseases, University Hospital Dubrava, Zagreb, Croatia
| | - Irzal Hadžibegović
- Department for Cardiovascular Diseases, University Hospital Dubrava, Zagreb, Croatia; Faculty of Dental Medicine and Health Care, Josip Juraj Strossmayer University, Osijek, Croatia.
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Sato R, Oikawa M, Kakita T, Okada T, Abe T, Yazawa T, Tsuchiya H, Akazawa N, Yoshimachi S, Ohira T, Harada Y, Okano H, Ito K, Tsuchiya T. Prognostic significance of the mean corpuscular volume (MCV) and red cell distribution width (RDW) in obstructive colorectal cancer patients with a stent inserted as a bridge to curative surgery. Surg Today 2022; 52:1699-1710. [PMID: 35441270 DOI: 10.1007/s00595-022-02504-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The prognostic significance of the mean corpuscular volume (MCV) and red cell distribution width (RDW) in patients with malignancy have not been intensely investigated and are largely overlooked. We, therefore, investigated the clinical significance of MCV and RDW in non-metastatic obstructive colorectal cancer (OCRC) patients with a self-expandable metallic stent inserted as a bridge to curative surgery. METHODS Eighty-five pathological stage II and III OCRC patients were retrospectively evaluated. The associations of the preoperative MCV and RDW values with short- and long-term outcomes were examined. RESULTS There were 50 males and 35 females, and the median age was 71 years old. The median interval between stenting and surgery was 17 days, and the median postoperative hospital stay was 16 days. Fifty-six patients were in the MCV ≥ 87 group, and 47 were in the RDW ≥ 13.8 group. Multivariate analyses revealed the MCV ≥ 87 status to be independently associated with a poor relapse-free survival (hazard ratio [HR] = 4.70, 95% confidence interval [CI] 1.52-14.58, P = 0.007). The RDW ≥ 13.8% was an independent predictor of postoperative infectious complications (HR = 7.28, 95% CI 1.24-42.70, P = 0.028). CONCLUSION The MCV and RDW are simple but strong predictors of postoperative outcomes in OCRC patients.
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Affiliation(s)
- Ryuichiro Sato
- Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan. .,Department of Surgery, Japanese Red Cross Sendai Hospital, 2-43-3 Yagiyama hon-cho, Taihaku-ku, Sendai, 982-8501, Japan.
| | - Masaya Oikawa
- Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Tetsuya Kakita
- Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Takaho Okada
- Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Tomoya Abe
- Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Takashi Yazawa
- Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Haruyuki Tsuchiya
- Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Naoya Akazawa
- Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Shingo Yoshimachi
- Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Tetsuya Ohira
- Department of Gastroenterology, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Yoshihiro Harada
- Department of Gastroenterology, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Haruka Okano
- Department of Gastroenterology, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Takashi Tsuchiya
- Department of Gastroenterological Surgery, Sendai City Medical Center Sendai Open Hospital, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
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Exploring red cell distribution width as a biomarker for treatment efficacy in home mechanical ventilation. BMC Pulm Med 2022; 22:115. [PMID: 35354396 PMCID: PMC8969261 DOI: 10.1186/s12890-022-01916-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 03/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With the growing practice of home mechanical ventilation, there is a need to identify biological markers for adequate follow-up. Red cell distribution width (RDW) is a promising candidate because it is convenient, objective and may reflect treatment effect over a long period of time. The aim of this study was to explore the possible role of RDW as a marker for home mechanical ventilation in real-life, unselected chronic respiratory patient populations. METHODS First, we identified characteristic RDW values for mixed case, unselected chronic respiratory failure and home mechanical ventilated patients through retrospective review within our institutional database. Next, we conducted a prospective observational study to identify RDW changes during the first six months of optimized home mechanical ventilation treatment. Adult patients starting home mechanical ventilation were included. Factors affecting RDW change during the first 6 months of treatment were analysed. RESULTS RDW was elevated in both chronic respiratory failure and home mechanical ventilation patients compared to healthy individuals in the retrospective review. In the prospective study of 70 patients, we found that 55.4% of patients starting home mechanical ventilation have abnormal RDW values which are reduced from 14.7 (IQR = 13.2-16.2)% to 13.5 (IQR = 13.1-14.6)% during the first 6 months of HMV treatment (p < 0.001). RDW improvement correlates with improvement in self-reported health-related quality of life and sleepiness scale scores, as well as physical functional status during the same time frame. RDW proved to be a comparable marker to other parameters traditionally used to evaluate treatment efficacy. CONCLUSIONS RDW is elevated in chronic respiratory failure patients and is significantly reduced in the first six months of optimized home mechanical ventilation. Although further research is needed to verify if RDW change reflects outcome and how comorbidities influence RDW values, our results suggest that RDW is a promising marker of home mechanical ventilation efficacy. Trial registration This study was approved by and registered at the ethics committee of Semmelweis University (TUKEB 250/2017 and TUKEB 250-1/2017, 20th of December 2017 and 1st of October 2019).
