El ancho de distribución eritrocitaria en el pronóstico de corrección quirúrgica de cardiopatías congénitas / Red cell distribution width in the prognosis of surgical correction of congenital heart diseases

Resumen Objetivo: Evaluar la capacidad del ancho de distribución eritrocitaria (ADE) para predecir la mortalidad en niños sometidos a cirugía cardiovascular en la Fundación Hospital Infantil Napoleón Franco Pareja, en Colombia. Método: Estudio analítico de corte transversal retrospectivo que incluyó 45 individuos de 0 a 17 años operados de cardiopatía congénita. Se aplicaron la escala RACHS-1 (Risk Adjustment in Congenital Heart Surgery) y variables de laboratorio, incluyendo el ADE. La asociación entre el ADE y la mortalidad se determinó mediante análisis por curva ROC y correlación rho de Spearman. Resultados: Un ADE superior al 15.52% representó 1.6 veces más riesgo, comparado con los individuos por debajo de ese valor (intervalo de confianza del 95%: 1.01-2.6; p = 0.034). Los valores del ADE no se correlacionaron con los días de estancia hospitalaria ni con las complicaciones. El ADE prequirúrgico y el puntaje RACHS-1 fueron significativamente mayores en el grupo de mortalidad. La relación entre el ADE prequirúrgico y el puntaje RACHS-1 fue significativa. Conclusiones: En nuestro estudio, el ADE prequirúrgico presentó un poder moderado para discriminar la mortalidad perioperatoria en la corrección quirúrgica de cardiopatías congénitas. Se precisan más estudios con mayor tamaño de muestra.

Abstract Objective: To evaluate the capacity of red cell distribution width (RDW) to predict mortality in children undergoing cardiovascular surgery at the Fundación Hospital Infantil Napoleón Franco Pareja, in Colombia. Method: Retrospective cross-sectional analytical study that included 45 individuals aged 0 to 17 years operated for congenital heart disease. The RACHS-1 (Risk Adjustment in Congenital Heart Surgery) scale and laboratory variables including the RDW were applied. The association between RDW and mortality was determined by ROC curve analysis and Spearman's rho correlation. Results: An RDW greater than 15.52% represented 1.6 times more risk, compared to individuals below that value (95% confidence interval: 1.01-2.6; p = 0.034). The RDW values did not correlate with days of hospital stay or complications. The preoperative RDW and RACHS-1 score were significantly higher in the mortality group. The relationship between presurgical RDW and the RACHS-1 score was significant. Conclusions: In our study, the preoperative RDW had moderate power to discriminate perioperative mortality in the surgical correction of congenital heart disease. More studies with a larger sample size are required.

Diagnosis of acute appendicitis and appendicular perforation: evaluation of platelet indices and red cell distribution width as emerging biomarkers / Diagnóstico de apendicite aguda e perfuração apendicular: avaliação dos índices de plaquetas e distribuição de glóbulos vermelhos como biomarcadores emergentes

ABSTRACT BACKGROUND: Acute appendicitis is a common surgical emergency worldwide. Recent studies on hematological inflammatory markers concerning acute appendicitis have shown variable results. AIMS: The aim of this study was to evaluate pre-operative values of platelet indices such as mean platelet volume (MPV) and platelet distribution width (PDW), and red cell distribution width (RDW) in relation to the diagnosis of acute appendicitis and their efficacy as predictors of appendicular perforation. METHODS: A prospective observational study of 190 patients diagnosed with appendicitis and who underwent an appendectomy was undertaken and confirmed histopathologically. Preoperatively, blood samples of white blood cells (WBCs), platelet count, MPV, PDW, and RDW were analyzed using a Sysmex XN1000 analyzer machine. RESULTS: Of 190 patients, 169 had acute appendicitis, and 21 had perforated appendicitis. The mean age of patients was 28.04 ± 14.2 years. The male-to-female ratio was 1.5:1. The WBC (p<0.05), MPV (p<0.05), and PDW (p<0.05) were found to have higher statistically significant values in acute appendicitis and perforated appendicitis compared to the RDW (p>0.05). However, perforated appendicitis had a higher RDW value compared to acute appendicitis, which can be a predictive factor. CONCLUSIONS: The elevated value of MPV and PDW associated with leukocytosis can be used as supportive evidence for the clinical and radiological diagnosis of acute appendicitis and appendicular perforation. Thus, these values can be used as diagnostic cost-effective inflammatory biomarkers.

RESUMO RACIONAL: A apendicite aguda é uma emergência cirúrgica comum em todo o mundo. Estudos recentes sobre marcadores inflamatórios hematológicos relacionados à apendicite aguda mostraram resultados variáveis. OBJETIVOS: Avaliar valores pré-operatórios de índices plaquetários como volume médio de plaquetas (VPM) e largura de distribuição de plaquetas (PDW), largura de distribuição de hemácias (RDW) em relação ao diagnóstico de apendicite aguda e sua eficácia como preditores de apendicite perfuração. MÉTODOS: Estudo observacional prospectivo de 190 pacientes diagnosticados com apendicite e submetidos a apendicectomia confirmados histopatologicamente. Amostras de sangue pré-operatórias de glóbulos brancos (WBC), contagem de plaquetas, volume plaquetário médio (MPV), distribuição das plaquetas (PDW) e distribuição dos glóbulos vermelhos (RDW) foram analisadas usando uma máquina analisadora Sysmex XN1000. RESULTADOS: Foram incluídos 190 pacientes, sendo que 169 tiveram apendicite aguda e 21 tiveram apendicite perfurada. A média de idade dos pacientes foi de 28,04 ± 14,2. A proporção homem-mulher foi de 1,5:1. Verificou-se que WBC (p<0,05), MPV (p<0,05) e PDW (p<;0,05) têm valores estatisticamente significativos mais altos na apendicite aguda e na apendicite perfurada em comparação com o RDW (p> 0,05). No entanto, a apendicite perfurada apresentou um valor de RDW maior em comparação com a apendicite aguda, o que pode ser um fator preditivo. CONCLUSÕES: O valor elevado de MPV e PDW associado à leucocitose pode ser usado como evidência de suporte para o diagnóstico clínico e radiológico de apendicite aguda e perfuração apendicular. Assim, esses valors podem ser usado como biomarcadores inflamatórios diagnósticos de baixo custo.

