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Red cell distribution width as a novel marker for predicting high-risk from upper gastro-intestinal bleeding patients.

ABSTRACT: In upper gastrointestinal bleeding (UGIB) patients, early risk stratification allows appropriate therapy that may be helpful for reducing morbidity and mortality.to evaluate the efficacy of red-cell distribution width (RDW) for prediction of high-risk in UGIB patients.We conducted a clinical retrospective observational study based on data for UGIB patients from 2012 to 2013. The primary outcome was the high-risk UGIB, defined as those who required urgent intervention and/or 30-days mortality. RDW was categorized into four quartiles: Q1 (?12.8%), Q2 (12.9-14.4%), Q3 (14.5-16.5%), and Q4 (?16.6%), and multivariable analysis was performed after adjustment of multiple other risk factor. We also evaluated the efficacy of addition of RDW scores to the Pre-endoscopic Rockall Score (PRS) and the Glasgow Blatchford Score (GBS) scoring system.Of 360 UGIB patients, 229 (63.6%) were high risk. In multivariable analysis, Q3 and Q4 were strongly associated with high risk; odds ratio (95% Confidence Interval) was 3.144 (1.250-7.905) and 4.182 (1.483-11.790) respectively (all p < 0.05). For lower GBS score group (? 6), the incidence of high risk was higher in Q4 (30%) and Q3 (20%) than in Q2 (12.5%) and Q1 (11.4%). For lower PRS group (? 2), the incidence of high-risk was higher in Q4 (73.7%) and Q3 (57.1%) than in Q1 (35.4%). Receiver operating characteristic analysis showed higher discrimination power in PRS + RDW (Area Under Curve [AUC] = 0.749) than PRS (AUC = 0.715) alone (p = 0.036). Otherwise GBS + RDW (AUC = 0.873) did not show a significant higher discrimination power than the GBS (AUC = 0.864) alone (p = 0.098).For UGIB patients, a high RDW (? 14.5%) was strongly associated with high risk UGIB. In practice, the combination of RDW with the PRS scoring indexes may increase the accuracy of risk stratification.

SUBMITTER: Lee KR

PROVIDER: S-EPMC5667835 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Red cell distribution width as a novel marker for predicting high-risk from upper gastro-intestinal bleeding patients.

Lee Kyeong Ryong KR Park Sang O SO Kim Sin Young SY Hong Dae Young DY Kim Jong Won JW Baek Kwang Je KJ Shin Dong Hyuk DH Lee Young Hwan YH

PloS one 20171102 11

<h4>Background</h4>In upper gastrointestinal bleeding (UGIB) patients, early risk stratification allows appropriate therapy that may be helpful for reducing morbidity and mortality.<h4>Objectives</h4>to evaluate the efficacy of red-cell distribution width (RDW) for prediction of high-risk in UGIB patients.<h4>Methods</h4>We conducted a clinical retrospective observational study based on data for UGIB patients from 2012 to 2013. The primary outcome was the high-risk UGIB, defined as those who req ...[more]

PMID: 29095860

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Project description:ObjectivePatients submitted to carotid artery endarterectomy (CEA) have a long-term risk of major adverse cardiovascular events (MACE) of 6-9% at 2 years. Hematological parameters have been shown to have a predictive function in atherosclerotic diseases, namely the red blood cell distribution width-coefficient of variation (RDW-CV). This parameter has been associated with worse outcomes such as myocardial infarction (MI), stroke, and all-cause mortality. This study aims to evaluate the potential role of preoperative hematologic parameters such as RDW-CV in predicting perioperative and long-term cardiovascular adverse events and mortality in patients submitted to CEA.MethodsFrom January 2012 to January 2019, 180 patients who underwent CEA with regional anesthesia in a tertiary care and referral center were selected from a prospective cohort database. Blood samples were collected preoperatively 2 weeks before admission, including a full blood count. The primary outcome included long-term MACE. Secondary outcomes included all-cause mortality, stroke, MI, acute heart failure, and major adverse limb events (MALE).ResultsAt baseline, 27.2% of patients had increased RDW-CV. Increased RDW-CV was independently associated with baseline hemoglobin (adjusted odds ratio [aOR] 0.715, 95% CI 0.588-0.869, p = 0.001) and atrial fibrillation (aOR 4.028, 95% CI 1.037-15.639, p = 0.001). After a median follow-up of 50 months, log-rank univariate analysis of RDW-CV demonstrated a significant association between increased RDW-CV and long-term all-cause mortality (log-rank <0.001), MACE (log-rank <0.001), and MI (log-rank = 0.017). After multivariate Cox regression analysis, increased RDW-CV was associated with increased long-term mortality (adjusted hazard ratio [aHR] 2.455, 95% CI 1.231-4.894, p = 0.011) and MACE (aHR 2.047, 95% CI 1.202-3.487, p = 0.008). A decreased hemoglobin to platelet ratio (aHR 2.650e-8, 95% CI 9.049e-15 to 0.078, p = 0.019) was also associated with all-cause mortality.ConclusionRDW is a widely available and low-cost marker that independently predicts long-term mortality, MACE, and MI after CEA. This biomarker could prove useful in assessing which patients would likely benefit from CEA in the long term.

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

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Red cell distribution width as a novel marker for predicting high-risk from upper gastro-intestinal bleeding patients.

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Red cell distribution width as a novel marker for predicting high-risk from upper gastro-intestinal bleeding patients.

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