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Akturk OM, Yildirim D, Cakir M, Vardar YM, Erozgen F, Akinci M. Is there a threshold for red cell distribution width to predict malignancy in breast masses? Niger J Clin Pract 2022; 25:349-353. [PMID: 35295059 DOI: 10.4103/njcp.njcp_1583_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Red cell distribution width (RDW) has been shown to have predictive properties in different diseases as well as solid cancers. Aim We aimed to investigate the discriminative properties of RDW in benign and malignant breast lesions. Subjects and Methods In a retrospective cohort study the files of patients who underwent surgery for fibroadenomas (Group A) and breast cancer with axillary lymph node metastasis (Group B) were reviewed. The pathology reports and laboratory parameters and demographics of the patients were recorded for comparison. The patients were later excluded if they had an hemoglobin level below 12 mg/dl and the outliers were removed for a comparison. Seventy-six patients in the fibroadenoma group and 62 patients in the breast malignancy group were compared for the RDW levels to predict the presence of malignancy. Receiver operating characteristic curves were plotted for RDW and a threshold for prediction of malignancy was calculated. Results The difference in RDW levels between group A and group B was found to be significant, 13,10% (IQR 12.60 -13.70) versus 13,80% (IQR 13.10-14.40) respectively, P = 0,00. The area under the curve was 0.71 (95% confidence interval 0.62 to 0.79), P = 0,00. For the threshold of 13,75 the positive predictive value was 67.35 (95% CI 55.72 to 77.17) and negative predictive value was 67.42 (95% CI 60.76% to 73.44). Conclusion The RDW levels, after adjusted for anemia, were found to have a positive prediction for malignancy in more than two thirds of the patients for the level of 13.75%.
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Affiliation(s)
- O M Akturk
- Department of Surgery, Haseki Training and Research Hospital, Istanbul, Turkey
| | - D Yildirim
- Department of Surgery, Haseki Training and Research Hospital, Istanbul, Turkey
| | - M Cakir
- Department of Surgery, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Y M Vardar
- Department of Surgery, Haseki Training and Research Hospital, Istanbul, Turkey
| | - F Erozgen
- Department of Surgery, Haseki Training and Research Hospital, Istanbul, Turkey
| | - M Akinci
- Department of Surgery, Haseki Training and Research Hospital, Istanbul, Turkey
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Ludwik TM, Heinrich DA, Rendahl A, Friedenberg SG. Red cell distribution width is a predictor of all-cause mortality in hospitalized dogs. J Vet Emerg Crit Care (San Antonio) 2022; 32:9-17. [PMID: 34432939 PMCID: PMC9272852 DOI: 10.1111/vec.13109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/09/2020] [Accepted: 04/16/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To determine whether RBC distribution width (RDW) is associated with an increased odds of mortality in hospitalized dogs and cats. DESIGN Retrospective, single-center study; data collected from 2007 to 2017. SETTING University teaching hospital. ANIMALS Six thousand six hundred and sixty-one animals (5183 dogs and 1478 cats). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Medical records were identified from animals presented to the emergency service and admitted to the ICU with a CBC and serum biochemistry performed on admission. Patients were stratified into quintiles based upon presenting RDW, and logistic regression modeling was performed to evaluate the relationship between RDW and in-hospital mortality. Canine patients with a presenting RDW in the upper fourth and fifth quintiles had an increased odds of all-cause in-hospital mortality (p < 0.0001). Specifically, dogs in the upper fifth quintile had a 2.1-fold greater odds of death compared to dogs in the first quintile, and dogs in the upper fourth quintile had a 1.9-fold greater odds of death compared to dogs in the first quintile. This relationship remained significant after adjusting for age, sex, key laboratory values excluding HCT, medical versus surgical disease, and diagnosis category. This relationship was no longer significant with the inclusion of HCT. No significant association was identified between presenting RDW and in-hospital mortality in cats. CONCLUSIONS Hospitalized dogs with higher RDW on presentation to the emergency service have greater odds of all-cause in-hospital mortality compared to dogs with a lower RDW. A similar association between RDW and mortality was not found in cats. Further studies are warranted to assess the usefulness of this biomarker for specific diseases in dogs and to better understand the mechanisms driving the association between increased RDW and mortality in canine patients.
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Affiliation(s)
- Tasia M Ludwik
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, USA
| | - Daniel A Heinrich
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, USA
| | - Aaron Rendahl
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, USA
| | - Steven G Friedenberg
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, USA
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Yoo KD, Oh HJ, Park S, Kang MW, Kim YC, Park JY, Lee J, Lee JS, Kim DK, Lim CS, Kim YS, Lee JP. Red blood cell distribution width as a predictor of mortality among patients regularly visiting the nephrology outpatient clinic. Sci Rep 2021; 11:24310. [PMID: 34934060 PMCID: PMC8692533 DOI: 10.1038/s41598-021-03530-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/22/2021] [Indexed: 11/09/2022] Open
Abstract
The association between increased red blood cell distribution width (RDW) and mortality among patients treated on an outpatient basis in the nephrology outpatient clinic is unclear. Therefore, our study aimed to investigate the association between baseline and time-averaged RDW and mortality risk in patients treated in our nephrology outpatient clinic. Our multi-center retrospective analysis was based on data of 16,417 outpatient nephrology patients with available baseline renal function and RWD values. The median baseline RDW was 13.0% (range, 10.0–32.1%). The high-RDW group was defined as the top quartile (≥ 13.8%, n = 4302). The crude mortality rate was 15.0% (n = 1806) at a median follow-up of 127.5 months. From the results of the multivariate Cox proportional hazards regression model adjusted for covariates, including eGFR, hemoglobin, and factors of anemia treatment, patients with a high time-averaged RDW had increased mortality risk (adjusted hazard ratio, 1.505; 95% confidence interval, 1.326–1.708; P < 0.001), irrespective of sex, presence of anemia, and chronic kidney disease, except in individuals aged < 45 years. Thus, increased baseline and time-averaged RDW were significantly associated with increased mortality in patients aged > 45 years treated on an outpatient basis in the nephrology clinic.
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Affiliation(s)
- Kyung Don Yoo
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hyung Jung Oh
- Department of Nephrology, Sheikh Khalifa Specialty Hospital, Ras al Khaimah, United Arab Emirates
| | - Sehoon Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Min Woo Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jae Yoon Park
- Department of Internal Medicine, Dongguk University College of Medicine, Dongguk University Ilsan Hospital, Seoul, Korea
| | - Jeonghwan Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jong Soo Lee
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea. .,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. .,Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea.