Hematological parameters: is there a difference between those released by the hematological analyzer and to the customer?

ABSTRACT Objective This study aimed to compare the hematological parameters released by hematological analyzers with those released in customer reports. Methods We conducted a descriptive study in the laboratories of a medium-sized municipality in the state of Minas Gerais registered in the National Register of Health Establishments. Interviews were conducted using a questionnaire to obtain information regarding the parameters released by the analyzers and those available in the customer's report. Results Sixteen laboratories were evaluated, and none of them released all the parameters obtained from the hematological analyzers to customers. The red blood cell distribution width was released in 88% of the laboratories, atypical lymphocytes in 70%, mean platelet volume in 50%, platelet distribution width and platelet count in 20%. No laboratory released information on reticulocytes, fraction of immature reticulocytes and immature granulocytes, nucleated erythrocyte count, immature platelet fraction and reticulocyte hemoglobin, and large platelet rate. Conclusion All evaluated clinical analysis laboratories had at least one parameter that was not released in the customer's report despite being released by the hematological analyzers. The lack of knowledge on the part of professionals about the clinical importance of each parameter of the complete blood count results in a loss in patient assessment, and it is important to include these parameters in the complete blood count report.

Investigation of the relationship between red blood cell distribution width and mortality in patients with hemophagocytic lymphohistiocytosis: a retrospective study

ABSTRACT BACKGROUND: Red blood cell distribution width (RDW) is related to sepsis-related mortality. Hemophagocytic lymphohistiocytosis (HLH) is a syndrome caused by severe infection, tumors, or autoimmunity without a specific diagnosis. OBJECTIVE: To explore the correlation between RDW and mortality in patients with HLH. DESIGN AND SETTING: A retrospective study conducted in a hospital in China. METHODS: A total of 101 inpatients with HLH from January 1, 2017 to December 31, 2021 were divided into non-survivor (n = 52) and survivor (n = 49) groups. A non-parametric test was used to analyze demographic, clinical, and laboratory data between groups. Independent variables with P < 0.05 were analyzed using binary logistic regression to screen out mortality-related variables. Selected variables were subjected to multivariate logistic regression analysis, and those with strong correlations were screened. Receiver operating characteristic (ROC) curves of strongly correlated variables and area under curve (AUC) values were obtained. RESULTS: The APACHE II score, RDW, and platelet (PLT) and fibrinogen (FIB) levels (P < 0.05) different significantly. RDW, PLT, FIB were correlated with mortality. The AUC values of RDW, PLT, and FIB were 0.857, 0.797, and 0.726, respectively. RDW was associated with mortality in patients with HLH (P < 0.01, cut-off value: 16.9). The sensitivity and specificity of predicting mortality were 97.96% and 96.1%, respectively. CONCLUSION: Logistic regression analysis showed a correlation between RDW and patients' mortality. Therefore, RDW can be used to predict mortality in patients with HLH.

Red blood cell distribution width and white matter hyperintensities / 国际脑血管病杂志

Dementia is one of the age-related diseases with the fastest increase in incidence. With the increasingly severe aging problem of the population, it further exacerbates the demand and burden of the healthcare system. Red blood cell distribution width (RDW) is an easily obtainable blood routine indicator that reflects the variability of red blood cell size. As an early marker of dementia risk, researches have shown an association between white matter hyperintensities (WMHs) and RDW. This article reviews the relationship between RDW and WMHs.

Evaluación del perfil férrico en donantes regulares de plasma / Evaluation of the iron profile in regular plasma donors

RESUMEN Fundamento un aspecto poco relacionado de la plasmaféresis productiva, es el efecto que puede causar sobre el hierro corporal en donantes regulares de plasma. Objetivo caracterizar el comportamiento del perfil férrico en donantes regulares de plasmaféresis. Métodos estudio descriptivo transversal, realizado con 115 donantes de plasma, registrados en el Banco Provincial de Sangre de Cienfuegos. En un periodo de dos años, se estudiaron las variables: sexo, edad, tiempo en el programa, intensidad de donaciones, sideremia, transferrina, capacidad e índice de saturación, mediciones básicas del hemograma y parámetros eritrocitarios. La información se extrajo de las historias clínicas y los informes de laboratorio. Resultados las mediciones del mineral prevalecieron dentro del rango normal. El 27,0 % de los donantes mostraron ferropenia, más frecuente entre las mujeres, los mayores de edad, aquellos que llevaban mayor tiempo en el programa y habían donado mayor número de veces. Más de la mitad de los individuos presentaron capacidad e índice de saturación patológicos, sugerente de hematopoyesis ferropénica. Los parámetros eritrocitarios fueron más sensibles al relacionar ferropenia latente, con predominio de mediciones patológicas de volumen corpuscular medio, hemoglobina corpuscular media e índice de distribución eritrocitario. Conclusión la deficiencia de hierro subclínica resultó más frecuente de lo esperado entre los donantes de plasmaféresis incluidos en el estudio.

