Evaluation of Sepsis Severity Using Combined High-Density Lipoprotein and Red Cell Distribution Width Indicators.

BackgroundAcute respiratory failure (ARF) is a common disease in the intensive care units (ICUs) with high risk of mortality. The red cell distribution width (RDW) is one of baseline ICU indicators which can be easily available, and has been used in the long-term prognostic analyses of diseases. However, no studies have explored the role of baseline RDW and its change during hospitalization in in-hospital mortality in ARF. Herein, this study aims to explore the association between RDW and its changes and the 30-day mortality in ARF patients.MethodsDemographic and clinical data of 7,497 patients with ARF were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database in 2012–2019 in this retrospective cohort study. Univariable and multivariable Cox regression analyses were used to explore the association between RDW and its changes and 30-day mortality with hazard ratios (HRs) and 95% confidence intervals (CIs). Subgroup analyses of different baseline RDW levels were also performed. We then assessed the predictive performance of RDW changes combined with the Sequential Organ Failure Assessment (SOFA) score on 30-day mortality using receiver operator characteristic curves (ROCs) with areas under curve (AUCs).ResultsTotally, 2,254 (30.07%) patients died in 30 days. After adjusting for covariates, we found that high baseline RDW [HR = 1.25, 95%CI: (1.15–1.37)] and RDW changes ≥0.3% [HR = 1.12, 95%CI: (1.01–1.24)] were both related to an increased risk of 30-day mortality. In patients whose baseline RDW level ≥14.9%, RDW changes ≥0.3% was also associated with an increased risk of 30-day mortality [HR = 1.19, 95%CI: (1.05–1.35)]. Moreover, the predictive value of RDW changes combined with SOFA on 30-day mortality was a little better than that of single SOFA score, with AUCs of 0.624 vs. 0.620.ConclusionHigh baseline RDW level and its changes during hospitalization was relate to the increased risk of 30-day mortality in ARF, and the predictive value of RDW changes for ARF short-term mortality is still needed exploration.

Increased red cell distribution width (RDW), a quantitative measure of erythrocyte size variability, has been associated with increased mortality in critically ill patients. In this post-hoc analysis of prospectively collected data, we studied 122 septic patients with and without shock who had undergone sublingual microcirculatory assessment using Sidestream Dark Field (SDF) videomicroscopy. Patient demographics, comorbidities, the Acute Physiology and Chronic Health Evaluation (APACHE) II score on admission and the Sequential Organ Failure Assessment (SOFA) score on the day of the microcirculatory assessment were collected. The RDW was retrospectively collected on the day of the microcirculatory evaluation from the routine daily blood count analysis. Median patient age was 68[55-77] years, and median APACHE II and SOFA scores were 22[17-28] and 10[8-12], respectively; ICU mortality was 43%. On the day of the microcirculatory analysis, the median RDW was 13.8[12.8-15.5]% and was elevated (>13.4%) in 74 (61%) patients. There was no correlation between RDW and microcirculatory parameters (functional capillary density, r2 = 0.12; proportion of small perfused vessels, r2 = 0.17; mean flow index, r2 = 0.14). RDW was not related to disease severity, the presence of shock or survival. RDW is not associated with microcirculatory alterations or prognosis in septic patients.