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10
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Slajus B, Brailovsky Y, Darwish I, Fareed J, Darki A. Utility of Blood Cellular Indices in the Risk Stratification of Patients Presenting with Acute Pulmonary Embolism. Clin Appl Thromb Hemost 2021; 27:10760296211052292. [PMID: 34846193 PMCID: PMC8649084 DOI: 10.1177/10760296211052292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pulmonary embolism (PE) clinical manifestations vary widely, and that scope is not fully captured by current all-cause mortality risk models. PE is associated with inflammatory, coagulation, and hemostatic imbalances so blood cellular indices may be prognostically useful. Complete blood count (CBC) data may improve current risk models like the simplified pulmonary embolism severity index (sPESI) for all-cause mortality, offering greater accuracy and analytic ability. Acute PE patients (n = 228) with confirmatory diagnostic imaging were followed for all-cause mortality. Blood cellular indices were assessed for association to all-cause mortality and were supplemented into sPESI using multivariate logistic regression. Multiple blood cellular indices were found to be significantly associated with all-cause mortality in acute PE. sPESI including red cell distribution width, hematocrit and neutrophil-lymphocyte ratio had better predictive ability as compared to sPESI alone (AUC: 0.852 vs 0.754). Blood cellular indices contribute an inflammatory and hemodynamic perspective not currently included in sPESI. CBC with differential is a widely used, low-cost test that can augment current risk stratification tools for all-cause mortality in acute PE patients.
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Affiliation(s)
- Brett Slajus
- Loyola University Medical Center, Stritch School of Medicine, Maywood, IL, USA
| | - Yevgeniy Brailovsky
- Advanced Heart Failure, Mechanical Circulatory Support, Heart Transplant, Jefferson Heart Institute, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Iman Darwish
- Loyola University Medical Center, Stritch School of Medicine, Maywood, IL, USA
| | - Jawed Fareed
- Cardiovascular Research Institute, Hemostasis and Thrombosis Research Division, 2456Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Amir Darki
- Loyola University Medical Center, Stritch School of Medicine, Maywood, IL, USA
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11
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Tsilingiris D, Makrilakis K, Barmpagianni A, Dalamaga M, Tentolouris A, Kosta O, Eleftheriadou I, Liatis S. The glycemic status determines the direction of the relationship between red cell distribution width and HbA1c. J Diabetes Complications 2021; 35:108012. [PMID: 34364778 DOI: 10.1016/j.jdiacomp.2021.108012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 10/20/2022]
Abstract
AIMS Available studies conducted on heterogenous populations on the association between the erythrocyte distribution width (RDW) and HbA1c have reported a positive, negative or neutral relationship. The aim of the present study is to investigate the debated relationship between RDW and HbA1c among hematologically healthy individuals with and without type 2 diabetes mellitus (T2DM). METHODS Paired measurements of RDW and HbA1c of 183 hematologically healthy individuals (100 without DM, 83 with T2DM) were obtained. The association of HbA1c with a) hematologic parameters (hemoglobin, log[ferritin], RDW) and b) factors related to glycemia (BMI, fructosamine, FPG) was examined within each group separately and in the sum of the study sample. RESULTS There was a significant positive correlation of RDW with HbA1c among those without DM while the opposite was true among individuals with T2DM (r = 0.315, p = 0.001 and r = -0.275, p = 0.011). In the T2DM group a significant negative correlation with fructosamine was noted (r = -0.274, p = 0.012) which was absent among normoglycemic individuals. Among those without DM the association between HbA1c and RDW remained significant after adjustment for all tested parameters. In the population with T2DM the significance was attenuated after including glycemia-related factors values. In multivariable regression in the sum of the study sample, the interaction between diabetes status and RDW as regards HbA1c was significant [unstandardized correlation coefficient - 0.397 (-0.646 to -0.147), p = 0.002] and remained significant after adjustment for multiple potential confounders. CONCLUSIONS Among individuals without DM, the RDW likely reflects the non-glycemic interference on HbA1c values, while in T2DM RDW may serve as an indirect index of glycemia and dysmetabolism.
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Affiliation(s)
- Dimitrios Tsilingiris
- First Department of Propaedeutic Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Department of Internal Medicine I and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany.