ABSTRACT Background a little related aspect of productive plasmapheresis is the effect it can have on body iron in regular plasma donors. Objective to characterize the behavior of the iron profile in regular plasmapheresis donors. Methods cross-sectional descriptive study, carried out with 115 plasma donors, registered in the Provincial Blood Bank of Cienfuegos. In a period of two years, the studied variables were: sex, age, time in the program, intensity of donations, serum iron, transferrin, capacity and saturation index, basic measurements of the blood count and erythrocyte parameters. Information was extracted from medical records and laboratory reports. Results the mineral measurements prevailed within the normal range. 27.0% of the donors showed iron deficiency, more frequent among women, the elderly, those who had been in the program for a longer time and had donated more times. More than half of the individuals presented pathological capacity and saturation index, suggestive of iron deficiency hematopoiesis. The erythrocyte parameters were more sensitive when relating latent iron deficiency, with a predominance of pathological measurements of mean corpuscular volume, mean corpuscular hemoglobin and erythrocyte distribution index. Conclusion subclinical iron deficiency was more frequent than expected among the plasmapheresis donors included in the study.

Amplitud de la distribución eritrocitaria en el segundo trimestre del embarazo como predictor de preeclampsia

Objetivo. Establecer la utilidad de la amplitud de distribución eritrocitaria en el segundo trimestre del embarazo como predictor del desarrollo de preeclampsia. Diseño. Estudio de casos-controles. Institución. Hospital Central "Dr. Urquinaona", Maracaibo, Venezuela. Participantes. Embarazadas entre 17 y 20 semanas que acudieron a la consulta prenatal y fueron seguidas hasta el término del embarazo. Métodos. Se tomaron muestras de sangre y fueron seguidas hasta el parto para establecer si desarrollaban preeclampsia. Principales medidas de resultado. Características generales, valores de la amplitud de la distribución eritrocitaria y eficacia pronóstica. Resultados. Los casos fueron 41 embarazadas que desarrollaron preeclampsia (grupo A) y 463 embarazadas fueron consideradas como controles (grupo B). No se encontraron diferencias estadísticamente significativas en la edad materna, edad gestacional y presión arterial sistólica y diastólica al momento de la realización de la ecografía (p = ns). La edad gestacional al momento del diagnóstico de preeclampsia en el grupo A fue de 35,0 +/- 3,2 semanas. Se encontraron diferencias significativas en los valores de amplitud de la distribución eritrocitaria entre las pacientes del grupo A (14,5 +/- 2,3%) y las pacientes del grupo B (13,8 +/- 1,8%; p = 0,039). Un valor de corte de 14% presentó un valor por debajo de la curva de 0,576 con sensibilidad del 63,4%, especificidad del 49,7%, valor predictivo positivo del 10,0% y valor predictivo negativo del 93,9%. Conclusión. Los valores de valores de la amplitud de la distribución eritrocitaria en el segundo trimestre no son útiles en la predicción de preeclampsia.

Objective: To establish the usefulness of red cell distribution width in the second trimester of pregnancy as a predictor of the development of preeclampsia. Design: Case-control study. Institution: Hospital Central "Dr. Urquinaona", Maracaibo, Venezuela. Participants: Pregnant women between 17 and 20 weeks who attended prenatal consultation and were followed up until to term. Methods: Blood samples were taken and followed up until delivery to establish if they developed preeclampsia. Main outcome measures: General characteristics, values of red cell distribution width and prognostic efficacy. Results: Cases were 41 pregnant women who developed preeclampsia (group A) and 463 pregnant women were considered as controls (group B). No statistically significant differences were found in maternal age, gestational age, and systolic and diastolic blood pressure at the time of ultrasound (p = ns). Gestational age at the time of diagnosis of preeclampsia in group A was 35.0 +/- 3.2 weeks. Significant differences were found in red cell distribution width values between patients in group A (14.5 +/- 2.3%) and patients in group B (13.8 +/- 1.8%; p = 0.039). A cut-off value of 14% presented a value under the curve of 0.576 with sensitivity of 63.4%, specificity of 49.7%, positive predictive value of 10.0% and negative predictive value of 93.9%. Conclusion: The values of red cell distribution width values in the second trimester are not useful in the prediction of preeclampsia.

Relation between red blood cell distribution width and acute kidney injury in patients with sepsis

ABSTRACT Objective The objective of the present study is to evaluate the association of red blood cell distribution width with acute kidney injury in sepsis. Methods This is a retrospective study of 849 critically ill patients with sepsis in intensive care unit. Demographic data, renal function, inflammation, complete blood count, and acid-base parameters were compared between acute kidney injury and non-acute kidney injury groups. Therefore, a multivariate analysis was performed to observe independent predictive factors. Results Comparatively, higher levels of C-reactive protein, lactate, red blood cell distribution width, and Simplified Acute Physiology Score 3 were found in the acute kidney injury group. The study showed a higher frequency of women, hemoglobin (Hgb) concentration, platelets, bicarbonate and PaO2/FiO2 ratio in the non-acute kidney injury group. In addition, there was an independent association of comorbidity-chronic kidney disease [OR 3.549, 95%CI: 1.627-7.743; p<0.001], urea [OR 1.047, 95%CI: 1.036-1.058; p<0.001] and RDW [OR 1.158, 95%CI: 1.045-1.283; p=0.005] with acute kidney injury in sepsis patients. Conclusion As an elective risk factor, red blood cell distribution width was independently associated with sepsis-related acute kidney injury. Thus, red blood cell distribution width acts like a predictive factor for sepsis-induced acute kidney injury in intensive care unit admission.

