High red blood cell distribution width and preclinical carotid atherosclerosis

Abstract

Background: Preclinical carotid atherosclerosis is associated with future risk of stroke. Data regarding the correlation between carotid atherosclerosis and biomarkers, which might predict the risk for the disease has been inconsistent and conflicting. Red blood cell distribution width (RDW) is also related to adverse clinical outcomes. Studies examining the relationship between RDW and preclinical and clinical carotid atherosclerosis were non-conclusive.

Objective: To study the association between RDW and preclinical carotid atherosclerosis in a large heterogeneous cohort.

Methods: Patients underwent Doppler ultrasound of the common carotid artery and Carotid Intima Media Thickness (CIMT). Advanced CIMT software analyzed over 100 samples in each exam. Blood samples for RDW were obtained on the same day. Logistic regression was used to evaluate the correlation between RDW and preclinical carotid atherosclerosis.

Results: Five hundred and twenty-two consecutive patients were included, with a mean age of 6.6?±?11. A cut-off value of 14.1% was used to differentiate between high and low RDW groups. The higher RDW group (RDW above 14.1%) was significantly older and with more cardiovascular risk factors. In a multivariate analysis, in all the patients including those treated by lipid modifying therapies, high RDW was significantly associated with advanced CIMT (OR?=?2.35, CI 95% 1.28–4.30, p?=?0.006). This association remained significant in subgroups of non-diabetic patients as well as patients not treated by lipid modifying drugs. RDW was also associated with significant carotid artery stenosis (OR?=?1.77, CI 95% 1.12–2.82, p?=?0.015).

Conclusions: High RDW correlates with increased risk for preclinical and clinical carotid atherosclerosis.     

Genetic markers in alcoholic liver cirrhosis.

11 genetic markers were typed in 157 individuals suffering from alcoholic cirrhosis, and compared with a random sample of healthy individuals. No significant differences were found for transferrin, specific group component, orosomucoid, esterase D, phosphogluconate dehydrogenase and adenylate kinase. Strong associations between alcoholic cirrhosis and alpha-1-antitrypsin PI*Z allele, haptoglobin HP*1 allele and acid phosphatase ACP AC phenotype were observed. The biological significance of these associations and their relationships with the development of alcoholic cirrhosis are also discussed.     

A high red blood cell distribution width predicts failure of arteriovenous fistula

In hemodialysis patients, a native arteriovenous fistula (AVF) is the preferred form of permanent vascular access. Despite recent improvements, vascular access dysfunction remains an important cause of morbidity in these patients. In this prospective observational cohort study, we evaluated potential risk factors for native AVF dysfunction. We included 68 patients with chronic renal disease stage 5 eligible for AVF construction at the Department of General and Vascular Surgery, Central Clinical Hospital Ministry of Internal Affairs, Warsaw, Poland. Patient characteristics and biochemical parameters associated with increased risk for AVF failure were identified using Cox proportional hazards models. Vessel biopsies were analyzed for inflammatory cells and potential associations with biochemical parameters. In multivariable analysis, independent predictors of AVF dysfunction were the number of white blood cells (hazard ratio [HR] 1.67; 95% confidence interval [CI] 1.24 to 2.25; p<0.001), monocyte number (HR 0.02; 95% CI 0.00 to 0.21; p?=?0.001), and red blood cell distribution width (RDW) (HR 1.44; 95% CI 1.17 to 1.78; p<0.001). RDW was the only significant factor in receiver operating characteristic curve analysis (area under the curve 0.644; CI 0.51 to 0.76; p?=?0.046). RDW>16.2% was associated with a significantly reduced AVF patency frequency 24 months after surgery. Immunohistochemical analysis revealed CD45-positive cells in the artery/vein of 39% of patients and CD68-positive cells in 37%. Patients with CD68-positive cells in the vessels had significantly higher white blood cell count. We conclude that RDW, a readily available laboratory value, is a novel prognostic marker for AVF failure. Further studies are warranted to establish the mechanistic link between high RDW and AVF failure.     

Prognostic value of pre-treatment red blood cell distribution width in lung cancer: a meta-analysis

Abstract

Objective: In recent years, increasing studies found that pre-treatment red blood cell distribution width (RDW) could predict clinical outcomes in various cancers. However, the prognostic value of pre-treatment RDW in lung cancer was inconsistent. Therefore, we performed a meta-analysis to determine prognostic value of pre-treatment RDW in lung cancer.

Methods: We performed a search in PubMed, The Cochrane Library, EMBASE (via OVID), Web of Science, CNKI, Wanfang, VIP, SinoMed databases, then we identified all records up to February 15, 2019. Outcomes of interest were overall survival (OS) and disease-free survival (DFS). Hazard ratios (HRs) and corresponding 95% confidence intervals (95% CIs) were calculated to assess the relevance of pre-treatment RDW to OS in lung cancer.