| | - Konstantinos Makrilakis
- First Department of Propaedeutic Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Barmpagianni
- First Department of Propaedeutic Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Dalamaga
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios Tentolouris
- First Department of Propaedeutic Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ourania Kosta
- First Department of Propaedeutic Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Eleftheriadou
- First Department of Propaedeutic Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavros Liatis
- First Department of Propaedeutic Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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12
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Ranchin B, Maucort-Boulch D, Bacchetta J. Big data and outcomes in paediatric haemodialysis: how can nephrologists use these new tools in daily practice? Nephrol Dial Transplant 2021; 36:387-391. [PMID: 33257930 DOI: 10.1093/ndt/gfaa225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Bruno Ranchin
- Centre de Référence des Maladies Rénales Rares, Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Bron Cedex, France
| | - Delphine Maucort-Boulch
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon, France.,CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France.,Faculté de Médecine Lyon Est, Université de Lyon, Lyon, France
| | - Justine Bacchetta
- Centre de Référence des Maladies Rénales Rares, Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Bron Cedex, France.,Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon, France.,CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France.,Faculté de Médecine Lyon Est, Université de Lyon, Lyon, France.,INSERM 1033, LYOS, Prévention des Maladies Osseuses, Lyon, France
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13
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Martínez-Velilla N, Ramírez-Vélez R, Sáez de Asteasu ML, Zambom-Ferraresi F, García-Hermoso A, Marín-Epelde I, Izquierdo M. Red Blood Cell Distribution Width Trajectory During a Multicomponent Exercise in Hospitalized Older Adults: A Secondary Analysis of a Randomized Clinical Trial. Rejuvenation Res 2021; 24:294-296. [PMID: 33715402 DOI: 10.1089/rej.2020.2405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Nicolás Martínez-Velilla
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de, Navarra (UPNA), IdiSNA, Pamplona, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
- Department of Geriatric Medicine, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Robinson Ramírez-Vélez
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de, Navarra (UPNA), IdiSNA, Pamplona, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Mikel L Sáez de Asteasu
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de, Navarra (UPNA), IdiSNA, Pamplona, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Fabricio Zambom-Ferraresi
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de, Navarra (UPNA), IdiSNA, Pamplona, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio García-Hermoso
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de, Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Itxaso Marín-Epelde
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de, Navarra (UPNA), IdiSNA, Pamplona, Spain
- Department of Geriatric Medicine, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Mikel Izquierdo
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de, Navarra (UPNA), IdiSNA, Pamplona, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
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14
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RDW Value may Increase the Diagnostic Accuracy of MPS. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2021; 55:76-80. [PMID: 33935539 PMCID: PMC8085445 DOI: 10.14744/semb.2019.58159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 12/02/2019] [Indexed: 11/27/2022]
Abstract
Objectives: As the feasibility of obtaining health care has improved in the last decade, there is an increase in the number of performing unnecessary coronary angiogram. Red Cell Distribution Width (RDW), which shows erythrocyte dispersion volume, is associated with coronary artery disease. The present study aims to evaluate the relationship between RDW value and the severity of coronary artery disease in patients who undergo myocardial perfusion scintigraphy (MPS) as an evaluation for coronary ischemia and after which patients had a coronary angiography. Methods: This retrospective study included 452 patients diagnosed as stabile angina that had MPS to evaluate coronary ischemia and after which coronary angiography was performed. Complete blood count was obtained on the same day. Patients were first divided into two groups: patients with and without ischemia on MPS. Then, the group who had ischemia on the MPS where divided into another two groups: patients who had RDW values ≥13.5 and the others who had RDW value <13.5. Patients who had fixed perfusion defect, chronic kidney disease, thyroid dysfunction, hematological disease, those who use iron supplements, and those who had active infectious disease were excluded from this study. Results: The basic characteristics were the same between study groups. We found that severe coronary vessel disease, single vessel, two vessels and three vessels diseases were higher in patients who had ischemia on the MPS and RDW values ≥13.5 (p-value were 0.032, 0.004, 0.042 respectively). RDW values ≥13.5 was found to be an independent predictor for the presence of severe coronary artery disease (p<0.001 OR: 3.55). Conclusion: Patients who have MPS for ischemic evaluation and RDW values of ≥ 13.5 were more severe coronary heart diseases. As a result, the findings suggest that using of RDW value is a cheap and feasible parameter that may prevent performing unnecessary coronary angiography for patients after MPS.
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15
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Zalyesov E, Shugaev I, Prokopov Y, Shahory R, Chirmicci S, Aizen E. Red Cell Distribution Width as a Predictor of Functional Outcome in Rehabilitation of Older Stroke Patients. Ann Geriatr Med Res 2020; 24:211-217. [PMID: 32937684 PMCID: PMC7533197 DOI: 10.4235/agmr.20.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/03/2020] [Accepted: 08/26/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Red cell distribution width (RDW) is a prognostic marker in vascular diseases. While increased RDW predicts mortality and outcomes after ischemic stroke, evidence regarding its prognostic significance in stroke rehabilitation is lacking. Thus, the present study investigated the relationship of RDW with stroke, orthopedic, and deconditioning rehabilitation outcomes. METHODS This prospective comparative study included three groups (stroke, orthopedic, and deconditioning) of older adult patients hospitalized for rehabilitation. The patients in each group were divided into two subgroups according to whether they had high (>14.5%) or normal (≤14.5%) RDW levels on admission. Functional outcome was assessed by total and motor FIM (Functional Independence Measure) score changes and efficiency at admission and on discharge. RESULTS Of the 234 eligible patients, 108 (46.2%) had high RDW. Of the 50 stroke rehabilitation patients, 13 (26%) had high RDW. FIM change and efficiency scores were significantly lower in patients with high RDW only in the stroke rehabilitation group. However, multiple linear regression analysis showed that high RDW was not independently associated with total and motor FIM gain or total and motor FIM efficiency. CONCLUSION High RDW levels on admission to rehabilitation were associated with poor rehabilitation outcome in stroke patients but were not an independent risk factor for rehabilitation outcomes.
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Affiliation(s)
- Eduard Zalyesov
- Fliman Geriatric Rehabilitation Hospital, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Inna Shugaev
- Fliman Geriatric Rehabilitation Hospital, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | | | - Ron Shahory
- Fliman Geriatric Rehabilitation Hospital, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Stefan Chirmicci
- Fliman Geriatric Rehabilitation Hospital, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Efraim Aizen
- Fliman Geriatric Rehabilitation Hospital, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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16
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Li CM, Chao CT, Chen SI, Han DS, Huang KC. Elevated Red Cell Distribution Width Is Independently Associated With a Higher Frailty Risk Among 2,932 Community-Dwelling Older Adults. Front Med (Lausanne) 2020; 7:470. [PMID: 32984367 PMCID: PMC7477345 DOI: 10.3389/fmed.2020.00470] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/13/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Older adults are at an increased risk of frailty, but laboratory surrogates for identifying frailty in this population remain controversial and clinicians frequently encounter difficulty during frailty screening. We examined whether having a high red cell distribution width (RDW) was associated with an increased probability of frailty in older adults. Methods: We prospectively included community-dwelling older adults between 2013 and 2016 from a single institute, with their clinical features/laboratory parameters documented. We used the Study of Osteoporotic Fractures index (malnutrition, poor physical performance, and fatigue) to delineate frailty, and harnessed multiple logistic regression to investigate whether having a high RDW (≥ 15.7%) was associated with an increased risk of having frailty among these participants. Results: A total of 2,932 older adults (mean 73.5 ± 6.7 years; 44.6% male) were included, among whom 113 (3.9%) and 76 (2.6%) had a high RDW and presented frailty, respectively. Older adults with a high RDW were more likely to be frail (p = 0.002) and had more positive SOF items than those with normal RDW levels (p = 0.013). Those with a high RDW exhibited a significantly higher risk of having frailty (odds ratio [OR] 2.689, 95% confidence interval [CI] 1.184–6.109) compared to those without. Sensitivity analyses using RDW as a continuous variable similarly showed that RDW levels were positively associated with frailty risk (OR 1.223 per 1% RDW higher). Conclusions: In older adults, higher RDW can be regarded as a frailty indicator, and the readiness in RDW assessment supports its screening utility.
