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Red cell distribution width (RDW) has been proposed as a surrogate marker for acute and chronic diseases and may be influenced by nutritional deficits. We assessed the prognostic value of RDW regarding clinical outcomes and nutritional treatment response among medical inpatients at nutritional risk. This is a secondary analysis of EFFORT, a randomized, controlled, prospective, multicenter trial investigating the effects of nutritional support in patients at nutritional risk in eight Swiss hospitals. We examined the association between RDW and mortality in regression analysis. Among 1,244 included patients (median age 75 years, 46.6 % female), high RDW (≥15 %) levels were found in 38 % of patients (n = 473) with a significant association of higher malnutrition risk [OR 1.48 (95%CI 1.1 to 1.98); p = 0.009]. Patients with high RDW had a more than doubling in short-term (30 days) mortality risk [adjusted HR 2.12 (95%CI 1.44 to 3.12); p < 0.001] and a signficant increase in long-term (5 years) mortality risk [adjusted HR 1.73 (95%CI 1.49 to 2.01); p < 0.001]. Among patients with high RDW, nutritional support reduced morality within 30 days [adjusted OR 0.56 (95%CI 0.33 to 0.96); p = 0.035], while the effect of the nutritional intervention in patients with low RDW was markedly smaller. Among medical patients at nutritional risk, RDW correlated with several nutritional parameters and was a strong prognostic marker for adverse clinical outcomes at short- and long-term, respectively. Patients with high baseline RDW levels also showed a strong benefit from the nutritional intervention. Further research is needed to understand whether monitoring of RDW over time severs as a nutritional biomarker to assess effectiveness of nutritional treatment in the long run. ClinicalTrials.gov Identifier: NCT02517476. [ABSTRACT FROM AUTHOR]

• Multiple indicators of RBCs senesce more rapidly in men than in women. • Higher levels of mtDNA in RBCs of men at aging. • The mtDNA content of senescent RBCs in men is elevated in aging. • SOD activity in RBC is reduced only in male senescence. Both we and others have found that RBC counts are significantly lower in older compared to younger. However, when gender is factored in, a significant age-related decrease of RBC counts is observed only in men but not in women. qPCR and confocal microscopy were used to detect the presence of mtDNA in RBCs. Flow cytometry and specific inhibitors were used to determine how RBCs uptake cf-mtDNA. The peripheral blood was collected from 202 young adults and 207 older adults and RBC and plasma were isolated. The levels of TLR9+RBCs and apoptotic RBCs after uptake of cf-mtDNA by RBCs were measured by flow cytometry. The kit detects changes in SOD and MDA levels after cf-mtDNA uptake by RBCs. Young RBCs (YR) and old RBCs (OR) from single individuals were separated by Percoll centrifugation. We found a significant decrease in RBC counts and a significant increase in the RDW with aging only in men. We also found that significantly elevated mtDNA content in RBCs was observed only in men during aging and was not found in women. Further studies demonstrated that RBCs could take up cf-mtDNA via TLR9, and the uptake of mtDNA might lead to a decrease in the RBC number and an increase in RDW due to an increase of oxidative stress. The RBC mtDNA content might be a potential marker of RBC aging and the elevated RBC mtDNA content might be the cause of faster senescence in males than females. [ABSTRACT FROM AUTHOR]

Diseases of the aorta, such as aortic aneurysm, dissection, and rupture, account for a large proportion of acute clinical emergencies. The red blood cell distribution width (RDW), which directly reflects anisocytosis (i.e., the heterogeneity of erythrocyte volumes), has emerged as a promising biomarker for many cardiovascular pathologies. Thus, we aimed to explore the implication of RDW in aortic pathologies. We searched Scopus and PubMed using the keywords "RDW" OR "red blood cell distribution width" AND "aortic aneurysm" OR "aortic dilatation" OR "aortic dissection" for identifying studies in which RDW values were measured in patients with these aortic diseases. Ten observational studies were finally included. In all studies, RDW value was increased in patients with aortic diseases. In the four studies in which sufficient RDW data were available for pooling, the weighted mean difference (WMD) of RDW in patients with or without complicated aortic pathologies was 0.575 (95 %CI, 0.254–0.896). RDW may be a valuable diagnostic and prognostic biomarker in patients with aortic pathologies. [ABSTRACT FROM AUTHOR]