The presence of anemia in patients with leg ulcer: laboratory test / La presencia de anemia en pacientes con úlcera de la pierna: prueba de laboratorio / Presença de anemia em pacientes com úlcera da perna: testes laboratoriais

ABSTRACT Objective: To evaluate the presence of anemia in patients with chronic lower limb ulcers based on profile and hematometric indices. Method: This is a cross-sectional study carried out in a university hospital in Rio de Janeiro. The sample was composed of 64 participants with lower limb ulcers and evolution time greater than 12 weeks. Data was collected between May/2016 and December/2017 from hematological analyses, records from medical records, and wound assessment form. Results: 36 (56.2%) were male; 38 (59.4%) between 60 and 80 years old; 56 (87.5%) with chronic diseases and 52 (81.2%) with venous ulcers. 6 years mean of active ulceration. Anemia was detected in 36 (56.2%), 27 (75%) of which were normochromic and normocytic; 14 (38.8%) had deficiency anemia recorded in their medical chart. Conclusion: The low hemoglobin concentration is recurrent among the participants characterizing an anemia condition, whose profile reveals congruence to the anemia of chronic disease.

RESUMEN Objetivo: Evaluar la presencia de anemia en pacientes con úlceras crónicas de miembros inferiores desde el perfil e índices hematimétricos Método: Este estudio seccional transcurrió en un hospital universitario de Río de Janeiro, con una muestra de 64 participantes con úlceras en los miembros inferiores y tiempo de evolución superior a 12 semanas. Los datos se recopilaron entre mayo/2016 y diciembre/2017 investigando los análisis hematológicos, registros en las historias clínicas y formularios de evaluación de la herida. Resultados: 36 (56,2%) eran hombres; 38 (59,4%) tenían entre 60 y 80 años; 56 (87,5%) padecían de enfermedades crónicas y 52 (81,2%), de úlceras venosas. El promedio era de 6 años de úlcera activa. Se detectó anemia en 36 (56,2%), siendo que en 27 (75%) era normocrómica/normocítica; 14 (38,8%) presentaban anemia carencial registrada en la historia clínica. Conclusión: La baja concentración de hemoglobina es recurrente entre los participantes caracterizando un cuadro de anemia que coincide con el de anemia de enfermedad crónica.

RESUMO Objetivo: Avaliar a presença de anemia em pacientes com úlceras crônicas de membros inferiores a partir do perfil e dos índices hematimétricos. Método: Estudo seccional realizado em um hospital universitário do Rio de Janeiro. Amostra composta por 64 participantes com úlceras de membros inferiores e tempo de evolução maior que 12 semanas. Dados coletados entre maio/2016 e dezembro/2017, a partir de análises hematológicas, registros nos prontuários e em formulário de avaliação da ferida. Resultados: 36 (56,2%) eram do sexo masculino; 38 (59,4%) entre 60 e 80 anos; 56 (87,5%) com doenças crônicas e 52 (81,2%) com úlceras venosas. Média de 6 anos de úlcera ativa. Detectou-se anemia em 36 (56,2%), sendo 27 (75%) normocrômica e normocítica; 14 (38,8%) apresentavam anemia carencial registrada em prontuário. Conclusão: A baixa concentração de hemoglobina é recorrente entre os participantes, caracterizando um quadro de anemia cujo perfil revela congruência ao da anemia da doença crônica.

Red cell distribution width is associated with cardiovascular risk in adults / A medida da amplitude da distribuição do tamanho dos eritrócitos está associada ao risco cardiovascular em adultos

Abstract Red cell distribution width (RDW) is a measure of erythrocyte size variability. Recent studies have shown that RDW is a predictive, and prognostic marker of mortality and cardiovascular (CVD) events in the general population and in CVD patients. This study aimed to investigate the association between RDW and CVD risk in a large sample of adults. A subsample of CVD free participants of the ELSA-Brasil cohort were included (n=4,481). In the cross-sectional approach, multiple regression analysis was used to investigate the association between RDW and the Framingham Risk Score (FRS). Linear mixed effect model evaluated whether baseline RDW predicted changes in CVD risk after about four-year follow up. Cross-sectional analysis showed that RDW was independently associated with FRS, participants in the fourth-quartile of RDW distribution had a 29% higher FRS than those in the first-quartile RDW (p<0.001). A longitudinal analysis revealed that RDW remained associated with increased FRS. In this large cohort of adult Brazilians, RDW was independently associated with increased CVD risk, as measured by the FRS, both at baseline and after four-year follow-up. However, RDW did not predict change in CVD risk in this short-term follow up.

Resumo Estudos recentes têm mostrado que o RDW (do inglês Red Cell Distribution Width) é um marcador preditivo e prognóstico de mortalidade e eventos cardiovasculares (DCV) na população geral e em pacientes com DCV. Este estudo teve como objetivo investigar a associação entre RDW e risco de DCV em uma grande amostra de adultos. Foram incluídas uma subamostra de participantes sem DCV da coorte ELSA-Brasil (n=4.481). Na abordagem transversal, a análise de regressão múltipla foi usada para investigar a associação entre o RDW e o Escore de Risco de Framingham (ERF). O modelo linear de efeito misto foi usado para avaliar se o RDW basal previa mudanças no risco de DCV após cerca de quatro anos de acompanhamento. A análise transversal mostrou que o RDW foi independentemente associado ao ERF, os participantes no quarto quartil da distribuição do RDW tiveram um ERF 29% maior do que aqueles no primeiro quartil RDW (p<0,001). Na análise longitudinal, o RDW permaneceu associado ao aumento do ERF. Nesta grande coorte de adultos brasileiros, o RDW foi independentemente associado ao aumento do risco de DCV, medido pelo ERF, tanto no início quanto após quatro anos de acompanhamento. No entanto, RDW não previu mudança no risco de DCV neste seguimento de curto prazo.

