Red cell distribution width may not have a prognostic value in patients with stable coronary artery disease
Yasemin GULCAN KURT, University
30 May 2014
Yasemin Gulcan Kurt1, Tuncer Cayci1, Ibrahim Aydin2,
Mehmet Agilli3, Fevzi Nuri Aydin4
1Department of Biochemistry, Gulhane Military Medical Academy, Ankara, Turkey.
2Department of Biochemistry, Sarikamis Military Hospital, Sarikamis, Kars, Turkey.
3Department of Biochemistry, Agri Military Hospital, Agri, Turkey.
4Department of Biochemistry, Sirnak Military Hospital, Sirnak, Turkey.
In a recent issue of BMC Cardiovascular Disorders, we read with great interest the published article by Osadnik et al. entitled with “Red cell distribution width is associated with long-term prognosis in patients with stable coronary artery disease” [1]. They have analyzed 2550 consecutive patients with stable coronary artery disease who underwent percutaneous coronary intervention (PCI) between 2007 and 2011 at the Silesian Center for Heart Diseases. They have shown that patients with the highest the red cell distribution width (RDW) values are older and more often burdened with diabetes, heart failure and chronic kidney disease. They concluded that there was an almost 4-fold increase in mortality during an average of 2.5 years of follow-up between the group of patients with RDW values lower than 13.1% and the group with RDW values higher than 14.1%. After adjusting for the covariates, RDW remained significantly associated with mortality in the whole cohort and in the subgroups stratified by gender, age, and presence of anemia, diabetes, heart failure and chronic kidney disease. Higher RDW values correspond to higher comorbidity burdens and higher mortality. RDW level is also an independent predictor of mortality in patients with stable coronary artery disease. However, we think that some points should be discussed.
RDW represents the variability in the red blood cell volume distribution and can be considered an index of heterogeneity in size of circulating erythrocytes [2]. Authors have excluded patients on dialysis, those with advanced valve disease, a history of cancer or other diseases potentially limiting survival, a history of cancer or other diseases potentially limiting survival. However, the RDW levels may also reflect neurohumoral activation, thyroid disease, nutritional deficiencies of folate, vitamin B12, and iron, bone marrow dysfunction, chronic or acute systemic inflammation [3] and some medications [4,5]. Patients have these situations are mostly excluded from the studies showing the prognostic value of the RDW [2,3].
In conclusion, the authors investigated the link between mortality and RDW in patients with stable coronary artery disease undergoing PCI [1]. However, authors only measured RBC and WBC counts, hemoglobin, hematocrit, mean corpuscular volume (MCV), and RDW levels. They did not measure other factors including iron, vitamin B12, folate, thyroid function tests, and inflammatory markers. In this study, because of all these causes, higher RDW levels could not correspond to higher comorbidity burdens and higher mortality in patients with stable coronary artery disease. However, RDW level is not an independent predictor of mortality in those patients. This could provide the readers of the journal clearer information for the prognostic value of the RDW in patients with stable coronary artery disease.
References
Osadnik T, Strzelczyk J, Hawranek M, Lekston A, Wasilewski J, Kurek A, Gutowski AR, Wilczek K, Dyrbuś K, Gierlotka M, Wiczkowski A, Gąsior M, Szafranek A, Poloński L. Red cell distribution width is associated with long-term prognosis in patients with stable coronary artery disease. BMC Cardiovasc Disord. 2013 Dec 10;13:113.
Yaman H, Celik T, Akgul EO, Cayci T, Kurt Y. Red cell distribution width and acute coronary syndromes. Int J Cardiol 2010; 145(2): 353.
Aydin I, Aydin FN, Agilli M. The association of red cell distribution width and morbid obesity. Clin Biochem. 2014 Apr 17. pii: S0009-9120(14)00180-5. doi:10.1016/j.clinbiochem.2014.04.011. [Epub ahead of print].
Balta S, Demirkol S, Arslan Z, Unlu M, Celik T. Inflammatory status as a major role of risk factor for atrial fibrillation. J Thromb Thrombolysis 2013 Jul 25. [Epub ahead of print].
Aydin I, Aydin F, Agilli M. The association between red cell distribution width and venous thromboembolism: A biochemical evaluation. Thromb Res. 2014 Apr 1. pii: S0049-3848(14)00179-0. doi: 10.1016/j.thromres.2014.03.049. [Epub ahead of print].