Results: We included ten articles in total. Pooled results revealed that elevated pre-treatment RDW was significantly associated with poor OS (HR?=?1.55, 95% CI: 1.26–1.92, p?<?0.001) and DFS (HR?=?1.53, 95% Cl: 1.15–2.05; p?=?0.004) in lung cancer. Further subgroup analysis manifested that lung cancer patients with elevated pre-treatment RDW had worse prognosis.

Conclusions: A higher value of pre-treatment RDW indicated worse survival of patients with lung cancer. RDW may serve as a reliable and economical marker for prediction of lung cancer prognosis.     

Blood thiamine and thiamine phosphate ester concentrations in alcoholic and non-alcoholic liver diseases.

Thiamine state was investigated in patients with alcoholic liver disease, patients with various non-alcoholic liver diseases, and controls using a direct technique (thiochrome assay) to measure thiamine, thiamine monophospate, and the active coenzyme thiamine pyrophosphate in whole blood after isolating the fractions by ion exchange chromatography. Overall nutrition was similar in all groups as assessed by anthropometry, and no patient had clinical evidence of thiamine deficiency. There was no significant difference among the groups in mean concentration of any form of thiamine. The scatter was much greater in patients with alcoholic liver disease but only 8.7% had biochemical thiamine deficiency (defined as a blood concentration of the active coenzyme greater than 2 SD below the mean control value). An unexpected finding was of abnormally high total thiamine concentrations (greater than 2 SD above the mean control value) in 17.4% of patients with alcoholic liver disease, the highest concentrations being found in two patients with severe alcoholic hepatitis and cirrhosis. The ratio of phosphorylated to unphosphorylated thiamine was calculated as an index of phosphorylation and, although the mean did not differ significantly among the groups, the range was greatest in alcoholic liver disease. The lowest ratios occurred in the two patients with severe alcoholic hepatitis, but neither had evidence of thiamine pyrophosphate deficiency. Contrary to studies using indirect assay techniques, these results suggest that thiamine deficiency is unusual in well nourished patients with alcoholic liver disease. The new finding of unexpectedly high thiamine concentrations in some patients may be due to abnormalities of hepatic storage or release in liver disease, particularly in severe alcoholic hepatitis. There was no convincing evidence of impaired thiamine phosphorylation in any patients with liver disease. Conclusions from studies using indirect assays on the prevalence and mechanisms of thiamine deficiency in liver diseases may not be valid.     

Actinomyces graevenitzii bacteremia in a patient with alcoholic liver cirrhosis

We report the first case of Actinomyces graevenitzii septicemia in a patient with alcoholic liver cirrhosis. It was identified as A.?graevenitzii by morphologic and 16S rRNA sequencing. Even though A.?graevenitzii is rarely associated with human infections, it should be considered as a potential causative agent of bacteremia.     

Increased red cell distribution width is associated with poor stem cell mobilization in patients with advanced chronic heart failure

Abstract

Parameters associated with poor CD34⁺ stem cell mobilization in advanced chronic heart failure (CHF) patients were investigated. Forty-four CHF patients underwent bone marrow stimulation with granulocyte colony stimulating factor. Poor cell mobilization presents in 32% of patients. Poor and good mobilizers did not differ significantly regarding age, gender, left ventricular ejection fraction, kidney or liver function and exercise capacity. Significant differences were found regarding NT-proBNP levels and red cell distribution width (RDW). Increased RDW was the only independent predictor of poor CD34⁺ stem cell mobilization on multivariable analysis and may serve as a biomarker of poor stem cell mobilization in CHF patients.     

Acid phosphatase distribution in the liver in cirrhosis

The distribution of acid phosphatase in liver cirrhosis, as well as in its reverse development, was investigated in mice using histochemistry and electron histochemistry methods. Histochemistry demonstrated a sharp activity increase of acid phosphatase (as compared with the same in the material of partial hepatectomy) in liver cells (especially hepatocytes) during liver cirrhosis regression 10 days after a partial hepatectomy. Electron histochemistry has shown the enzyme withdraw out of hepatocytes and connective tissue cells of fibrotic stratum in the extra-cell medium. The reaction product localized on the neighbouring collagen fibres giving evidence that during reverse development of liver cirrhosis the lisosomal enzyme release from specified cells by means of exocytosis and they are involved in the lysis of collagen.     