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Affiliation(s)
- Chia-Ming Li
- Department of Family Medicine, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan.,Geriatric and Community Medicine Research Center, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan
| | - Chia-Ter Chao
- Geriatric and Community Medicine Research Center, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan.,Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan.,Graduate Institute of Toxicology, National Taiwan University, Taipei, Taiwan
| | - Shih-I Chen
- Geriatric and Community Medicine Research Center, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan.,Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan
| | - Der-Sheng Han
- Geriatric and Community Medicine Research Center, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan.,Department of Rehabilitation and Physical Medicine, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan
| | - Kuo-Chin Huang
- Department of Family Medicine, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan.,Geriatric and Community Medicine Research Center, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan.,Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
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17
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Katsaros M, Paschos P, Giouleme O. Red cell distribution width as a marker of activity in inflammatory bowel disease: a narrative review. Ann Gastroenterol 2020; 33:348-354. [PMID: 32624654 PMCID: PMC7315702 DOI: 10.20524/aog.2020.0486] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 03/08/2020] [Indexed: 02/07/2023] Open
Abstract
Red blood cell distribution width is a parameter measured automatically in every complete blood count that actually reflects the degree of anisocytosis of the red blood cell population. It is a cost-effective tool used in everyday clinical practice along with other parameters to define and narrow the cause of anemia. In a series of pathologic entities, such as cardiovascular diseases, autoimmune diseases, malignancy, chronic renal diseases and chronic respiratory diseases, where inflammation and oxidative stress comprise the major pathophysiologic insults, red cell distribution width behaves as a significant and competent marker able to predict and assess disease activity and severity. A number of clinical studies based on these observations have aimed to evaluate its potential utility as an index of activity in inflammatory bowel disease. In this narrative review we present data from the international literature regarding its ability to express disease activity and we look into its relation with clinical, laboratory and endoscopic indices used to identify active disease. According to the results of published clinical trials, red cell distribution width is considerably correlated with disease activity and might serve as an index to differentiate Crohn's disease from ulcerative colitis.
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Affiliation(s)
- Marios Katsaros
- Gastroenterology and Hepatology Division of the Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital (Marios Katsaros, Olga Giouleme)
| | - Paschalis Paschos
- First Department of Internal Medicine, "Papageorgiou" Hospital (Paschalis Paschos), Thessaloniki, Greece
| | - Olga Giouleme
- Gastroenterology and Hepatology Division of the Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital (Marios Katsaros, Olga Giouleme)
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min-SIA: a Lightweight Algorithm to Predict the Risk of 6-Month Mortality at the Time of Hospital Admission. J Gen Intern Med 2020; 35:1413-1418. [PMID: 32157649 PMCID: PMC7210334 DOI: 10.1007/s11606-020-05733-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 02/10/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Predicting death in a cohort of clinically diverse, multi-condition hospitalized patients is difficult. This frequently hinders timely serious illness care conversations. Prognostic models that can determine 6-month death risk at the time of hospital admission can improve access to serious illness care conversations. OBJECTIVE The objective is to determine if the demographic, vital sign, and laboratory data from the first 48 h of a hospitalization can be used to accurately quantify 6-month mortality risk. DESIGN This is a retrospective study using electronic medical record data linked with the state death registry. PARTICIPANTS Participants were 158,323 hospitalized patients within a 6-hospital network over a 6-year period. MAIN MEASURES Main measures are the following: the first set of vital signs, complete blood count, basic and complete metabolic panel, serum lactate, pro-BNP, troponin-I, INR, aPTT, demographic information, and associated ICD codes. The outcome of interest was death within 6 months. KEY RESULTS Model performance was measured on the validation dataset. A random forest model-mini serious illness algorithm-used 8 variables from the initial 48 h of hospitalization and predicted death within 6 months with an AUC of 0.92 (0.91-0.93). Red cell distribution width was the most important prognostic variable. min-SIA (mini serious illness algorithm) was very well calibrated and estimated the probability of death to within 10% of the actual value. The discriminative ability of the min-SIA was significantly better than historical estimates of clinician performance. CONCLUSION min-SIA algorithm can identify patients at high risk of 6-month mortality at the time of hospital admission. It can be used to improved access to timely, serious illness care conversations in high-risk patients.
