Assessing the Predictive Power of the Hemoglobin/Red Cell Distribution Width Ratio in Cancer: A Systematic Review and Future Directions

Hemoglobin to red cell distribution width ratio predicts postoperative delirium in older patients undergoing hip fracture surgery: A retrospective cohort study

AIM

This study aimed to investigate the predictive effect of hemoglobin to red cell distribution width ratio (HRR) on postoperative delirium (POD) in older patients undergoing hip fracture surgery.

METHODS

POD was diagnosed by capturing descriptive words from the medical records. The correlation between POD and HRR was determined using logistic regression analysis, and the receiver operating characteristic curve was used to further evaluate the value of HRR in predicting POD.

RESULTS

In total, 202 older patients accepting hip fracture surgery were included in our study. The result of multiple logistic regression analysis presented HRR (odds ratio, 0.504 [95% confidence interval, 0.340-0.747]; P < 0.001), American Society of Anesthesiologists physical status >2, and neutrophils were independently correlated with POD. The area under the curve of HRR was 0.746 (95% confidence interval, 0.676-0.815), and the optimal cutoff value was 8.322.

CONCLUSIONS

HRR, American Society of Anesthesiologists physical status >2 and neutrophils could independently predict POD in older patients undergoing hip fracture surgery, and HRR had satisfactory predictive value. However, further research is needed to confirm our findings. Geriatr Gerontol Int 2025; 25: 565-571.

Trends in hemoglobin-to- red cell distribution width ratio and its prognostic value for all-cause, cancer, and cardiovascular mortality: a nationwide cohort study

The hemoglobin-to-red blood cell distribution width ratio (HRR) has emerged as a potential predictor of various health outcomes. This study aimed to investigate the association between HRR and all-cause, cancer, and cardiovascular mortality. This cohort study used data from 28,825 participants in the 1999-2018 U.S. National Health and Nutrition Examination Survey. Weighted Cox regression was used to assess the associations between HRR and mortality. Restricted cubic spline (RCS) models evaluated the non-linear associations between HRR and mortality risk. Subgroup and sensitivity analyses were conducted to assess the robustness of the study results. Trend tests assessed the temporal trends of mean HRR. Lower HRR was significantly linked to increased risks of all-cause, cancer, and cardiovascular mortality. According to the fully adjusted model, the highest quintile of HRR (Q5) showed lower mortality risks compared to the lowest quintile (Q1): all-cause mortality (HR 0.47, 95% CI 0.40, 0.55), cancer mortality (HR 0.51, 95% CI 0.37, 0.71), and cardiovascular mortality (HR 0.43, 95% CI 0.32, 0.56). A significant trend effect was observed across HRR quintiles (P for trend < 0.0001). Nonlinear association analyses suggested a linear relationship between HRR and cardiovascular mortality, while "L"-shaped associations were observed for all-cause and cancer mortality. Notably, the mean HRR levels decreased from 1.18 (95% CI 1.16-1.19) in 1999-2000 to 1.07 (95% CI 1.05-1.08) in 2017-2018. An inverse association between HRR and mortality risk was found, with lower HRR levels indicating higher mortality risk. Over the past two decades (1999-2018), there has been a significant decline in HRR levels among U.S. adults. HRR may serve as a valuable and easily obtainable predictor for mortality risk assessment in clinical practice.

Role of Hb to RDW ratio in metastatic renal cell carcinoma patients treated with first-line immunotherapy combinations

BACKGROUND

The present study aimed to investigate the prognostic and predictive roles of Hb/RDW ratio in patients with mRCC treated with first-line immunotherapy combinations (TKI plus ICI or ICI plus ICI).

MATERIALS AND METHODS

We performed a sub-analysis of a multicenter retrospective observational study (ARON-1 project) involving patients with mRCC treated with first-line immunotherapy combinations.

RESULTS

Three hundred and twenty-nine patients were enrolled, 244 males and 85 females. Median age was 65.5 years. The prognostic impact of the Hb/RDW ratio on PFS and OS was observed in the whole population examined. Hb/RDW ratio had a correlation with neutrophil-to-lymphocyte ratio (NLR), a blood inflammatory parameter.

CONCLUSION

Hb/RDW ratio is a new inflammatory prognostic factor, easy to use in daily clinical practice.