To investigate the value of neutrophil- lymphocyte ratio (NLR), platelet- lymphocyte ratio (PLR), red blood cell distribution width (RDW), mean platelet volume (MPV) as biomarkers of disease severity and clinical manifestations in systemic sclerosis (SSc). This study included 35 SSc patients, together with 45 controls. Disease severity was assessed by Medsger severity score (MSS). NLR, PLR, MPV, RDW were measured by COULTER LH 750 assay analyzer. The mean age of SSc patients and controls was 42.8 ± 12.6 and 40.8 ± 9.7 years respectively. MPV, RDW, NLR, PLR were significantly higher in patients compared to controls (p = 0.03, < 0.001, <0.001, 0.02). NLR, PLR were significantly higher in patients presenting with myositis (p = 0.002, 0.004), and proximal muscle weakness on MSS (p = 0.009, 0.02). NLR was significantly higher in patients with severe peripheral vascular ischemia (p = 0.02). RDW was significantly higher in patients with higher general MSS (p = 0.03) NLR, PLR were significantly positively correlated with severity of muscle weakness (p = 0.001, 0.004), RDW was significantly associated with general MSS (p = 0.002). NLR and PLR were the valuable predictors of muscle involvement (p = 0.003, 0.005) and severity of muscle weakness (p = 0.001, 0.003). MPV, RDW, NLR, PLR were significantly higher in SSc patients suggesting their role as biomarkers reflecting the enduring inflammatory process in SSc. Increased NLR and PLR were related to muscular involvement, and severity of muscular weakness. Increased NLR predicted severity of peripheral vascular ischemia and elevated RDW predicted general severity, MPV did not predict severity or disease manifestations of SSc. [ABSTRACT FROM AUTHOR]

The inflammatory factors of complete blood count (CBC) are associated with a decrease in the in vitro embryo production (IVP) outcome in women. The relation between the blood indices and in vitro fertilization (IVF) outcomes in bovines remains to be elucidated. Using ovum pick-up (OPU), oocytes were retrieved from heifers (n = 60) and inseminated separately with sperm. The blastocyst formation was recorded on day 7 after insemination for each animal and the blood indices were evaluated at the time of OPU. Then, heifers were classified on the basis of (1) blastocyst formation, cleaved vs. failed, or (2) inflammation, low-grade inflammation (lymphocyte counts > 5.6 × 109/L) vs. no inflammation (lymphocyte counts < 5.6 × 109/L). Oocytes derived from heifers with higher lymphocytes, red blood cells (RBC), platelets, hematocrit, red cell distribution width (RDW-SD) and plateletcrit values and lower monocytes, eosinophils, mean corpuscular hemoglobin (MCH) and MCH concentration (MCHC) successfully developed to the blastocyst stage. Heifers with low-grade inflammation numerically had a higher percentage of blastocyst formation than normal heifers. The principle component analysis (PCA) showed that blastocyst formation had the strongest positive association with RDW-cv and RDW-SD, while having a strong negative association with mean corpuscular volume (MCV), hemoglobin, MCHC and MCH. The PCA determined that the number of grade A COCs and the percentage of COCs reached the cleavage stage had a negative association with white blood cells (WBC), lymphocytes, basophils and monocytes, and a positive correlation with platelet to lymphocyte ratio, platelet distribution width (PDW) and plateletcrit. Network mapping detected close similarities between BFR and RDW-SD, MPV, and lymphocytes. The area under the receiver operating characteristic curve (AUC) identified that, eosinophils (AUC 0.80), RDW-SD (AUC 0.76), monocytes (AUC 0.76) and lymphocytes (AUC 0.76) had a good predictive ability to detect heifers with high OPU-IVP outcome (≥60%). In conclusion, these findings suggest that CBC indices at the time of OPU were associated with the IVF outcome and may be incorporated into protocols for the identification of heifers with high potential for blastocyst formation. • Eosinophils and RDW-SD had a good predictive ability to predict high IVF outcomes. • Blood indices are associated with in vitro embryo production. • Blood indices may be integrated into the OPU-IVP protocols. • A multi-level approach provides a simple insight into the prediction of IVF outcomes. [ABSTRACT FROM AUTHOR]

We sought to explore the association of red blood cell distribution width (RDW) with the severity and long-term prognosis of chronic hepatitis B (CHB)–related liver diseases. 1482 treatment-naïve CHB patients without liver cirrhosis (LC), 485 CHB-related LC (CHB-LC) patients and 325 healthy controls (HCs) were enrolled. The median follow-up time for CHB-LC patients was 33.9 months. RDW was significantly higher in CHB-LC (15.0%) than CHB (12.7%) patients or HCs (12.5%). RDW was slightly higher in CHB patients than HCs (p < 0.001). Among CHB patients, the RDW of immune clearance and HBeAg negative hepatitis patients was significantly higher than immune-tolerant and low-replicative phase patients. RDW was positively correlated with Child–Turcotte–Pugh (r = 0.363; p < 0.001) and the model of end-stage liver disease scores (r = 0.218; p < 0.001). The areas under the receiver operating characteristic curve of RDW in predicting one-year, three-year, five-year and global mortality rates were 0.696, 0.668, 0.628 and 0.660, respectively. Through multivariable Cox regression analysis, RDW (p = 0.048) was identified as an independent predictor of liver-related mortality. Over a median follow-up of 33.9 months, CHB-LC patients with RDW ≥ 15.1% had significantly higher liver-related mortality than RDW < 15.1% patients (18.8% vs. 8.6%; p = 0.002). RDW is positively associated with the severity of CHB and can independently predict the long-term prognosis of CHB-LC patients. [ABSTRACT FROM AUTHOR]