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Kaner J, Desai P, Mencia-Trinchant N, Guzman ML, Roboz GJ, Hassane DC. Clonal Hematopoiesis and Premalignant Diseases. Cold Spring Harb Perspect Med 2020; 10:a035675. [PMID: 31615870 PMCID: PMC7117948 DOI: 10.1101/cshperspect.a035675] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Clonal hematopoiesis (CH) arises when mutations in the hematopoietic system confer a fitness advantage to specific clones, thereby favoring their disproportionate growth. The presence of CH increases with age and environmental exposures such as cytotoxic chemotherapy or radiotherapy. The most frequent mutations occur in epigenetic regulators, such as DNMT3A, TET2, and ASXL1, leading to dysregulation of tumor suppressor function, pathogen response, and inflammation. These dysregulated processes elevate risk of overall mortality, cardiovascular disease, and eventual hematologic malignancy (HM). CH is likely acting as an initiating event leading to HM when followed by cooperating mutations. However, further evidence suggests that CH exerts a bystander influence through its pro-inflammatory properties. Delineating the mechanisms that lead to the onset and expansion of CH as well as its contribution to risk of HM is crucial to defining a management and intervention strategy. In this review, we discuss the potential causes, consequences, technical considerations, and possible management strategies for CH in the context of HMs and pre-HMs.
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Affiliation(s)
- Justin Kaner
- Division of Hematology & Oncology, Weill Cornell Medical College, New York, New York 10065, USA
| | - Pinkal Desai
- Division of Hematology & Oncology, Weill Cornell Medical College, New York, New York 10065, USA
| | - Nuria Mencia-Trinchant
- Division of Hematology & Oncology, Weill Cornell Medical College, New York, New York 10065, USA
| | - Monica L Guzman
- Division of Hematology & Oncology, Weill Cornell Medical College, New York, New York 10065, USA
| | - Gail J Roboz
- Division of Hematology & Oncology, Weill Cornell Medical College, New York, New York 10065, USA
| | - Duane C Hassane
- Division of Hematology & Oncology, Weill Cornell Medical College, New York, New York 10065, USA
- Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medical College, New York, New York 10065, USA
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Fukuokaya W, Kimura T, Miki J, Kimura S, Watanabe H, Bo F, Okada D, Aikawa K, Ochi A, Suzuki K, Shiga N, Abe H, Egawa S. Red cell distribution width predicts time to recurrence in patients with primary non-muscle-invasive bladder cancer and improves the accuracy of the EORTC scoring system. Urol Oncol 2020; 38:638.e15-638.e23. [PMID: 32184059 DOI: 10.1016/j.urolonc.2020.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/22/2020] [Accepted: 01/27/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To investigate the clinical prognostic value of red cell distribution width (RDW) in patients with non-muscle-invasive bladder cancer (NMIBC). MATERIALS AND METHODS We retrospectively evaluated 582 consecutive patients with primary NMIBC. The efficacy of preoperative RDW at predicting treatment outcome was assessed. A cut-off point for predicting recurrence was also identified. Uni- and multivariable analyses of time to recurrence (TTR) and progression were conducted. Harrell's concordance index (c-index) was used to evaluate the additive value of RDW to the European Organization of Research and Treatment of Cancer (EORTC) risk scoring model for recurrence. RESULTS According to the receiver operating characteristic curve of RDW for recurrence, a RDW ≥ 14.5% was classified as high. In the multivariable analysis, a high RDW could independently predict shorter TTR (subdistribution hazard ratio [SHR]: 2.65, 95% confidence interval [CI]: 1.83-3.84, P < 0.001), irrespective of tumor characteristics. No significant relationship was observed between RDW and time to progression (SHR: 1.75, 95% CI: 0.76-4.08, P = 0.19). Adding binary-coded RDW to the EORTC risk scoring model significantly improved its discriminatory performance in assessing recurrence risk (c-index: 0.62, improvement: 0.052, P < 0.001). High RDW was associated with shorter TTR in patients treated with bacillus Calmette-Guerin in the multivariable analysis (SHR: 2.0, 95% CI: 1.01-3.98, P = 0.047). CONCLUSIONS RDW was an independent, significant prognostic factor of TTR in patients with primary NMIBC. Adding RDW to the EORTC risk model significantly improved the model's predictability for tumor recurrence.
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Affiliation(s)
- Wataru Fukuokaya
- Department of Urology, Kameda Medical Center, Kamogawa City, Chiba, Japan; Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan.
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Shoji Kimura
- Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Hisaki Watanabe
- Department of Urology, Kameda Medical Center, Kamogawa City, Chiba, Japan; Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Fan Bo
- Department of Urology, Kameda Medical Center, Kamogawa City, Chiba, Japan
| | - Daigo Okada
- Department of Urology, Kameda Medical Center, Kamogawa City, Chiba, Japan
| | - Koichi Aikawa
- Department of Urology, Kameda Medical Center, Kamogawa City, Chiba, Japan; Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Atsuhiko Ochi
- Department of Urology, Kameda Medical Center, Kamogawa City, Chiba, Japan
| | - Koichiro Suzuki
- Department of Urology, Kameda Medical Center, Kamogawa City, Chiba, Japan
| | - Naoki Shiga
- Department of Urology, Kameda Medical Center, Kamogawa City, Chiba, Japan
| | - Hirokazu Abe
- Department of Urology, Kameda Medical Center, Kamogawa City, Chiba, Japan
| | - Shin Egawa
- Department of Urology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
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Wang L, Wang C, Wu S, Li Y, Guo W, Liu M. Red blood cell distribution width is associated with mortality after acute ischemic stroke: a cohort study and systematic review. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:81. [PMID: 32175374 DOI: 10.21037/atm.2019.12.142] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Whether red blood cell distribution width (RDW) is associated with the prognosis of acute ischemic stroke is inconclusive according to recent studies. We performed a cohort study and meta-analysis to explore the association between RDW and functional outcome. Methods Patients with ischemic stroke admitted to the Department of Neurology within 24 hours of stroke onset between January 1, 2015 to December 31, 2018 were enrolled. Blood was sampled within 24 hours after admission. We searched PubMed, Embase, Web of Science databases up to Nov 2019 to identify studies investigating the association between RDW values and prognosis following stroke. Outcomes included 3-month death and poor functional outcome [defined by modified Rankin Scale (mRS) score ≥3]. Results We included 1,558 patients in cohort study. RDW was independently associated with 3-month death [odds ratio (OR), 1.19; 95% confidence interval (CI), 1.03, 1.37], but not associated with 3-month poor outcome (OR 1.05, 95% CI, 0.95, 1.16), after adjustment for confounders. A dose-dependent relationship between RDW levels and 3-month death was revealed in the restricted cubic spline plot. Seven observational studies with 4,407 patients were identified for systematic review. When combining our study and previous studies, the association was significant for RDW predicting death (5 studies with 3,366 patients, OR 1.25, 95% CI, 1.15, 1.35), as well as for poor outcome (4 studies with 3,483 patients, OR 1.23, 95% CI, 1.05, 1.44). Conclusions RDW was an independent predictor of 3-month functional outcome, and a trend of dose-dependent relationship between RDW and 3-month death was detected.