Non-Invasive Cancer Detection Using Blood Test and Predictive Modeling Approach

Purpose

The incidence of cancer, which is a serious public health concern, is increasing. A predictive analysis driven by machine learning was integrated with haematology parameters to create a method for the simultaneous diagnosis of several malignancies at different stages.

Patients and Methods

We analysed a newly collected dataset from various hospitals in Jordan comprising 19,537 laboratory reports (6,280 cancer and 13,257 noncancer cases). To clean and obtain the data ready for modelling, preprocessing steps such as feature standardization and missing value removal were used. Several cutting-edge classifiers were employed for the prediction analysis. In addition, we experimented with the dataset's missing values using the histogram gradient boosting (HGB) model.

Results

The feature ranking method demonstrated the ability to distinguish cancer patients from healthy individuals based on hematological features such as WBCs, red blood cell (RBC) counts, and platelet (PLT) counts, in addition to age and creatinine level. The random forest (RF) classifier, followed by linear discriminant analysis (LDA) and support vector machine (SVM), achieved the highest prediction accuracy (ranging from 0.69 to 0.72 depending on the scenario and method investigated), reliably distinguishing between malignant and benign conditions. The HGB model showed improved performance on the dataset.

Conclusion

After investigating a number of machine learning methods, an efficient screening platform for non-invasive cancer detection is provided by the integration of haematological indicators with proper analytical data. Exploring deep learning methods in the future work, could provide insights into more complex patterns within the dataset, potentially improving the accuracy and robustness of the predictions.

Unveiling the Prognostic Power of HRR in ICU-Admitted COPD Patients: A MIMIC-IV Database Study

Objective

This study sought to examine the potential relationship between Hemoglobin/Red Cell Distribution Width Ratio (HRR) and the all-cause mortality risk in critically ill patients with chronic obstructive pulmonary disease (COPD).

Patients and Methods

In a retrospective analysis of the MIMIC-IV database, patients were divided into two groups based on a specific HRR threshold. Propensity score matching (PSM) was employed to address covariate imbalances. Logistic regression models was used to examine the association between HRR and mortality. A restricted cubic spline (RCS) model was employed to visualize the association between HRR and mortality. Receiver Operating Characteristic (ROC) curves were utilized to assess the predictive capability of HRR, and Decision Curve Analysis (DCA) was conducted for clinical evaluation. Furthermore, subgroup analyses were performed to explore potential variations within specific cohorts.

Results

A comprehensive analysis identified a total of 1,061 patients. The threshold value established for HRR is 5.395 g/L/%. Following the application of PSM, the matched cohort comprised 544 patients. Both the original and matched cohorts exhibited higher rates of all-cause mortality and extended hospital stays among individuals with low HRRs. Logistic regression analyses demonstrated that HRR is an independent risk factor of mortality. The RCS analysis demonstrated a significant linear relationship between HRR and mortality. The ROC curves yielded values of 0.58 for the original cohort and 0.60 for the matched cohort. DCA analysis indicated that HRR is clinically valuable. Subgroup analyses further validated the robustness of these core findings.

Conclusion

A lower HRR is positively associated with all-cause mortality in critically ill patients with COPD.

Nomogram prediction model for gastric cancer risk in chronic atrophic gastritis: Role of blood cell ratios

BACKGROUND

Chronic atrophic gastritis (CAG) is a precancerous condition for gastric cancer. Although endoscopy is the standard method for monitoring CAG, its invasive nature and high cost limit its use.

AIM

To identify risk factors for gastric cancer in the CAG population, focusing on blood cell ratios, and develop a personalized prediction model using a nomogram.

METHODS

A retrospective analysis was conducted on 314 GAG patients admitted to Hangzhou Normal University Affiliated Hospital from January 2018 to January 2024. Data collected included demographic, serological, and blood cell parameters. Independent risk factors were identified using multivariate logistic regression and a nomogram model was constructed with R. Model performance was assessed using the area under the ROC curve (AUC), the Hosmer-Lemeshow test, and decision curve analysis (DCA).