Background Red blood cell distribution width (RDW) is a marker of anisocytosis available in standard complete blood counts. Elevated RDW values reflect abnormalities in erythropoiesis but are also associated with aging, systemic inflammation, and chronic diseases. Increasing evidence suggests a prognostic role for higher RDW levels in cardiovascular diseases. Purpose This study aimed to investigate the association between RDW levels and clinical outcomes in patients with atrial fibrillation (AF). Methods We used data from a prospective observational study of patients with AF. Patients were stratified into tertiles based on RDW values at baseline: (i) lowest (RDW ≤ 13.5%), (ii) intermediate (RDW 13.6%-14.6%), and (iii) highest tertile (RDW ≥ 14.7%). All-cause death was the primary outcome. The composite outcome of any thromboembolic event (TE), acute coronary syndrome (ACS), or hospitalization for heart failure (HF) (i.e. Major Adverse Cardiovascular Events - MACE) was also evaluated. Results A total of 940 AF patients were included (median age of 75 years). Baseline comparison between the three groups based on RDW values are shown in the Table. The median age, CHA2DS2-VA score, and burden of comorbidities- such as heart failure, coronary artery disease, hypertension, diabetes, CKD, cancer and cognitive impairment - were significantly and progressively higher across the tertiles. Overall, the use of oral anticoagulants (OAC) was substantially high in the cohort (89.7%) with no significant differences among groups. After a median follow-up of 665 days, we observed significant differences in all-cause mortality rates among the RDW tertiles with the highest tertile showing the highest mortality (10.5% in the lowest vs 12.2% in the intermediate vs 26.4% in the highest tertile, p < 0.001). Kaplan-Meier survival curves are shown in the Figure. Additionally, the rates of MACE were significantly and progressively higher among the tertiles, reaching up to 16.7% in the highest tertile (p = 0.04). At the adjusted Cox regression analysis, the highest RDW tertile was independently associated with a higher risk of all-cause mortality compared with the lowest tertile (adjusted HR 2.01, 95% CI 1.30-3.12). ROC analysis yielded an area under the curve (AUC) of 0.657 (95% CI 0.606-0.707) for RDW in predicting all-cause death. Conclusions In a contemporary cohort of patients with AF, elevated RDW values were significantly associated with an increased risk of all-cause mortality. Our findings suggest that this inexpensive and readily available biomarker may help identify patients at higher risk for adverse outcomes, aiming to improve AF clinical management.

Red cell distribution width (RDW) represents the heterogeneity of red blood cells (anisocytosis). Spontaneous echo contrast (SEC) is thought to be a manifestation of red cell aggregation and it has been linked to the development of thromboemboli. The aim of this study was to evaluate the association between RDW levels and the presence of left atrial SEC (LASEC).One-hundred and 72 patients who underwent transesophageal echocardiography for various indications were enrolled in the study. All patients were categorized into 2 groups according to the presence of LASEC and into 4 groups according to the severity of LASEC. The baseline clinical characteristics, echocardiographic measurements, and laboratory findings, including RDW, were compared between the groups.The RDW (%) level was higher in the LASEC group (14.95 ± 1.32) compared with the non-LASEC group (12.20 ± 1.45; P = 0.0001). When the relationship between RDW and SEC was evaluated according to the increasing grade of SEC, a significant positive correlation was found (r = 0.645, P < 0.0001). In the ROC analysis, an RDW level >13.8% had 70% sensitivity and 89.2% specificity in predicting LASEC (area under the curve = 0.834, P < 0.0001, 95% CI 0.656–0.773). In multivariate analysis, RDW levels >13.8% and the presence of atrial fibrillation were independently associated with LASEC (odds ratio [OR] 1.697; 95% confidence interval [CI] 1.198–2.085; P = 0.001 and OR 1.586; 95% CI 1.195–2.098; P = 0.003, respectively].Elevated RDW value is associated with the presence and the severity of SEC. RDW may be a useful marker and independent predictor for the presence of SEC.

Background We aimed to investigate the prognostic value of red cell distribution width (RDW) in metastatic renal cell carcinoma (mRCC) patients treated with targeted therapy, including sunitinib and pazopanib. Methods A total of 104 mRCC patients were included. The Kaplan–Meier method was used to estimate overall survival (OS) and progression-free survival (PFS), and the long-rank test was used for comparison. Univariate and multivariate Cox proportional hazards models were used to determine the association between RDW and PFS and OS. Results The PFS and OS of all cohorts were 11.8 mo and 25.9 mo, respectively. Receiver operating characteristic analysis revealed that RDW level ≥15.4 was the optimal cutoff value for OS prediction with 73.53% sensitivity and 61.11% specificity (area under curve: 0.64, P = 0.012). RDW level ≥15.4 was found as an independent prognostic parameter for OS when adjusted for the number of covariates, including the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) scoring system (hazard ratio: 1.125, 95% confidence interval: 1.024–2.235, P = 0.014). Conclusions Our study revealed that high RDW level, a routinely and easily assessed marker, was significantly associated with worse survival outcomes in mRCC patients treated with targeted therapy.