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Affiliation(s)
- Lu Wang
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Changyi Wang
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Simiao Wu
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yuxiao Li
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Wen Guo
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Ming Liu
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China
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Abstract
Gallbladder cancer (GBC) is a rare biliary malignancy. The relationship between red blood cell distribution width (RDW) and cancer prognosis has been confirmed by many studies, however, the relationship between RDW and gallbladder cancer is rarely reported. Therefore, we aimed to assess the correlation between RDW and the advancements of GBC in this study.A retrospective study was performed on 108 GBC patients and 119 age and gender-matched individuals who were admitted to the First Affiliated Hospital of Guangxi Medical University from January 2012 to December 2018.The GBC patients had significantly higher RDW(%) levels compared to the healthy controls group (15.7 ± 2.4 vs 13.5 ± 0.6; P = .000). In addition, GBC patients with stage III+IV had higher levels of RDW(%) than stage I+II (16.1 ± 2.5 vs 14.9 ± 2.0, P = .011). Correlation analysis showed that RDW had positive correlations with TNM stage (correlation coefficient = 0.302, P = .002). The cut-off value of RDW was observed to be 14.5% in patients with GBC (area under the curve = 0.757, 95% confidence interval = 0.677-0.838, P = .000). Univariate logistic regression and multivariate logistic regression analysis showed that RDW was an independent risk factor for GBC lymph node metastasis.Our results suggest that elevated levels of RDW are independently associated with GBC patients and may serve as potential markers for the advancements of GBC.
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Affiliation(s)
- Youjun Xie
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University
| | - Lingling Zhang
- Department of Clinical Laboratory, Children's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Lingling Zhan
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University
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Ferreira IB, Lima EDNS, da Silva NC, Prestes IV, Pena GDG. Combination of red blood cell distribution width and body mass index (COR-BMI) predicts in-hospital mortality in patients with different diagnoses? PLoS One 2019; 14:e0219549. [PMID: 31306467 PMCID: PMC6629057 DOI: 10.1371/journal.pone.0219549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 06/26/2019] [Indexed: 12/14/2022] Open
Abstract
Background The combination of red blood cell distribution width and body mass index (COR-BMI) is indicated as a new prognostic index of survival in patients with laryngeal cancer. However, the ability of this prediction in other types of cancer or whether its use can be expanded to non-oncological patients is unknown. The aim of this study was to investigate the prediction of prognosis of in-hospital mortality of the COR-BMI in oncological and non-oncological patients. Methods A retrospective study was performed with all hospitalized patients between 2014 and 2016, totaling 2930 patients, 262 oncological and 2668 non-oncological. The COR-BMI was divided into three classes: 0, RDW ≤ 13.1% and BMI ≥ 25 kg/m2; 1, RDW ≤ 13.1% and BMI < 18.5 or ≥ 18.5 but < 25 kg/m2 and RDW > 13.1% and BMI ≥ 18.5 but < 25 or BMI ≥ 25 kg/m2; and 2, RDW > 13.1% and BMI < 18.5 kg/m2. In order to analyze the relationship between COR-BMI and in-hospital mortality in the studied population, the Cox Proportional Hazards Model was used in a multivariate analysis based on a conceptual model. Results The COR-BMI was an independent predictor of in-hospital mortality in non-oncological patients (1 versus 0: HR = 3.34; CI = 1.60–6.96, p = 0.001; 2 versus 0: HR = 3.38; CI = 1.22–9.39, p = 0.019). The survival rate of these patients was lower among those with the highest scores on the COR-BMI. This prediction was not found in oncological patients. Conclusion The present study suggests that the COR-BMI may have its practical use expanded to non-oncological patients as an independent predictor of in-hospital mortality.
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Affiliation(s)
- Isabela Borges Ferreira
- Multiprofessional Residence Program, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | | | - Nayara Cristina da Silva
- Graduate Program in Health Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | | | - Geórgia das Graças Pena
- Graduate Program in Health Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
- * E-mail:
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Jurin I, Trkulja V, Ajduk M, Letilović T, Hadžibegović I. Red cell distribution width in acute pulmonary embolism patients: A simple aid for improvement of the 30-day mortality risk stratification based on the pulmonary embolism severity index. Heart Lung 2019; 48:436-445. [PMID: 30905389 DOI: 10.1016/j.hrtlng.2019.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 11/04/2018] [Accepted: 02/23/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Pulmonary embolism (PE) severity index (PESI) well predicts 30-day mortality in acute PE patients, yet improvements have been advocated. OBJECTIVES To evaluate predictivity of the red cell distribution width (RDW) through a comparison with PESI and to explore their interaction as a potential improvement in this respect. METHODS Retrospective analysis of consecutive adult PE patients. RESULTS Of the 299 patients, 19 severely unstable died within 48 h. Among the stabilized patients, 30-day mortality was 12.1% (34/280). With PESI ≤125, mortality was 4.9% (9/185), but it was 0.7% (1/140) if RDW ≤15.0% and 17.8% (8/45) if RDW >15.0%; with PESI >125, mortality was 26.3% (25/95), but it was 15.9% (7/44) if RDW ≤15.0% and 35.3% (18/51) if RDW >15.0%. Adjusted relative risk with PESI >125 vs. ≤125 was 17.5 (95%CI 2.37-129) at RDW ≤15.0% and 1.60 (0.76-3.36) at RDW >15.0%. CONCLUSIONS Thirty-day mortality predictions based on the PESI score may be improved by accounting for RDW.