Roles of certain biochemical and hematological parameters in predicting mortality and ICU admission in COVID-19 patients

SUMMARY OBJECTIVE: In this study, we aimed to retrospectively analyze the roles of certain hematological and biochemical parameters in predicting mortality and intensive care unit admission in patients diagnosed with coronavirus disease 2019 (COVID-19). METHODS: We analyzed the complete blood count and biochemical parameters of 186 COVID-19 patients by using the polymerase chain reaction test. Whether these parameters can be used to predict intensive care unit admission and mortality in the COVID-19 patients was investigated. RESULTS: The complete blood count and biochemical parameters of COVID-19 patients and in those admitted to intensive care unit were compared. The red cell distribution width, ferritin, lactate dehydrogenase, D-dimer, C-reactive protein, prothrombin time, and creatinine levels were found to be the most significant parameters. We found that these parameters are significant for predicting not only intensive care unit admission, but also the mortality of the patients admitted to the intensive care unit. CONCLUSIONS: We determined that the most effective parameters to predict intensive care unit admission and mortality in COVID-19 patients are ferritin, lactate dehydrogenase, D-dimer, C-reactive protein, red cell distribution width, creatinine, and intensive care unit. Close monitoring of these parameters and early intervention in alterations are of vital importance.

Red cell distribution width predicts the severity of non-ST-elevation myocardial infarction in patients / 中国基层医药

Objective:To analyze the relationship between red cell distribution width (RDW) and disease severity in patients with non-ST-elevation myocardial infarction.Methods:Seventy patients with non-ST-elevation myocardial infarction who received treatment in Chaozhou People's Hospital from June 2019 to June 2020 were included in the observation group. An additional 70 patients with ST-elevation myocardial infarction who concurrently received treatment in the same hospital were included in the control group. All patients underwent electrocardiography and blood biochemical index examination. RDW was compared between the observation and control groups. The relationship between RDW and the severity of non-ST-elevation myocardial infarction was analyzed.Results:RDW in the observation group was significantly higher than that in the control group [(14.60 ± 1.00) % vs. (13.06 ± 1.70) %, t = 5.884, P = 0.012). The detection rate of coronary artery thrombosis in the observation group was significantly higher than that in the control group [70.00% (49/70) vs. 50.00% (35/70), χ2 = 7.563, P = 0.002]. In the observation group, the area under the receiver operating characteristic (ROC) curve plotted taking RDW as the variable was 0.649 (95% CI 0.546-0.753, P = 0.006). When the critical value of RDW was 14%, the sensitivity and specificity of RDW in the prediction of non-ST-elevation myocardial infarction were 73% and 59% respectively. RDW was positively correlated with cardiac troponin I level ( r = 0.19, P = 0.006). Conclusion:In patients with non-ST-elevation myocardial infarction, the increase in RDW is related to myocardial injury and the increase in cardiac troponin I level. RDW can be used as an effective index to predict the severity of non-ST-elevation myocardial infarction.

Comparison of the operative and postoperative effects of del Nido and blood cardioplegia solutions in cardiopulmonary bypass surgery

Abstract Objective: Our goal was to compare the operative and postoperative effects of del Nido cardioplegia (DN group) and blood cardioplegia (BC group) performed in cardiac surgery. Methods: A total of 83 patients were included, separated into DN group and BC group. The operative and postoperative effects of the two groups were compared for the first 24 hours until extubation. The operative and postoperative complete blood count (CBC), biochemical values and clinical parameters were compared. Results: The first control activated clotting time (ACT) levels in DN group patients were lower (P=0.003) during the operation. The amount of cardioplegia in DN group were lower than that in BC group (P=0.001). The pump outflow and postoperative lactate level of DN group were lower than those of BC group (P=0.005, P=0.018, respectively), as well as the amounts of NaHCO3 (P=0.006) and KCl (P=0.001) used during the operation. The same occurred with the first monocytes (Mo) and mean corpuscular volume (MCV) levels in the postoperative intensive care unit (P=0.006, P=0.002). However, the first glucose level and the eosinophil (Eo) level were higher in DN group (P=0.011, P=0.047, respectively). Conclusion: In the operative evaluation, the amount of cardioplegia, the first ACT levels, the pump outflow lactate level and the amounts of NaHCO3 and KCl in DN group were lower. In postoperative evaluation, measured level of lactate, Mo and MCV in DN group were all lower; their glucose and Eo levels were higher.

Amplitud de distribución eritrocitaria un biomarcador inflamatorio relacionado a retinopatía diabética proliferativa / Red Blood Cell Distribution Width An Inflammatory Biomarker Related To Proliferative Diabetic Retinopathy

Objetivo: El objetivo de este estudio fue determinar la asociación entre el ancho de distribución de glóbulos rojos y la retinopatía diabética proliferativa en pacientes con diabetes tipo 2. Métodos: Realizamos un estudio de casos y controles en un hospital. Pacientes adultos (≥ 18 años) con diagnóstico de Retinopatía Diabética que fueron sometidos a controles médicos en el servicio de Oftalmología donde se inscribieron en nuestro estudio. Seleccionamos un tamaño de muestra total de 262 pacientes, de los cuales 131 casos tenían retinopatía diabética proliferativa y 131 controles tenían retinopatía diabética no proliferativa. Se registraron datos sobre edad, sexo, índice de masa corporal, antecedentes de hipertensión, nefropatía diabética, insuficiencia cardíaca congestiva, hemoglobina y HbA1c para las personas que cumplieron con los criterios de inclusión. Se utilizó un modelo de razón de probabilidades para probar la relación entre el ancho de distribución de glóbulos rojos y la retinopatía diabética proliferativa. Resultados: El ancho medio de distribución de glóbulos rojos +/- DE de los casos fue 14,41 +/- 0,84 y los controles fue 13,49 +/- 1,26. De acuerdo con el análisis bivariado, se encontró una asociación entre el ancho de distribución de los glóbulos rojos y la retinopatía diabética proliferativa (OR 3,79, P = 0,000, IC = 2,12-6,78). El análisis de regresión logística multivariante indicó que el ancho de distribución de glóbulos rojos (OR 2,15, P = 0,037, IC = 1,05-4,43) era un factor de riesgo independiente para el desarrollo de retinopatía diabética proliferativa. Conclusión: Los valores elevados del ancho de distribución de glóbulos rojos se relacionaron con la retinopatía diabética proliferativa, lo que sugiere la posible aplicación del ancho de distribución de glóbulos rojos como un biomarcador predictivo accesible de la progresión de la enfermedad en pacientes con retinopatía diabética.