• RDW can be used as a prognostic and diagnostic index severe infections and sepsis. • In suspected sepsis, RDW has modest value for predicting positive blood culture. • Increased RDW on admission is associated with unfavorable outcomes. • RDW could be used as a prognostic index in septic patients. Previous studies showed that red blood cell distribution width (RDW) can be used as a prognostic and diagnostic index in various non-hematological diseases, including severe infections and sepsis. Here, we provide a narrative review to summarize the findings of available studies investigating the relationship between RDW and sepsis. Current evidence suggests that increased RDW on admission, both in adults and neonates, may be associated with unfavorable outcomes on the short- and long-term. In patients with suspected sepsis, RDW has modest value for predicting positive blood culture. Accordingly, its diagnostic value for sepsis seems limited, whilts dynamic changes of RDW are associated with outcome of sepsis. Taken together, these results suggest that RDW could be used as a prognostic index in septic patients. [ABSTRACT FROM AUTHOR]

Objective: To assess survival and identify predictors of survival more than 30-days after discharge in a cohort of consecutive patients diagnosed with pneumococcal pneumonia.Methods: Observational study including all consecutive immunocompetent adult patients surviving more than 30-days after hospitalization. The bacteriological diagnosis was based on the results of urinary antigen testing and/or blood culture. Life expectancy was calculated for each patient considering their sex, age and date of discharge.Results: We included 1114 patients that survived more than 30- days after discharge. Of them, 431 (38.6%) died during follow-up (median follow-up of 6.7 years). Age, history of cancer, liver disease, chronic renal disease, chronic obstructive pulmonary disease, cerebrovascular disease, atrial arrhythmia and coronary disease, red cell distribution width (RDW) > 15%, positive blood culture, hematocrit < 30% and living in a nursing home were independent risk factors for reduced long-term survival after hospital discharge. Cumulative 1-, 3- and 5-year survival rates were 93.9%, 85.3% and 76%, respectively. Among non-survivors, 361 (83.8%) died earlier than expected given their life expectancy.Conclusions: Survival after hospital discharge is mainly associated with age and comorbidities. The findings of bacteremia and elevated RDW on admission could help identify patients at high risk of long-term mortality. [ABSTRACT FROM AUTHOR]

Abstract Red blood cell distribution width (RDW) is a hematimetric index used to diagnose anisocytosis. In human medicine, it has been widely used as a predictor and biomarker of various diseases, but there are few comparable studies in equine medicine. We aimed to compare RDW values between healthy and hospitalized Quarter Horses (QH). A total of 176 QH were evaluated, 95 healthy animals reared on 27 farms, and 81 animals treated at a Veterinary School Hospital. Blood samples were evaluated using an automated hematological analyzer to obtain RDW. Red blood cell distribution width values in hospitalized horses (18.6%) were significantly higher than in healthy ones (17.8%, P =.0006). Values from our healthy group can be used as a reference for QH. We suggest that further studies are needed to evaluate the use of RDW as a biomarker or predictor of various disorders or diseases in equines. Highlights • Comparison of red blood cell distribution width (RDW) in healthy and hospitalized Quarter Horses (QH). • Obtaining reference values of RDW in QH. • Red blood cell distribution width in hospitalized horses was significantly higher than the healthy horses. • Sex and age did not influence the value of RDW in healthy QH. [ABSTRACT FROM AUTHOR]

No-till (NT) has repeatedly been reported to result in several environmental advantages, including the reduction of soil erosion, sequestration of carbon from the atmosphere and increase of water retention in soils. However, experimental evidences to date show negative effects of NT on soil physical parameters ( i.e. , increasing penetration resistance and soil bulk density) and root development of plants, thus reducing crop yield. A three-year field study (2014–2016) was conducted to assess the effects of NT vs conventional tillage (CT) on root growth in maize, soybean, and winter wheat, on a silty clay soil in the Northern Italy. Root length density (RLD), diameter class length (DCL), root dry weight (RDW) and roots composition (C and N) in the top 60 cm of soil were measured. The total amount of root C (TRC) was calculated by multiplying RDW by root C content. Relationships among root traits, soil bulk density (BD) and penetration resistance (PR) were investigated using the non-parametric Spearman rank coefficient. RLD was significantly increased under NT compared to CT in the topsoil (0–5 cm) in maize (6.37 vs. 2.03 mg cm −3 ) and winter wheat (5.38 vs. 2.90 cm cm −3 ), while it was lower in NT than in CT in the deeper soil (5–15 cm) only in maize (3.19 vs. 4.53 cm cm −3 ). RDW was increased under NT compared to CT in the 0–5 cm layer in maize (3.86 vs. 0.50 mg cm −3 ), soybean (4.33 vs. 0.43 mg cm −3 ), and winter wheat (0.96 vs. 0.38 mg cm −3 ). NT significantly reduced root C:N ratio of maize (-9%), increased C:N ratio of soybean (+14%), and did not affect C:N ratio of winter wheat. This was mainly related to the effect of NT on coarse roots, which decreased average roots N content. A negative correlation between root traits (RLD, RDW) and soil physical parameters (BD, PR) was found in this study under NT while no correlation occurred for CT. This corroborates the hypothesis that when tillage is abandoned roots are major drivers and detectors of soil physical conditions, which in turn affects roots growth again. Moreover, these results showed that BD did not always represent the main factor affecting root development and the increase of soil strength and particle density under NT did not reduce downwards root growth, which suggests that stability of continuous biopores as induced by NT in well-structured soils is probably much more relevant than the total amount of pores to affect root traits. [ABSTRACT FROM AUTHOR]