Introduction Multiple myeloma (MM) is a complex plasma cell malignancy characterized by clonal proliferation and monoclonal immunoglobulin production. Despite the availability of several prognostic markers for MM, many are challenging to implement routine clinical practice due to cost, complexity, or lack of standardization. Red cell distribution width (RDW), a cost-effective and routinely measured parameter in complete blood counts, has gained increasing attention as a prognostic marker due to its association with disease severity and outcomes in MM. This study investigates the prognostic utility of RDW in MM, focusing on its relationship with patient outcomes, particularly in those undergoing autologous stem cell transplantation (ASCT). Methods This retrospective study included 218 patients diagnosed with MM between 2010 and 2018. Demographic, clinical, and laboratory data, including RDW levels at ASCT and first relapse, were collected. Patients were stratified into high (>16.5%) and low (≤16.5%) RDW groups. The impact of RDW levels and their changes on progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier and log-rank tests. Results Higher RDW levels at diagnosis were significantly associated with advanced disease stages, notably R-ISS stage 3 (p=0.022). While no significant survival differences were observed based on baseline RDW levels, dynamic changes in RDW from diagnosis to first relapse were strongly prognostic. Patients maintaining low RDW had the longest PFS (37 months) and OS (88.8 months), whereas those transitioning from low to high RDW experienced the shortest PFS (nine months) and OS (40.6 months). At relapse, patients with low RDW demonstrated superior outcomes (PFS: 34 vs. 14 months, OS: 81.2 vs. 40.6 months; p<0.001). ASCT markedly improved survival outcomes, with longer PFS (p=0.028) and OS (p<0.001). Higher hemoglobin levels (>10 g/dL) were also associated with extended PFS (p=0.038). Reassessing RDW prior to ASCT did not yield significant differences, suggesting that the prognostic value of RDW lies in its dynamic changes, particularly around relapse events. Conclusions RDW levels at diagnosis reflect advanced disease stages in MM but are not independent predictors of survival. However, dynamic changes in RDW, particularly from diagnosis to relapse, highlight its potential as a robust marker for monitoring disease progression and relapse risk. ASCT remains a cornerstone of MM management, significantly improving survival outcomes and complementing RDW trends in prognosis. Standardizing RDW thresholds and integrating its dynamic trends into clinical workflows could enhance risk stratification and personalized treatment strategies. Prospective, multi-center trials are essential to validate these findings and establish RDW's role in comprehensive prognostic frameworks for MM.

As an indicator of variability in circulating erythrocyte size, red cell distribution width (RDW) is linked to chronic inflammation. The association of rheumatic heart valve stenosis and inflammation is also well-known. This study aimed to assess the relationship between RDW and presence and severity of rheumatic mitral valve stenosis (RMVS). A total of 417 consecutive patients with RMVS, and 81 age- and -gender matched healthy control subjects were included in the study between February 2009 and April 2014. Transthoracic echocardiography and demographic characteristics were recorded for all participants. Baseline characteristics were similar in the two groups. However, median RDW was significantly higher in patients with RMVS compared to control group (14.4% [11.3-19.6] vs. 13.6% [11.6-18.1], p<0.001). Additionally, both median C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR) were also higher in the RMVS group; (6.1 [0.4-24.2] vs. 3.6 [0.3-15.3] mg/dl, p=0.001 for CRP, and 2.8 [0.4-10.6] vs. 2.1 [0.7-5.7], p<0.001 for NLR respectively). In regression analysis, RDW (OR: 1.504, p=0.005), CRP (OR: 1.139, p=0.008), NLR (OR: 1.528, p=0.018) and left atrial diameter (OR: 1.218, p<0.001) were found as independent predictors of the presence of RMVS. Furthermore, there was a significant positive correlation between CRP (r=0.140, p=0.007) and NLR levels (r=0.276, p<0.001) with RDW levels. Furthermore, we determined that RDW levels increased in parallel with severity of mitral stenosis (mild, moderate and severe) [13.7% (12.9-14.8), 14.4% (13.4-15.4), 14.8% (13.6-16.3), p<0.001, respectively]. The study demonstrated significantly higher RDW in patients with RMVS. Furthermore, RDW independently predicted the presence of RMVS. RDW is an easily available marker, and because of its correlation with common inflammatory indicators may also be a sign of chronic inflammatory continuum in patients with RMVS.