RESULTS

Significant predictive factors for gastric cancer in the CAG population included male gender (odds ratio [OR] = 2.214, P < 0.05), Helicobacter pylori (H. pylori) infection (OR = 2.686, P < 0.05), gastrin 17 (G-17) (OR = 1.037, P < 0.05), hemoglobin-to-red blood cell distribution width ratio (HRR) (OR = 0.648, P < 0.05), and lymphocyte-to-monocyte ratio (LMR) (OR = 0.645, P < 0.05). The prediction model, with an AUC of 0.854, demonstrated good fit (Hosmer-Lemeshow test: χ² = 6.062, P = 0.640). DCA indicated the potential generalizability of the model.

CONCLUSION

The nomogram provides a noninvasive, convenient, and cost-effective tool for screening gastric cancer in CAG patients, showing excellent discrimination and calibration. Further large-scale, multicenter studies are necessary to validate its efficacy across diverse populations.

The role of interleukin-20 and vascular endothelial growth factor-A biomarkers in the detection of renal impairment in patients with multiple myeloma

BACKGROUND

Multiple myeloma (MM) is a malignant incurable disease characterized by monoclonal plasma cell increase associated with renal impairment. Evaluation of neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), hemoglobin/red cell distribution width (HB/RDW), interleukin-20 (IL-20), and vascular endothelial growth factor-A (VEGFA) in patients with MM (with or without renal impairment) as prognostic and severity indicators.

RESEARCH DESIGN AND METHODS

A cross-sectional study was conducted on sixty MM patients with renal impairment, sixty MM patients without renal impairment, and sixty subjects (control group). Complete blood count, IL-20 immunoassay, and gene expression of IL-20, and VEGFA were evaluated.

RESULTS

Higher levels of NLR, MLR, and IL-20, and moreover lower levels of PLR, HB/RDW, as well as upregulation of IL-20, and VEGFA gene expression were detected in MM patients, especially those with renal impairment. Receiver operating characteristic curves analysis of NLR, MLR, PLR, and IL-20 showed high sensitivity and specificity in the diagnosis of MM and disease stages.

CONCLUSIONS

NLR, MLR, PLR, HB/RDW, IL-20, and VEGFA may be implicated in the inflammatory process of MM and renal impairment pathogenesis. NLR, MLR, and IL-20 can be used as prognostic markers in MM stages.

Exploring the influence of anemia and inflammation indices on colorectal cancer: analysis of the national health and nutrition examination survey From 2011 to 2018

Purpose

Patients with colorectal cancer (CRC) frequently present with anemia and signs of infection. However, the relationships between these factors remain unclear. This study investigated the potential association between anemia, inflammatory indices, and CRC.

Methods

We analyzed data from the 2011-2018 National Health and Nutrition Examination Survey to investigate links between anemia, inflammation, and CRC. Inflammatory indices, including the neutrophil-percentage-to-albumin ratio, neutrophil-to-lymphocyte ratio, and eosinophil-to-lymphocyte ratio, were analyzed. Following rigorous inclusion criteria, 14,114 participants were included. Statistical methods such as logistic regression and subgroup analyses were employed. Moreover, survival analysis was performed.

Results

Among the 14,114 participants, 0.6% had CRC and 11.0% were diagnosed with anemia. Anemia and inflammatory indices were associated with CRC, suggesting an increased risk (OR range: 2.03-2.50, P<0.05). Patients with CRC had lower red blood cell counts, reduced hemoglobin levels, and higher inflammatory indices. This is accompanied by an increase in the inflammatory indices, which is also a risk factor for CRC (OR range: 1.12-7.00, P<0.05). Survival analyses indicated that anemia was associated with lower survival rates, impacting all-cause, cancer, and CRC mortality.

Conclusion

Our results indicate that anemia and inflammatory indices are correlated with CRC. Patients with CRC tend to exhibit increased inflammatory indices and decreased red blood cell count and albumin levels, potentially impacting survival.

Association between red cell distribution width and hypertension: Results from NHANES 1999-2018

The relationship between red cell distribution width (RDW) and hypertension remains a contentious topic, with a lack of large-scale studies focusing on the adults in the United States. This study aimed to investigate the association between RDW and hypertension among US adults from 1999 to 2018.

METHODS

Data were derived from the National Health and Nutrition Examination Survey (NHANES) 1999-2018. RDW values were obtained from the Laboratory Data's Complete Blood Count with 5-part Differential-Whole Blood module. Hypertension data were obtained through hypertension questionnaires and blood pressure measurements. Multivariable weighted logistic regression analyses were conducted to assess the association between RDW and hypertension, followed by subgroup and smooth curve analyses.