Background The red cell distribution width (RDW) predicts mortality in numerous populations. The Intermountain Risk Scores (IMRS) predict patient outcomes using laboratory measurements including RDW. Whether the RDW or IMRS predicts in-hospital outcomes is unknown. Methods The predictive abilities of RDW and two IMRS formulations (the complete blood count [CBC] risk score [CBC-RS] or full IMRS using CBC plus the basic metabolic profile) were studied among percutaneous coronary intervention patients at Intermountain (males: N = 6007, females: N = 2165). Primary endpoints were a composite bleeding outcome and in-hospital mortality. Results IMRS predicted the composite bleeding endpoint (females: χ 2  = 47.1, odds ratio [OR] = 1.13 per +1 score, p < 0.001; males: χ 2  = 108.7, OR = 1.13 per +1 score, p < 0.001) more strongly than RDW (females: χ 2  = 1.6, OR = 1.04 per +1%, p = 0.20; males: χ 2  = 11.2, OR = 1.09 per +1%, p < 0.001). For in-hospital mortality, RDW was predictive in females (χ 2  = 4.3, OR = 1.13 per +1%, p = 0.037) and males (χ 2  = 4.4, OR = 1.11 per +1%, p = 0.037), but IMRS was profoundly more predictive (females: χ 2  = 35.5, OR = 1.36 per +1 score, p < 0.001; males: χ 2  = 72.9, OR = 1.40 per+1 score, p < 0.001). CBC-RS was more predictive than RDW but not as powerful as IMRS. Conclusions The IMRS, the CBC-RS, and RDW predict in-hospital outcomes. Risk score-directed personalization of in-hospital clinical care should be studied. [ABSTRACT FROM AUTHOR]

Background Increased red blood cell distribution width (RDW) has been associated with poor outcome after cardiac resynchronization therapy (CRT). However, whether baseline RDW, and its serial changes after CRT implant, have incremental prognostic value is unknown. Methods and results In 148 consecutive patients (age, 68 ± 9 years; 122 men) undergoing CRT, RDW was assessed before and 3 months after implant. Patients were categorized according to baseline RDW (≤ 14.5% vs > 14.5%); and as “stable”, “decreased”, “increased”, relative to post-implant changes. Primary end-point was a composite of death/HF hospitalization during follow-up (median 21 months). A reduction in left ventricular (LV) end-systolic volume by ≥ 15% at 6-month identified LV reverse remodeling. By multivariable logistic regression analysis “increased” (OR:0.22, 95%CI: 0.07-0.69, P = 0.010) and “stable-high” RDW at follow-up (OR: 0.39, 95%CI: 0.17–0.89, P = 0.027) showed a lower likelihood to develop LV reverse remodeling, while baseline RDW was no longer predictive of LV remodeling. During follow-up, there were 57 events. Baseline RDW > 14.5% (HR: 2.24, 95%CI: 1.05–4.77, P = 0.036), “increased” (HR: 2.55, 95% CI: 1.09–5.97, P = 0.030) and “stable-high” RDW (HR: 2.95, 95% CI: 1.45–5.99, P = 0.003) independently predicted outcome after adjusting for functional improvement after CRT, radial dyssynchrony, BNP, creatinine clearance, and left atrial volume index. However, integrated discrimination improvement and net reclassification improvement were not statistically significant when both baseline RDW and its changes were added to a base predictive model. Conclusion Increased and stable-high values of RDW were independently associated with both LV reverse remodeling and outcome after CRT; however, RDW did not show any incremental predictive value. [ABSTRACT FROM AUTHOR]