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Affiliation(s)
- Ivana Jurin
- University Hospital Dubrava, Avenija Gojka Šuška 6, Zagreb, 10000, Croatia.
| | - Vladimir Trkulja
- Zagreb University School of Medicine, Šalata 3b, Zagreb, 10000, Croatia.
| | - Marko Ajduk
- University Hospital Dubrava, Avenija Gojka Šuška 6, Zagreb, 10000, Croatia; Zagreb University School of Medicine, Šalata 3b, Zagreb, 10000, Croatia.
| | - Tomislav Letilović
- Zagreb University School of Medicine, Šalata 3b, Zagreb, 10000, Croatia; University Hospital Merkur, Zajčeva 19, Zagreb, 10000, Croatia.
| | - Irzal Hadžibegović
- University Hospital Dubrava, Avenija Gojka Šuška 6, Zagreb, 10000, Croatia; Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University, Osijek, Croatia.
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Red cell distribution width associations with clinical outcomes: A population-based cohort study. PLoS One 2019; 14:e0212374. [PMID: 30865651 PMCID: PMC6415845 DOI: 10.1371/journal.pone.0212374] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 01/31/2019] [Indexed: 02/07/2023] Open
Abstract
Importance Higher levels of red cell distribution width (RDW) are associated with adverse outcomes, especially in selected cohorts with or at risk for chronic disease. Whether higher RDW or the related parameter standard deviation of the red blood cell distribution (SD-RBC) can predict a broader range of outcomes in the general population is unknown. Objective To evaluate the association of RDW and SD-RBC with the risk of adverse outcomes in people from the general population. Design Population-based retrospective cohort study. Setting Health care system in a Canadian province (Alberta). Participants All 3,156,863 adults living in Alberta, Canada with at least one measure of RDW and SD-RBC between 2003 and 2016. Data were analyzed in September 2018. Exposure RDW and SD-RBC, classified into percentiles (<1, 1–5, 5–25, 25–75, 75–95, 95–99, >99). Main outcomes All-cause death, first myocardial infarction, first stroke or transient ischemic attack, placement into long-term care (LTC), progression to renal replacement therapy (initiation of chronic dialysis or pre-emptive kidney transplantation), incident solid malignancy, and first hospitalization during follow-up. Results Over median follow-up of 6.8 years, 209,991 of 3,156,863 participants (6.7%) died. The risk of death increased with increasing RDW percentile. After adjustment, and compared to RDW in the 25th to 75th percentiles, the risk of death was lower for participants in the <25th percentiles but higher for participants in the 75th-95th percentiles (HR 1.42, 95% CI 1.40,1.43), the 95th-99th percentiles (HR 1.86, 95% CI 1.83,1.89) and the >99th percentile (HR 2.18, 95% CI 2.12,2.23). Similar results were observed for MI, stroke/TIA, incident cancer, hospitalization and LTC placement, but no association was found between RDW and ESRD. Findings were generally similar for SD-RBC, except that all associations tended to be stronger than for RDW, and both lower and higher values of SD-RBC were independently associated with ESRD. Conclusion and relevance RDW and SD-RBC may be useful as prognostic markers for people in the general population, especially for outcomes related to chronic illness. SD-RBC may be superior to RDW.
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The Association between Red Blood Cell Distribution Width and Mortality in Critically Ill Patients with Acute Kidney Injury. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9658216. [PMID: 30345313 PMCID: PMC6174796 DOI: 10.1155/2018/9658216] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/08/2018] [Accepted: 08/19/2018] [Indexed: 12/25/2022]
Abstract
Background Several investigators have sought risk factors for mortality in acute kidney injury (AKI). However, no epidemiological studies have investigated the impact of red blood cell distribution width (RDW) on prognosis for critically ill patients with AKI. The aim of this study was to investigate the association of RDW with mortality in these patients. Methods We analyzed data from the MIMIC-III. RDW was measured upon ICU admission. The association between RDW and mortality of AKI was determined using a multivariate logistic regression and was expressed as the adjusted odds ratio with associated 95% confidence interval (CI). We also conducted subgroup analyses to determine the consistency of this association. Results A total of 14,078 critically ill patients with AKI were eligible for this analysis. In multivariate analysis, adjusted for age and gender and compared with the reference group (RDW 11.1-13.4%) related to hospital mortality, the adjusted ORs (95% CIs) for RDW levels 13.5-14.3%, 14.4-15.6%, and 15.7-21.2% were 1.22 (1.05, 1.43), 1.56 (1.35, 1.81), and 2.66 (2.31, 3.06), respectively. After adjusting for confounding factors, with high RDW linked to an increase in mortality (RDW 15.7-21.2% versus 11.1-13.4%: OR, 1.57; 95% CI, 1.22 to 2.01; P trend <0.0001). A similar trend was observed for 30-day mortality. Conclusions RDW appeared to be an independent prognostic marker in critically ill patients with AKI and higher RDW was associated with increased risk of mortality in these patients.
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