Aim Red cell distribution width (RDW), an index of erythrocyte size, is associated with high risk for cardiovascular disease. Nondipping hypertension (HT) is lack of nocturnal fall in blood pressure(BP). The association between RDW and non-dipping BP in normotensive and hypertensive patients was investigated. Methods A total of 170 patients were categorized into 4 groups: Normotensive-Dipper (NT-D), Normotensive-Non-dipper (NTND), Hypertensive-Dipper (HT-D) and Hypertensive-Non-dipper(HT-ND). RDW and hs-CRP levels were measured. Results Hypertensive patients had higher RDW and hs-CRP levels(14.5 ± 0.87 vs.12.7 ± 0.66, p<0.001 for RDW; 0.99 ± 0.52 vs.0.63 ± 0.43, p<0.001 for hs-CRP). Besides, the RDW levels were higher in non-dippers (13.0 ± 0.63 vs.12.4 ± 0.55, p<0.001 for NT-ND and NT-D; 14.9 ± 0.78 vs.14.2 ± 0.82, p<0.001 for HT-ND and HT-D) Conclusion RDW is elevated in non-dipping BP both in normotensive and hypertensive subjects, which may be related with increased inflammatory state.

ObjectiveThis study aims to investigate the correlation between red cell distribution width (RDW) and overall mortality in adults diagnosed with osteomyelitis.MethodsIn this retrospective study, we examined data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, comprising 2,700 patients with osteomyelitis and available RDW data on the initial day of admission. Employing Kaplan-Meier survival analysis, we assessed the incidence rate of primary outcome events among groups categorized by RDW levels (Q1: RDW ≤ 13.5, Q2: 13.5 < RDW ≤ 14.6, Q3: 14.6 < RDW ≤ 16.1, Q4: 16.1 < RDW), with differences evaluated using the Log-rank test. Subsequently, Cox proportional hazards analyses were conducted to investigate the correlation between RDW and the overall mortality risk. Additionally, we performed stratified analyses based on factors such as gender, congestive heart failure, diabetes, and myocardial infarction to scrutinize the consistency of RDW’s prognostic significance.ResultsOver the 90-day follow-up, 10.7% of patients with osteomyelitis succumbed. Unadjusted RDW correlated significantly with in-hospital, 30-day, and 90-day mortality (p < 0.05). Higher RDW levels proved more effective in predicting increased risks. RDW emerged as an independent prognostic indicator, showing no significant interactions with sex, congestive heart failure, diabetes, and myocardial infarction (interaction p-values: 0.254 to 0.920).ConclusionsThe noteworthy link between RDW and heightened all-cause mortality in patients with osteomyelitis who were hospitalized in the intensive care unit highlights RDW’s potential as a valuable marker for identifying at-risk individuals during hospitalization.

Red Cell Distribution Width (RDW) at Diagnosis of Diffuse Large B-Cell Lymphoma (DLBCL) Is Associated to Higher Mortality and Worse Overall Survival