Background Patients with coronary artery disease (CAD) are considered as high risk in terms of secondary cardiovascular prevention. However, obviously the risk is not homogenous across the whole group. Red blood cell distribution width (RDW) has been recently related to adverse outcomes in patients with atherosclerosis. Calcium score (CaS) may be used for risk stratification in primary prevention. The value of these biomarkers for prediction of cardiovascular outcomes in patients with CAD is unknown. Methods The study group comprised 269 consecutive patients with significant stable CAD. The primary endpoint was a composite of death or nonfatal myocardial infarction. Results Median post-discharge follow up was 43.2 months (IQR39.2–48.6). The primary outcome was observed in 27 patients including 13 deaths and 14 nonfatal myocardial infarction. According to ROC analysis the best cut-off value for RDW for prediction of the primary event was 14% [(AUC) = 0.69; 95%CI:0.63–0.75; p = 0.0002] and for CaS was 603 [(AUC) = 0.66; 95%CI:0.60–0.72; p = 0.001]. According to multivariable Cox regression analysis both RDW>14% (HR 2.6; 95%CI:1.1–5.9) and CaS>603 (HR 2.3; 95%CI:1.1–5.1) were independently correlated to the primary outcome. Subsequently, patients were categorized into three risk subgroups: LOW: CaS≤603 and RDW≤14–124(46.1%), MID: either CaS>603 or RDW>14–104(38.7%), and HIGH - CaS>603 and RDW>14–41(15.2%) patients. The respective risk of events according to Kaplan–Meier analysis were 4.03%, 9.62%, and 29.27% (p < 0.0001). Conclusions RDW and calcium score may be predictors of future cardiovascular events in patients with significant CAD. They may be useful tools for risk stratification and may indicate patients suitable for more aggressive secondary prevention measures. [ABSTRACT FROM AUTHOR]

Objectives Red cell distribution width was shown to reliably predict mortality and morbidity in numerous clinical settings, including patients hospitalized on surgical intensive care units (ICU). Patients hospitalized on an ICU usually comprise a very heterogeneous patient population. The aim of this analysis was to investigate whether (1) RDW is related to survival outcomes in patients hospitalized on a medical ICU and (2) the prognostic value of RDW is dependent on the diagnosis that led to ICU admission. Methods 829 patients hospitalized on the medical ICU of a tertiary care hospital were retrospectively investigated. Patients were divided in two groups according to the main diagnosis that led to ICU admission. Group 1: non-infectious cardiac disease and group 2: other. The prognostic value of RDW for ICU- and long-term mortality was investigated for the entire patient cohort as well as for the two subgroups. Results The median RDW of the whole study population was 16.1%. Patients with an RDW above this threshold were exposed to an increased risk for ICU mortality (34.4% vs. 17.2%, p < 0.001) and long-term mortality (log-rank p < 0.001). Similarly, this cut-off was able to distinguish patients with an elevated risk for death in subgroup 2 (ICU mortality: 37.9% vs. 19.2%, p < 0.001; long-term mortality: log-rank p < 0.001). In subgroup 1, this value was not able to identify patients with an increased risk for ICU-mortality (17.6% vs. 11.8%, p = 0.26) as well as long-term mortality (log-rank p = 0.3). Conclusions Data of this analysis revealed that (1) RDW is a powerful predictor for ICU- and long-term mortality in patients hospitalized on a medical ICU and (2) RDW cut-offs to assess risk for death differ according to the main diagnosis that led to ICU admission. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to evaluate whether the addition of red blood cell distribution width (RDW) improves the prognostic value of current intensive care unit (ICU) scoring systems, namely APACHE III. Design and Methods All patients admitted to a mixed ICU in Brisbane between June 2013 and July 2014 for whom RDW was available were included in the study. Analyses included descriptive statistics, linear regression correlation, and receiver operating characteristic (ROC) curves. Results The study included 708 patients for whom both ICU mortality prediction and RDW were available. In univariate analysis higher RDW values were associated with increased hospital mortality. Adding RDW to APACHE III increased the area under the ROC marginally (from 0.9586 to 0.9613). RDW was not correlated with C-reactive protein, white cell count, or patient's length of stay in ICU. Conclusion RDW was an independent predictor of mortality. The addition of RDW to APACHE III improved its mortality prediction marginally. The underlying mechanism of RDW elevation warrants further investigation. [ABSTRACT FROM AUTHOR]