RESULTS

Compared to the non-hypertensive group, the hypertensive group exhibited higher RDW values (13.33±1.38 vs. 12.95±1.27, P <0.001). After adjusting for covariates, weighted multivariable logistic regression analysis revealed a positive correlation between RDW and hypertension prevalence (OR: 1.17, 95% CI 1.13, 1.21, P <0.001). When RDW was included as a categorical variable, participants in the fourth quartile had the highest risk of hypertension (OR: 1.86, 95% CI 1.70, 2.03, P <0.001). Subgroup analysis showed that, except for age, BMI and weak/failing kidneys, gender, race, education level, smoking, alcohol use, congestive heart failure, and stroke did not significantly influence this correlation (all P-values for interaction >0.05).Smooth curve fitting analysis revealed a reverse J-shaped relationship between RDW and hypertension prevalence, with an inflection point at 12.93%.

CONCLUSION

We first explored the relationship between RDW and hypertension among US adults and discovered a reverse J-shaped association, providing further insights into the relationship between blood cell counts and hypertension and offering a new foundation for hypertension prevention and control.

Anaemia in Hospitalized Cancer Patients: A Retrospective Study of Two Cohorts before and after the Guideline Update

INTRODUCTION

The incidence of anaemia and its consequences are often underestimated during cancer management. We propose to evaluate the situation before and after the recommendations were updated in order to assess their impact on the day-to-day practice.

METHODS

In this single-centre retrospective study, eligible patients were treated for cancer and warranted overnight hospitalization over two periods (n = 206 in 2011, n = 143 in 2018). The diagnosis of anaemia was defined by a haemoglobin level below 12 and 13 g/dL for women and men, respectively.

RESULTS

The prevalence of anaemia was 26% in 2011 and 16% in 2018 (p < 0.001). Biological assessment had changed between the two periods, with more tests of iron metabolism and measurements of inflammatory parameters. Patients hospitalized in 2018 had more advanced cancer and more severe anaemia (8.2 g/dL [±1.07] in 2011 vs. 7.9 g/dL [±1.18] in 2018). Rate of transfusion therapy did not change, but patients with mild and moderate anaemia were transfused less in 2018 (57% in 2011 vs. 44% in 2018). Intravenous iron and erythropoiesis-stimulating agent were used more frequently in 2018 (1 and 5 and 13 and 23% in 2011 and 2018, respectively), mainly for mild anaemia and life-threatening anaemia, respectively. Overall survival was poor in both cohorts at 24 months (15.4% in 2011 and 6.5% in 2018, p = 0.048).

CONCLUSION

Practices have changed in the diagnosis of anaemia and prescriptions for erythropoiesis-stimulating agents and intravenous iron have increased. Efforts must continue to explore the causes of anaemia, optimize patients' quality of life, and reduce transfusions.

Platelet Dynamics in Neurodegenerative Disorders: Investigating the Role of Platelets in Neurological Pathology

Background: Neurological disorders, particularly those associated with aging, pose significant challenges in early diagnosis and treatment. The identification of specific biomarkers, such as platelets (PLTs), has emerged as a promising strategy for early detection and intervention in neurological health. This systematic review aims to explore the intricate relationship between PLT dynamics and neurological health, focusing on their potential role in cognitive functions and the pathogenesis of cognitive disorders. Methods: Adhering to PRISMA guidelines, a comprehensive search strategy was employed in the PubMed and Scholar databases to identify studies on the role of PLTs in neurological disorders published from 2013 to 2023. The search criteria included studies focusing on PLTs as biomarkers in neurological disorders, their dynamics, and their potential in monitoring disease progression and therapy effectiveness. Results: The systematic review included 104 studies, revealing PLTs as crucial biomarkers in neurocognitive disorders, acting as inflammatory mediators. The findings suggest that PLTs share common features with altered neurons, which could be utilised for monitoring disease progression and evaluating the effectiveness of treatments. PLTs are identified as significant biomarkers for detecting neurological disorders in their early stages and understanding the pathological events leading to neuronal death. Conclusions: The systematic review underscores the critical role of PLTs in neurological disorders, highlighting their potential as biomarkers for the early detection and monitoring of disease progression. However, it also emphasises the need for further research to solidify the use of PLTs in neurological disorders, aiming to enhance early diagnosis and intervention strategies.