Objective To study the predictive value of acute gastrointestinal injury (AGI) grading system introduced into Sequential Organ Failure Assessment (SOFA) score in patients with severe acute pancreatitis (SAP) in order to provide a reliable clinical tool for the evaluation of prognosis of SAP. Methods Patients with acute pancreatitis admitted to ICU from July 2012 to July 2014 were enrolled for study. The criteria of exclusion were the age below 18 years old, pregnancy, or patients without consent to the treatment. A total of 63 patients with 37 males and 26 females aged (47 ±15.3) years were included. The data of their acute physiology and chronic health evaluation (APACHE) Ⅱ score, the highest SOFA score and AGI grade within the first week, and the 28-day mortality rate were collected. Patients without AGI were defined as zero point, and AGI grade I -IV were defined as 1-4 points. The receiver operating characteristic curve (ROC) was used to evaluate the value of APACHEⅡ score, SOFA score, and SOFA + AGI score in predicting the prognosis of SAP. The areas under ROC curve (AUC) of the APACHEⅡ score, SOFA score, and SOFA +AGI score were compared with MedCalc software, and P value less than 0.01 was considered to be statistical significance. Results (1) The 28-day mortality of the 63 patients with SAP was 20.6% (13/63), in which 50 patients in the survival group, 13 patients in the death group. The APACHEⅡ scores of two groups were (15.62 ± 4.33 vs. 12.10 ± 3.74, P =0.0048), the SOFA scores were (14.77 ± 3.09 vs. 9.24 ± 2.88, P <0.01), and the SOFA +AGI scores were (18.77 ± 3.09 vs. 10.74 ± 3.17, P <0.01). (2) The AUC of APACHEⅡ score was 0.748 ± 0.084 (95% CI: 0.622-0.849), the AUC of SOFA score was 0.902 ± 0.059 (95% CI: 0.801-0.962), and the AUC of SOFA +AGI score was 0.963 ± 0.037 (95% CI, 0.882-0.994) ; There was no significant difference in AUC between APACHEⅡ score and SOFA score (P =0.10) , and there was statistical significance between the AUC of APACHEⅡ score and that of SOFA +AGI score (P =0.013) , and the difference in AUC between SOFA score and SOFA +AGI score was statistically significant (P =0.008). The Youden index and the positive likelihood ratio of SOFA +AGI score system were the greatest to be 0.863 and 15.38, respectively. Conclusions SOFA scoring system has better predictive value in patients with SAP when AGI grading system was introduced into it. Key words: Acute gastrointestinal injury grading system; APACHEⅡ score; SOFA score; Severe acute pancreatitis; Prognosis

Sepsis is a life-threatening condition arising from a dysregulated host response to infection leading to organ dysfunction. Traditional clinical signs are often unreliable for detecting sepsis, necessitating the exploration of more accurate biomarkers. Furthermore, currently, recommended screening scores perform poorly, necessitating more effective biomarkers to identify sepsis. Therefore, in this study, we evaluated the predictive capabilities of six inflammatory biomarkers - C-reactive protein (CRP), red cell distribution width (RDW), neutrophil-lymphocyte ratio (NLR), monocyte distribution width (MDW), mean neutrophil volume (MNV), and mean monocyte volume (MMV) - measured from samples taken for complete blood count (CBC) for the development of sepsis in ICU patients. We conducted a prospective observational study involving ICU patients at a tertiary-care hospital in Hyderabad, India, over a one-year period to primarily assess the predictability of these six biomarkers for sepsis. As a secondary outcome, we also analyzed the predictiveness of the biomarkers with respect to mortality, the need for vasopressors, invasive mechanical ventilation or renal replacement therapy (RRT), the presence of organ failure, and hospital length of stay. Blood samples were collected for CRP and CBC on the first day of admission, from which RDW, NLR, MDW, MNV, and MMV were measured. Demographic data, including Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores, clinical progression (recovery or mortality), requirement for vasopressors, invasive mechanical ventilation, RRT, presence of organ failure, and overall length of hospital stay, were documented. We analyzed data from 84 patients after one patient withdrew consent. The study sample had a mean age of 65.83 years, with 60 (71.4%) patients >60 years of age and a male predominance (n = 50; 59.5%). About 57 (67.85%) patients had three or more comorbidities. About 71 (84.5%) patients met the sepsis-3 criteria. Mean APACHE II and SOFA scores were 18.73 and 5.36, respectively. Primary outcome analysis showed that CRP and MDW were the most sensitive, with sensitivities of 81.75% and 81.7%, respectively, whereas MDW, MNV, and MMV had the highest specificity at 100% each. Correlation analysis revealed that MDW had the best area under the curve (AUC) of 0.932 in predicting sepsis. Multivariate logistic regression identified both MDW and MMV to have a significant positive correlation in the prediction of sepsis. The overall mortality rate was 9.5%. About 82 (97.6%) patients had organ failure, 35 (41.7%) required vasopressors, 20 (23.8%) required invasive mechanical ventilation, 16 (19%) required RRT, and 59 (70.2%) had a hospital stay exceeding five days, with an average length of hospital stay of eight days. No biomarkers showed strong AUC or specificity compared to the SOFA score (0.710, 94.74% specificity in predicting mortality). However, among the six biomarkers, MDW was the most specific (86.84%). A CRP of >65 mg/L was the best indicator for prolonged hospital stay, vasopressor use, and RRT. An MMV of >179 and MDW of >21.86 U were the most sensitive markers for vasopressor requirements. Our findings suggest that easily accessible biomarkers derived from routine CBC tests, particularly MDW and MMV, may serve as valuable tools for early sepsis diagnosis in resource-limited settings.