Objective Although cardiovascular protective action of bilirubin has been attributed to its antioxidant effect, there was scarce data regarding the anti-inflammatory properties. Herein, we aimed to assess the relationship between serum total bilirubin level and severity of coronary artery disease (CAD) in association with the direct inflammatory marker such as C-reactive protein (CRP), the other indirect markers included in inflammation process such as neutrophil to lymphocyte ratio (NLR) and red cell distribution width (RDW) in patients with stable CAD. Methods Angiographic data of 1501 patients were analyzed in this retrospective cross-sectional study. Patients were categorized according to Gensini scores as control, mild CAD and severe CAD groups. The association of clinical and laboratory parameters with the severity of CAD were determined by multivariable linear regression analysis. Results Total bilirubin level in the control group was significantly higher than those of the other groups. After multivariable linear regression analysis total bilirubin [β = −3.131 (−4.481, −1.782), p < 0.001] was significantly associated with the severity of CAD. Futhermore, there was a moderate and significant inverse correlation between serum total bilirubin level and the severity of CAD (r = −0.173, p < 0.001), CRP (r = −0.112, p < 0.001), NLR (r = −0.070, p = 0.026) and RDW (r = −0.074, p = 0.027). Conclusion Serum total bilirubin level was independently and inversely associated with the severity of coronary atherosclerosis in patients with stable CAD. In addition, total bilirubin level was inversely correlated with CRP, NLR and RDW. These results suggest that besides its already known effect on the oxidative stress, higher serum total bilirubin level may exhibit an anti-inflammatory effect in the coronary atherosclerotic process. [ABSTRACT FROM AUTHOR]

High RDW values are associated with adverse prognosis in many clinical conditions including short and medium term outcome of patients with ST Elevation Myocardial Infarction (STEMI). The aim of the present study was to evaluate the association between RDW and long term mortality in STEMI patients undergoing primary angioplasty (PPCI). Material and methods A cohort of 535 STEMI patients undergoing PPCI were divided into two groups (RDW 14%, RDW↜14%) using CHAID and CART methods. The association between RDW and 5-year all-cause mortality was assessed using Cox's proportional hazards analysis. Results A total of 37 patients died during follow up of 5years (mean: 1059, median: 1013, range 2-2130 days). RDW 14% was associated with increased risk of all-cause mortality (HR=5, CI 95% 2.7- 9.9, p<0.001). In multivariate analysis, RDW>14 remained significantly associated with increased risk for all-cause mortality (HR=3.8, CI 95% 1.8- 7.99, p<0.001). Patients with RDW above 14% did not have lower ejection fraction, higher CPK or more conventional risk factors. Conclusion RDW value above 14 is independently associated with increased long term all-cause mortality in patients with STEMI undergoing PPCI. [ABSTRACT FROM AUTHOR]

To assess analytical imprecision and comparability of red blood cell distribution width (RDW) on Abbott Sapphire, Mindray BC6800, Siemens Advia 2120 and Sysmex XE-5000. Design and methods Within-run imprecision was assessed on three pools and comparability using 132 inpatient samples. Results The imprecision of RDW was comprised between 0.3 and 1.2%, but the values exhibited broad variation among different analyzers, with bias exceeding the desirable quality specifications. Conclusions Harmonization of RDW is still an unmet need. [ABSTRACT FROM AUTHOR]

Abstract: Background: An elevated red cell distribution width (RDW) and iron deficiency (ID) at baseline predict enhanced mortality in chronic heart failure (CHF), but little is known about the prognostic implications of their temporal trends. We sought to determine the survival implications of temporal changes in RDW and evolving ID in patients with CHF. Methods: The relation between red cell indices on first consultation and over time with mortality in 274 stable patients with systolic CHF was analysed. The combination of a rising RDW with a falling mean cell volume (MCV) over time defined evolving ID. Results: Over a median 12month period, 51% and 23% of patients had a rise in RDW and evolving ID, respectively. After a median follow-up of 27months, 60 (22%) patients died. A rising RDW predicted enhanced all-cause mortality (unadjusted HR for 1% per week rise 9.27, 95% CI 3.58 to 24.00, P<0.0001) independently and incrementally to baseline RDW, with an absolute increase >0.02% per week optimally predictive. Evolving ID also related to higher rates of mortality (HR 2.78, 95% CI 1.64 to 4.73, P<0.001) and was prognostically worse than a rising RDW alone (P<0.005). Patients with evolving ID who maintained their Hb levels over time had a 2-fold greater risk of death than those whose Hb levels declined without evolving ID. Conclusions: An expanding RDW and evolving iron deficiency over time predict an amplified risk of death in CHF and should be utilised for risk stratification and/or therapeutically targeted to potentially improve outcomes. [Copyright &y& Elsevier]

Abstract: Background: Red blood cell distribution width (RDW), a measure of anisocytosis, is a prognostic biomarker for heart failure (HF). However it is still unclear how RDW is associated with heart function and established cardiac biomarkers. Methods and results: In a prospective hospital cohort of 296 patients referred for echocardiography because of suspected HF, blood sampling and clinical examination were performed within 24h after echocardiography. The patients were divided into four HF groups, including one group where the HF diagnosis was uncertain (gray zone). In the patients the mean age was 70±11years, 44% with systolic HF (SHF), 18% with heart failure with normal ejection fraction (HFNEF), 17% with gray zone and 21% without HF (non-HF). RDW was higher among patients with SHF and HFNEF, compared with gray zone and non-HF patients. The distribution of different variables over the RDW quartiles showed an inverse correlation between RDW levels and LVEF and a positive correlation between RDW and NT-proBNP levels. Further analysis with stepwise multiple linear regression demonstrated that NT-proBNP levels, but not LVEF, were independently correlated with RDW. Conclusion: In patients referred for echocardiography because of suspected HF, RDW levels were higher in patients with SHF and HFNEF. Moreover, NT-proBNP levels were independently linked with elevated RDW. [Copyright &y& Elsevier]