Objective: The aim of this study was to determine the association between Red Blood cell Distribution width and Proliferative Diabetic Retinopathy in patients with type 2 diabetes. Methods: We conducted a hospital-based case-control study. Adult patients (≥ 18 years old) with the diagnosis of Diabetic Retinopathy who underwent medical check-ups at the ophthalmology department where enrolled in our study. We selected a total sample size of 262 patients, of which 131 cases had Proliferative Diabetic Retinopathy and 131 controls had Non Proliferative Diabetic Retinopathy. Data about age, gender, body mass index, history of hypertension, diabetic nephropathy, Congestive heart failure, Hemoglobin and HbA1c were registered for individuals who met inclusion criteria. Odds ratio model was used to test the relationship between Red Blood Cell Distribution Width and Proliferative Diabetic Retinopathy. Results: Mean Red Blood cell Distribution width +/- SD of the cases was 14.41+/-0.84 and the controls was 13.49+/-1.26. According to bivariate analysis, an association was found between Red Blood cell Distribution width and Proliferative Diabetic Retinopathy (OR 3.79, P=0.000, IC=2.12-6.78). Multivariate logistic regression analysis indicated that Red Blood cell Distribution width (OR 2.15, P=0.037, IC= 1.05-4.43) was an independent risk factors for the development of Proliferative Diabetic Retinopathy. Conclusion: Elevated values of Red Blood cell Distribution width were related to Proliferative Diabetic Retinopathy, suggesting the potential application of Red Blood cell Distribution width as an accessible predictive biomarker of disease progression in patients with diabetic retinopathy.

Values of procalcitionin and red blood cell distribution width in evaluating severity and prognosis of septicemia in preterm infants / 中华围产医学杂志

Objective@#To analyze the variations of procalcitionin (PCT) and red blood cell distribution width (RDW) in premature infants with septicemia and to investigate their values in evaluating the severity and prognosis of septicemia.@*Methods@#A retrospective study was conducted to analyze the medical records of 96 premature infants diagnosed with septicemia and admitted to the First Affiliated Hospital of Anhui Medical University from December 1, 2014 to December 1, 2018. According to the severity of the disease and neonatal shock score, there were 42 cases selected to the severe septicemia group (severe clinical condition with shock, shock score >6 points) and 54 in the mild septicemia group (mild clinical condition without shock or shock score ≤6 points). Moreover, after three days' treatment, they were divided into two groups: death group (n=10) and survival group (n=86, survived during hospitalization). Peripheral venous blood samples were collected before and on the first and third day after treatment to detect PCT and RDW. Dynamic changes of the two indexes were compared between different groups. Mann-Whitney U test, Wilcoxon rank sum test, Friedman test or receiver operating characteristic (ROC) curve was used for statistical analysis.@*Results@#(1) Before and on the first and third day after treatment, the severe septicemia group had a higher level of PCT than the mild group [3.7 (0.4-37.3) vs 1.4 (0.2-5.0) ng/ml, 43.1 (18.7-83.0) vs 17.1 (4.1-34.6) ng/ml, 26.1 (3.8-67.3) vs 4.8 (0.3-32.9) ng/ml; Z=-2.017, -3.350 and -2.932; all P<0.05]. In both groups, PCT level on the first day after treatment was the highest, and that on the third day after treatment was higher than that before treatment (all P<0.05). On the first and third day after treatment, RDW in the severe group was higher than that in the mild group [16.5% (16.2%-18.6%) vs 16.3% (15.5%-17.3%), 16.1% (15.5%-19.4%) vs 15.7% (15.1%-16.5%); Z=-1.992 and -2.165; both P<0.05]. In the severe and mild groups, RDW on the first day after treatment was higher than that before and on the third day after treatment; in the mild group, RDW on the third day after treatment was lower than that before treatment, while in the severe group, RDW on the third day after treatment was higher than that before treatment (all P<0.05). (2) On the first and third day after treatment, PCT and RDW in the death group were higher than those in the survival group [PCT: 162.0 (62.9-187.2) vs 19.9 (4.3-46.1) ng/ml, 122.6 (65.0-180.8) vs 6.2 (0.5-32.9) ng/ml; Z=-4.114 and -4.594; RDW: 18.4% (16.9%-21.2%) vs 16.3% (15.7%-17.2%), 21.8% (20.6%-22.2%) vs 15.8% (15.2%-16.5%); Z=-3.307 and -4.831; all P<0.05]. In both groups, PCT on the first day after treatment was higher than that before and on the third day after treatment, and the level on the third day after treatment was higher than that before treatment (all P<0.05). In the death group, RDW on the first and third day after treatment were higher than that before treatment, and RDW on the third day after treatment was higher than that on the first day; in the survival group, RDW on the first day after treatment was higher than that before treatment, but on the third day after treatment, it was lower than that before and on the first day after treatment (all P<0.05). (3) The cut-off values of PCT for predicting severe septicemia in premature infants before and on the first and third day after treatment were 3.475, 29.765 and 3.460 ng/ml, respectively, and the sensitivity and specificity were 54.8% and 75.9%, 69.0% and 72.2%, and 83.3% and 46.3%, respectively. The cut-off values of PCT for predicting the death of premature infants with septicemia on the first and third day after treatment were 40.595 and 64.855 ng/ml, respectively, with the specificity of 73.3% and 87.2% and sensitivity of both 100.0%. The predictive thresholds of RDW for severe septicemia on the first and third day after treatment were 15.650% and 18.300%, respectively, and the sensitivity and specificity were 95.2% and 29.6%, 33.3% and 92.6%, respectively. The predictive thresholds for death were 16.650% and 18.450%, and the sensitivity and specificity were 100.0% and 68.6%, 100.0% and 91.9%, respectively.@*Conclusions@#Dynamic monitoring of PCT and RDW levels may help with early diagnosis, determination of severity and prognosis prediction of severe septicemia in premature infants.