Objective To evaluate the application value of maximum sequential organ failure assessment (SOFA) score and mean SOFA score for the prediction of clinical outcome in patients with sepsis caused by gram-positive/gram-major pathogens. Methods Patients diagnosed sepsis of emergency ICU and comprehensive ICU of our hospital, from Oct. 2016 to Jul. 2017 were included in our study. Blood culture and sputum culture were immediately taken at the time of admission, and the pathogenic bacteria were isolated. All patients were divided into Gram-negative bacteria (G-) group and Gram-positive bacteria (G+) group and G-pathogenic bacteria (G+) group according to the pathogen test results. PO2/FiO2 (represented respiratory system function), total bilirubin (represented liver function), creatinine (represented kidney function), mean arterial pressure (represented circulation system function), platelet count (represented coagulation function), and GCS score (represented brain function) were collected at the time of admission, 24 hours, 48 hours, 72 hours, 4 days, 5 days... after admission, until the patient died or out of hospital. Then, calculated maximum SOFA score and mean SOFA score. Results Totally 62 patients were enrolled, including 20 females and 42 males, with an average age of (65.79±14.17) years. There were 28 cases in the G+ group and 34 cases in the G- group. The maximum SOFA score showed a clear correlation with the number of patient′s organ failure (G+ male, correlation coefficient 0.927; G+ female, correlation coefficient 0.847, P<0.05; G- male, correlation coefficient 0.719, P<0.01); the maximum SOFA score was significantly associated with the prognosis of death of patients (G+ correlation coefficient 0.480, G- correlation coefficient 0.621, P<0.01); the maximum SOFA score showed the highest area under the ROC curve. Conclusions Maximum SOFA score was associated with the number of patient′s organ failure and the death outcome of patient. Maximum SOFA score also showed more significance value in evaluating prognosis. Key words: SOFA core; Gram-positive pathogen; Gram-negative pathogen; Clinical outcome

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A potential independent association was recently demonstrated between high red blood cell distribution width (RDW) and the risk of all-cause mortality in patients with cardiovascular disease, although the mechanism remains unclear. However, there have been no reports on the relationship between RDW and mortality in acute kidney injury (AKI) patients treated with continuous renal replacement therapy (CRRT). In this study, we assessed whether RDW was associated with mortality in AKI patients on CRRT treatment in the intensive care unit (ICU). We enrolled 470 patients with AKI who were treated with CRRT at the Yonsei University Medical Center ICU from August 2007 to September 2009 in this study. We performed a retrospective analysis of demographic, biochemical parameters and patient outcomes. Following CRRT treatment, 28-day all-cause mortality was evaluated. At the initiation of CRRT treatment, RDW level was significantly correlated with white blood cell count, hemoglobin (Hb) and total cholesterol. Patients with high RDW levels exhibited significantly higher 28-day mortality rates than patients with low RDW levels (P < 0.01). Baseline RDW level, Sequential Organ Failure Assessment (SOFA) score, low mean arterial pressure (MAP) and low cholesterol levels were independent risk factors for mortality. In multivariate Cox proportional hazard analyses, RDW at CRRT initiation was an independent predictor for 28-day all-cause mortality after adjusting for age, gender, MAP, Hb, albumin, total cholesterol, C-reactive protein and SOFA score. Our study demonstrates that RDW could be an additive predictor for all-cause mortality in AKI patients on CRRT treatment in the ICU.