Abstract: Background: Red cell distribution width (RDW) is associated with morbidity and mortality in coronary artery disease (CAD), but the connection of RDW with chronic inflammation is equivocal. Methods: In 1,489 patients with CAD and 8.4–15.2years of follow-up all-cause mortality and RDW were studied using Cox regression. RDW and its associations with inflammation, liver function, renal function, and body mass were assessed. A population of 449 normal (No-CAD) patients also was evaluated. Results: RDW predicted all-cause mortality in a step-wise manner (HR=1.37 per quintile; 95% CI=1.29, 1.46; p-trend<0.001). A significant but meaningless correlation between RDW and high-sensitivity C-reactive protein (hsCRP) was identified (r=0.181; p<0.001). With full adjustment, RDW remained significant (p-trend<0.001) and the strongest predictor of mortality among all factors included in the model. RDW also strongly predicted all-cause mortality in the normal control population (HR=1.33 per quintile, CI=1.15, 1.55; p-trend<0.001), but hsCRP did not predict mortality among normal controls. Conclusions: RDW was associated with mortality in patients with CAD and may provide clinically useful prognostication. Although RDW was correlated with hsCRP, they were independent predictors of mortality. RDW has been incorporated into risk prediction tool using data from basic chemistries available at: http://intermountainhealthcare.org/IMRS. [Copyright &y& Elsevier]

Abstract: Introduction: Red-cell distribution width (RDW) has been identified as a novel prognostic marker in heart failure patients. However, evidence is limited for its predictive value in the setting of patients hospitalized with decompensated heart failure (DHF) and no data are available for African Americans (AA). Methods and Results: Data that included baseline characteristics, laboratory findings, and discharge medications were collected retrospectively on a total of 789 patients with DHF (mean age 62.7 ± 15.1 years, 50% males and 80% AA), admitted to an urban medical center between January 2007 and August 2007, 145 (18.38%) died during median follow-up of 573 days. Unadjusted and adjusted Cox-proportional hazard models were used to analyze predictive value of discharge RDW on mortality. There was a significant negative association between RDW and statin use, blood hemoglobin levels and mean corpuscular volume (MCV); whereas serum creatinine and blood urea nitrogen (BUN) increased with increasing RDW. A statistically significant graded increase in all-cause mortality with higher RDW quartiles (lowest vs highest quartile), independent of hemoglobin and creatinine levels, was found for all patients (adjusted hazard ratio [HR] 3.21; 95% confidence interval [CI]: 1.77–5.83, P < .05) for AAs (adjusted HR 2.92; 95% CI: 1.50–5.71, P < .05) and for non-AAs (adjusted HR-1.27, 95% CI: 1.03–1.55, P = 0.019; RDW evaluated as continuous variable). Conclusion: Discharge RDW is an independent predictor of all-cause mortality in predominantly AA patients hospitalized with DHF. Further research is warranted to delineate underlying pathophysiological mechanisms including the association between statin use and RDW. [Copyright &y& Elsevier]

Abstract: Background: Red blood cell distribution width (RDW), a numerical measure of the variability in size of circulating erythrocytes, has recently been shown to be a strong predictor of adverse outcomes in patients with heart failure and in patients with prior myocardial infarction but no symptomatic heart failure at baseline, even after adjustment for hematocrit. However, there are no data in other cardiac populations, including patients with acute coronary syndromes (ACS). Methods: The present study investigated the long-term prognostic significance of baseline RDW in a well-characterized cohort of 389 male patients who were referred to coronary angiography for a variety of indications. All patients were followed prospectively for all-cause mortality, and data regarding this endpoint was available for 97% of the population at 24 months. Results: After controlling for a variety of baseline variables (including hemoglobin and the presence of heart failure), RDW (analyzed as a categorical variable comparing the upper tertile of baseline values to the lower two levels combined) was a strong and independent predictor of all-cause mortality using a Cox proportional hazards model [hazard ratio (HR) 2.69, 95% confidence interval (CI) 1.50–4.84, p =0.0008]. In addition, baseline RDW was also an independent predictor of all-cause mortality in the non-anemic (HR 4.73, 95% CI 2.06–10.86, p =0.0003) and ACS (HR 2.90, 95% CI 1.32–6.38, p =0.0082) subpopulations of patients. Conclusions: These data demonstrate that elevated RDW is a strong and independent predictor of all-cause mortality in an unselected population of male patients across a broad spectrum of risk (including ACS) referred for coronary angiography. [Copyright &y& Elsevier]