Predictive value of elevated red blood cell distribution width for no early improvement after intravenous thrombolysis in patients with acute ischemic stroke / 国际脑血管病杂志

Objective To investigate the predictive value of red blood cell distribution width (RDW) for no early improvement after intravenous thrombolysis in patients with acute ischemic stroke.Methods Patients with acute ischemic stroke received intravenous thrombolysis in the Department of Neurology,the Second Hospital of Tianjin Medical University between January 2017 and December 2018 were enrolled retrospectively.The National Institutes of Health Stroke Scale (NIHSS) score declined ≥4 or the NIHSS score 0-1 in 24 h after thrombolytic therapy was defined as early improvement,and the NIHSS score declined＜4 was defined as no early improvement.Multivariate logistic regression analysis was used to determine the independent risk factors for no early improvement.Receiver operator characteristic (ROC)curve was used to analyze the predictive value of RDW for no early improvement after intravenous thrombolysis in patients with acute ischemic stroke.Results A total of 119 patients were enrolled in the study,46 (38.7％) had early improvement and 73 (61.3％) had no early improvement.Hypersensitive C-reactive protein,RDW,the time from onset to thrombolysis,and the proportion of complicated hypertension and fasting blood glucose in the no early improvement group were higher or longer than those in the early improvement group,and the differences were statistically significant (all P ＜0.05).Multivariate logistic regression analysis showed that the elevated RDW was an independent risk factor for no early improvement (odds ratio 3.119,95％ confidence interval 1.584-6.141;P =0.001).ROC curve analysis showed that the best cut-off value of RDW for predicting no early improvement after intravenous thrombolysis in acute ischemic stroke was 13.35％.The area under the curve was 0.737 (95％ confidence interval 0.645-0.828).The sensitivity and specificity were 64.4％ and 87.0％,respectively.Conclusion Elevated RDW has certain predictive value for no early improvement after intravenous thrombolysis in patients with acute ischemic stroke.

Values of procalcitionin and red blood cell distribution width in evaluating severity and prognosis of septicemia in preterm infants / 中华围产医学杂志

Objective To analyze the variations of procalcitionin (PCT) and red blood cell distribution width (RDW) in premature infants with septicemia and to investigate their values in evaluating the severity and prognosis of septicemia. Methods A retrospective study was conducted to analyze the medical records of 96 premature infants diagnosed with septicemia and admitted to the First Affiliated Hospital of Anhui Medical University from December 1, 2014 to December 1, 2018. According to the severity of the disease and neonatal shock score, there were 42 cases selected to the severe septicemia group (severe clinical condition with shock, shock score >6 points) and 54 in the mild septicemia group (mild clinical condition without shock or shock score ≤6 points). Moreover, after three days' treatment, they were divided into two groups: death group (n=10) and survival group (n=86, survived during hospitalization). Peripheral venous blood samples were collected before and on the first and third day after treatment to detect PCT and RDW. Dynamic changes of the two indexes were compared between different groups. Mann-Whitney U test, Wilcoxon rank sum test, Friedman test or receiver operating characteristic (ROC) curve was used for statistical analysis. Results (1) Before and on the first and third day after treatment, the severe septicemia group had a higher level of PCT than the mild group [3.7 (0.4-37.3) vs 1.4 (0.2-5.0) ng/ml, 43.1 (18.7-83.0) vs 17.1 (4.1-34.6) ng/ml, 26.1 (3.8-67.3) vs 4.8 (0.3-32.9) ng/ml; Z= － 2.017, － 3.350 and － 2.932; all P<0.05]. In both groups, PCT level on the first day after treatment was the highest, and that on the third day after treatment was higher than that before treatment (all P<0.05). On the first and third day after treatment, RDW in the severe group was higher than that in the mild group [16.5% (16.2%-18.6%) vs 16.3% (15.5%-17.3%), 16.1% (15.5%-19.4%) vs 15.7% (15.1%-16.5%);Z= － 1.992 and － 2.165; both P<0.05]. In the severe and mild groups, RDW on the first day after treatment was higher than that before and on the third day after treatment; in the mild group, RDW on the third day after treatment was lower than that before treatment, while in the severe group, RDW on the third day after treatment was higher than that before treatment (all P<0.05). (2) On the first and third day after treatment, PCT and RDW in the death group were higher than those in the survival group [PCT: 162.0 (62.9-187.2) vs 19.9 (4.3-46.1) ng/ml, 122.6 (65.0-180.8) vs 6.2 (0.5-32.9) ng/ml; Z= － 4.114 and － 4.594; RDW: 18.4% (16.9%-21.2%) vs 16.3% (15.7%-17.2%), 21.8% (20.6%-22.2%) vs 15.8% (15.2%-16.5%); Z=－3.307 and －4.831;all P<0.05]. In both groups, PCT on the first day after treatment was higher than that before and on the third day after treatment, and the level on the third day after treatment was higher than that before treatment (all P<0.05). In the death group, RDW on the first and third day after treatment were higher than that before treatment, and RDW on the third day after treatment was higher than that on the first day; in the survival group, RDW on the first day after treatment was higher than that before treatment, but on the third day after treatment, it was lower than that before and on the first day after treatment (all P<0.05). (3) The cut-off values of PCT for predicting severe septicemia in premature infants before and on the first and third day after treatment were 3.475, 29.765 and 3.460 ng/ml, respectively, and the sensitivity and specificity were 54.8% and 75.9%, 69.0% and 72.2%, and 83.3% and 46.3%, respectively. The cut-off values of PCT for predicting the death of premature infants with septicemia on the first and third day after treatment were 40.595 and 64.855 ng/ml, respectively, with the specificity of 73.3% and 87.2% and sensitivity of both 100.0%. The predictive thresholds of RDW for severe septicemia on the first and third day after treatment were 15.650% and 18.300%, respectively, and the sensitivity and specificity were 95.2% and 29.6%, 33.3% and 92.6%, respectively. The predictive thresholds for death were 16.650% and 18.450%, and the sensitivity and specificity were 100.0% and 68.6%, 100.0% and 91.9%, respectively. Conclusions Dynamic monitoring of PCT and RDW levels may help with early diagnosis, determination of severity and prognosis prediction of severe septicemia in premature infants.