Red cell distribution width may not have a prognostic value in patients with stable coronary artery disease
30 May 2014
Yasemin Gulcan Kurt1, Tuncer Cayci1, Ibrahim Aydin2,
Mehmet Agilli3, Fevzi Nuri Aydin4
1Department of Biochemistry, Gulhane Military Medical Academy, Ankara, Turkey.
2Department of Biochemistry, Sarikamis Military Hospital, Sarikamis, Kars, Turkey.
3Department of Biochemistry, Agri Military Hospital, Agri, Turkey.
4Department of Biochemistry, Sirnak Military Hospital, Sirnak, Turkey.
In a recent issue of BMC Cardiovascular Disorders, we read with great interest the published article by Osadnik et al. entitled with “Red cell distribution width is associated with long-term prognosis in patients with stable coronary artery disease” [1]. They have analyzed 2550 consecutive patients with stable coronary artery disease who underwent percutaneous coronary intervention (PCI) between 2007 and 2011 at the Silesian Center for Heart Diseases. They have shown that patients with the highest the red cell distribution width (RDW) values are older and more often burdened with diabetes, heart failure and chronic kidney disease. They concluded that there was an almost 4-fold increase in mortality during an average of 2.5 years of follow-up between the group of patients with RDW values lower than 13.1% and the group with RDW values higher than 14.1%. After adjusting for the covariates, RDW remained significantly associated with mortality in the whole cohort and in the subgroups stratified by gender, age, and presence of anemia, diabetes, heart failure and chronic kidney disease. Higher RDW values correspond to higher comorbidity burdens and higher mortality. RDW level is also an independent predictor of mortality in patients with stable coronary artery disease. However, we think that some points should be discussed.
RDW represents the variability in the red blood cell volume distribution and can be considered an index of heterogeneity in size of circulating erythrocytes [2]. Authors have excluded patients on dialysis, those with advanced valve disease, a history of cancer or other diseases potentially limiting survival, a history of cancer or other diseases potentially limiting survival. However, the RDW levels may also reflect neurohumoral activation, thyroid disease, nutritional deficiencies of folate, vitamin B12, and iron, bone marrow dysfunction, chronic or acute systemic inflammation [3] and some medications [4,5]. Patients have these situations are mostly excluded from the studies showing the prognostic value of the RDW [2,3].
In conclusion, the authors investigated the link between mortality and RDW in patients with stable coronary artery disease undergoing PCI [1]. However, authors only measured RBC and WBC counts, hemoglobin, hematocrit, mean corpuscular volume (MCV), and RDW levels. They did not measure other factors including iron, vitamin B12, folate, thyroid function tests, and inflammatory markers. In this study, because of all these causes, higher RDW levels could not correspond to higher comorbidity burdens and higher mortality in patients with stable coronary artery disease. However, RDW level is not an independent predictor of mortality in those patients. This could provide the readers of the journal clearer information for the prognostic value of the RDW in patients with stable coronary artery disease.
References
Osadnik T, Strzelczyk J, Hawranek M, Lekston A, Wasilewski J, Kurek A, Gutowski AR, Wilczek K, Dyrbuś K, Gierlotka M, Wiczkowski A, Gąsior M, Szafranek A, Poloński L. Red cell distribution width is associated with long-term prognosis in patients with stable coronary artery disease. BMC Cardiovasc Disord. 2013 Dec 10;13:113.
Yaman H, Celik T, Akgul EO, Cayci T, Kurt Y. Red cell distribution width and acute coronary syndromes. Int J Cardiol 2010; 145(2): 353.
Aydin I, Aydin FN, Agilli M. The association of red cell distribution width and morbid obesity. Clin Biochem. 2014 Apr 17. pii: S0009-9120(14)00180-5. doi:10.1016/j.clinbiochem.2014.04.011. [Epub ahead of print].
Balta S, Demirkol S, Arslan Z, Unlu M, Celik T. Inflammatory status as a major role of risk factor for atrial fibrillation. J Thromb Thrombolysis 2013 Jul 25. [Epub ahead of print].
Aydin I, Aydin F, Agilli M. The association between red cell distribution width and venous thromboembolism: A biochemical evaluation. Thromb Res. 2014 Apr 1. pii: S0049-3848(14)00179-0. doi: 10.1016/j.thromres.2014.03.049. [Epub ahead of print].
Competing interests
None declared