Objective: Preeclampsia is a serious disease and a leading cause of maternal and perinatal mortality and morbidity. Red blood cell distribution width (RDW), a measure of anisocytosis, is used as an inflammation marker in hypertension and cardiovascular diseases. Although the relationship between RDW and hypertension has been well documented, the association between preeclampsia and RDW is not clear. We aimed to investigate the relationship between RDW and preeclampsia and its severity.Materials and Methods: One hundred eighteen pregnant women with preeclampsia and one hundred twenty uncomplicated pregnant women were included in the study. Blood samples for routine CBC and RDW levels were analyzed.Results: The RDW values were significantly higher in preeclampsia group compared with the control group (15.23±1.96 vs 14.48±1.70, p<0.05). We also confirmed that RDW levels were significantly higher in severe preeclampsia group than mild preeclampsia group in subgroup analyses (15.08±2.07, 15.92±1.99, p<0.05).Conclusion: Our study showed that there is an association between RDW and preeclampsia and also its severity. RDW, a marker which is easy, inexpensive and calculated as a part of blood cell count, can be used as a significant diagnostic and prognostic marker in patient with preeclampsia like the other cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: : Tacrolimus (FK506) is a potent immunosuppressive drug used for prevention of rejection following transplantation. Several methods including immunoassays have been used for monitoring tacrolimus levels. The purpose of the present study was to compare the effects of various hematological parameters on whole blood tacrolimus concentrations which were measured with two different analytical methods, namely the microparticle enzyme immunoassay (MEIA II) and enzyme multiplied immunoassay technique (EMIT). Design and methods: : The effects of hematological variables, namely hematocrit (Htc), hemoglobin (Hb), red blood cell (RBC), mean cell volume (MCV), mean cell hemoglobin (MCH), mean cell hemoglobin concentration (MCHC), red cell distribution width (RDW) and platelet (PLT) counts on tacrolimus concentrations (n = 2430 measurements) measured with EMIT (n = 1171) and MEIA II (n = 1259) methods in whole blood samples from kidney or liver or combined kidney-pancreas transplant patients (n = 162) during a 2-year post-transplantation period were compared. Results: : The whole blood tacrolimus concentrations measured with MEIA II method were affected much more significantly by hematological parameters than those measured with EMIT method. In MEIA II method, RDW (r = 0.479, P &#60; 0.01) showed a stronger correlation with tacrolimus concentration than Htc (r = −0.239, P &#60; 0.01) in all patients. A negative significant correlation (r = −0.468, P &#60; 0.01) was also observed between the Htc and tacrolimus concentration in patients with Htc values ≤25% in MEIA II method. Conclusions: : The results of the present study suggest that EMIT method might be preferred to MEIA II in determination of whole blood tacrolimus concentrations in anemic transplant patients. For better therapeutic drug monitoring, physicians should be aware of these assay differences. Evaluation of hematologic factors that affect the whole blood concentrations of tacrolimus may be helpful in deciding the dosage of this drug. [Copyright &y& Elsevier]

Hemostatic disturbances are frequent findings in human accidents caused by Lonomia obliqua caterpillars in the southern region of Brazil. In severe envenomation, patients may present life-threatening bleedings. Such disturbances may be mimicked in rats, which also develop intravascular hemolysis. The scope of this study was to investigate the time-course and intensity of intravascular hemolysis induced by i.d. injection of 750μg/kg crude L. obliqua bristle extract in rats. Total blood cell count, reticulocyte count, plasma hemoglobin and haptoglobin assays were performed in control and envenomed rats at 1, 6, 24 and 48h after envenomation. Rats presented a drastic drop of haptoglobin levels at 1 and 6h with increased plasma hemoglobin levels, a decrease in packed cell volume values at 6, 24 and 48h, and increased reticulocyte counts throughout after envenomation. Such observations indicated that intravascular hemolysis occurred as early as 1h following envenomation, and lasted for more than 6h. Intravascular hemolysis is probably induced by phospholipase A2 and other proteins with direct hemolytic activity present in crude caterpillar bristle extract. [Copyright &y& Elsevier]

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. [ABSTRACT FROM AUTHOR]

Abstract: Red blood cell distribution width (RDW), a numerical measure of the variability in size of circulating erythrocytes, has recently been shown to be a strong predictor of adverse outcomes in a variety of patient populations, including those with known or suspected coronary artery disease. In this reply, we provide data as to why it is highly unlikely that the association between RDW and mortality is related to, or confounded by, nutritional deficiencies and/or other hematologic coefficients. We make the case that elevated RDW is indeed an independent predictor of poor outcomes. [ABSTRACT FROM AUTHOR]