Early predictive value of red cell distribution width for contrast - induced nephropathy in patients after enhanced computed tomography / 中华肾脏病杂志

Objective To explore the early predictive value of red cell distribution width (RDW) for contrast-induced nephropathy (CIN) in patients after enhanced computed tomography (CT). Methods A total of 218 patients who underwent enhanced CT between June 2015 and June 2017 at Huizhou Central Municipal Hospital were enrolled in this study. Patients were divided into CIN group and no-CIN group. The diagnostic criteria for CIN is an increase in serum creatinine (Scr) of more than 44.2 μmol/L or 25％ of the baseline value within 3 days of contrast agent use. The general information and clinical characteristics in two groups were compared. The risk factors of CIN were analyzed by logistic regression analysis. The receiver operator characteristic curve (ROC) was used to assess the value of RDW for predicting the occurrence of CIN. Results Among 218 patients, 10(4.59％ ) patients had CIN. In the CIN group age, baseline Scr and baseline RDW were significantly higher, while hemoglobin, baseline estimated glomerular filtration rate (eGFR), red blood cell, white blood cell, albumin, and high - density lipoprotein cholesterol were significantly lower than those in the no - CIN group (all P＜0.05). Binary logistic regression analysis revealed that baseline RDW (OR=2.250, 95％CI 1.031-4.911, P=0.042) and eGFR (OR=0.963, 95％ CI 0.928-0.999, P=0.044) were correlated with the occurrence of CIN. ROC analysis confirmed the area under the curve of RDW as a predictor of CIN was 0.798 (P＜0.001). The cut - off value of RDW was 14.5％ , and the diagnostic sensitivity and specificity in CIN were 70.00％ and 85.58％, respectively. Conclusions Increased baseline RDW and decreased eGFR are the risk factors of the occurrence of CIN after enhanced CT. RDW has a good predictive value, and it may be a good biomarker for the early diagnosis of CIN.

Red blood cell distribution width and ischemic stroke / 国际脑血管病杂志

The incidence, mortality and disability of ischemic stroke are higher, which has caused serious harm to people's health. In recent years, red blood cell distribution width as an independent risk factor and predictor of various diseases is receiving increasing attention. This article reviews the relationship between red blood cell distribution width and ischemic stroke.

Association between red cell distribution width and mortality in patients undergoing continuous ambulatory peritoneal dialysis / 中华肾脏病杂志

Objective To investigate the association of red cell distribution width (RDW) with all-cause and cardiovascular disease (CVD)-related mortality in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).Methods A retrospective analysis was performed on 207 patients who initiated CAPD for more than 3 months between July 2005 and March 2016 in the First Hospital Affiliated to Zhengzhou University.Baseline data on demographic,clinical and biochemical variables as well as comorbidities were obtained;medications and clinic outcomes were recorded.According to receiver operator characteristic curve (ROC) analysis,patients were divided into high RDW (RDW ＞ 15.1％) and low RDW (RDW≤ 15.1％) groups.The data of two groups were compared and Spearman's correlation analysis was used to explore the association of RDW with clinical and biochemical parameters.Survival curves were calculated using Kaplan-Meier method.Cox regression model was employed to analyze risk factors of all-cause and CVD-related mortality.Results In this study,207 CAPD patients were enrolled.The overall median survival time was 80 months.And the median survival time of high RDW group (68 patients) and low RDW group (139 patients) were 59 months and 96 months,respectively.There were statistical differences in diastole pressure,hemoglobin,hematocrit,serum albumin,intact parathyroid hormone (iPTH),eGFR,cholesterol,lipoprotein a,4-hour dialysate-to-plasma ratio for creatinine (4hD/Pcr),total Ccr (P ＜ 0.05,respectively);the two groups also varied in the proportion of chronic obstructive pulmonary disease,cardiovascular disease and hyperlipidemia,as well as in the use of iron supplements,angiotensin-converting enzyme (ACE) inhibitors or angiotensin Ⅱ receptor blockers (ARB),and beta-receptor blockers (P＜0.05,respectively).Cardiovascular event was a leading cause of mortality.Kaplan-Meier survival curves showed that the high RDW group had higher all-cause and CVD-related mortality compared with the low RDW group (P ＜ 0.01).The 1-year,3-year,and 5-year patient survivals of the high RDW and low RDW group were 87.97％ vs 97.01％,58.02％ vs 81.53％,and 41.62％ vs 67.96％,respectively,demonstrating significant differences (P=0.001).Multivariate Cox regression analysis showed that high RDW was independent risk factor for all-cause mortality (HR=1.212,95％CI:1.007-1.458,P=0.042) and CVD-related mortality (HR=1.697,95％ CI:1.030-2.795,P=0.038).Conclusion RDW is associated with mortality risks in CAPD patients and can be stratified as a valuable indicator for the risk of death.