Increased proportion of giant platelets and platelet distribution width are better indicators of altered platelet homeostasis than mean platelet volume in liver cirrhosis

Platelet count, mean platelet volume (MPV), giant platelet percentage, expressed by us as megathrombocytic index (MTI) and platelet distribution width (PDW) have been evaluated in 32 control subjects and in 27 patients suffering from liver cirrhosis (LC) and thrombocytopenia. MTI and PDW were linearly and inversely correlated to platelet count both in controls and patients. MTI and PDW were markedly increased in LC as compared to controls, while MPV was not significantly different. It is concluded that MTI and PDW are good indices of thrombopoietic stimulus both in controls and in CL and better indicators of altered platelet homeostasis than MPV in LC.     

Blood calcitonin in alcoholic cirrhosis]

In spite of an important metabolic role of the liver in the synthesis and degradation of hormonal peptides and seco-stero?ds, the clinical occurrence of disturbed regulation of calcium and phosphorus metabolism is rare in hepatic disorders. 23 patients suffering from alcoholic cirrhosis were studied. All had normal plasma calcium and phosphorus concentration as well as immunoreactive parathyroid hormone levels. 25 hydroxyvitamin D3 levels were decreased. Immunoreactive calcitonin were increased in relation to the increase in plasma alkaline phosphatase activity. The causes and consequences of these endocrine disturbances are discussed.     

Malondialdehyde production by erythrocytes from alcoholic and non-alcoholic subjects

A survey of the capacity of erythrocyte suspensions to handle a standard hydrogen peroxide oxidative load was made in a population of white male hospitalized alcoholics and non-hospitalized, non-alcoholic subjects. As measured by malondialdehyde (MDA) production, the capacity to handle this oxidative load was decreased in a significant percentage of individuals with a positive family history of alcoholism and who have experienced problems with alcohol sufficient to produce cytopathological changes and to require hospitalization.     

Association between red blood cell distribution width and long-term mortality among patients undergoing percutaneous coronary intervention with previous history of cancer

Abstract

Background: The number of patients suffering from coronary heart disease with cancer is rising. There is scarce evidence concerning the biomarkers related to prognosis among patients undergoing percutaneous coronary intervention (PCI) with cancer. Thus, the aim of this study was to investigate the association between red blood cell distribution width (RDW) and prognosis in this population.

Methods: A total of 172 patients undergoing PCI with previous history of cancer were enrolled in this retrospective study. The endpoint was long-term all-cause mortality. According to tertiles of RDW, the patients were classified into three groups: Tertile 1 (RDW <12.8%), Tertile 2 (RDW ≥12.8% and <13.5%) and Tertile 3 (RDW ≥13.5%).

Results: During an average follow-up period of 33.3 months, 29 deaths occurred. Compared with Tertile 3, mortality of Tertile 1 and Tertile 2 was significantly lower in the Kaplan–Meier analysis. In multivariate Cox regression analysis, RDW remained an independent risk factor of mortality (HR: 1.938, 95% CI: 1.295–2.655, p?<?0.001). The all-cause mortality in Tertile 3 was significantly higher than that in Tertile 1 (HR: 5.766; 95% CI: 1.426–23.310, p?=?0.014).

Conclusions: An elevated RDW level (≥13.5%) was associated with long-term all-cause mortality among patients undergoing PCI with previous history of cancer.     

肝炎肝硬化和酒精性肝硬化的B超表现比较

目的比较肝炎肝硬化和酒精性肝硬化的B超表现,为临床工作提供参考。方法收集2007年1月1日至2008年12月31日入住温州医学院附属第三医院肝硬化患者的B超资料,回顾性分析比较其B超表现特点。结果酒精性肝硬化患者肝脏肿大的比例高于肝炎肝硬化患者,差异有统计学意义(P0.001),但二者肝脏缩小比例差异无统计学意义。酒精性肝硬化患者肝脏表面光滑的比例较高而呈锯齿状的比例较低,与肝炎肝硬化患者比较差异均有统计学意义(P=0.015和P=0.027)。酒精性肝硬化患者肝内明显可见结节的比例低于肝炎肝硬化患者,二者差异有统计学意义(P=0.009)。门静脉宽度比较2组均数差异无统计学意义(P=0.581)。结论与肝炎肝硬化患者比较,酒精性肝硬化患者肝右叶斜径增大的比例较高,表面较光滑而较少出现锯齿状,发现粗大不规则结节的比例较低,而门静脉内径二者无差异。     

Selected indices of immunoreactivity dependent on HBV infection in patients with alcoholic liver cirrhosis]

The study involved 85 patients with alcohol-produced liver cirrhosis divided into two groups depending on the presence or absence of HBV infection serological markers (HBV+-51; HBV-34). The study was aimed at comparing selected indices of both humoral and cell-mediated reactions in the blood of patients with alcohol-produced liver cirrhosis depending on immuno-serologically confirmed infection with HBV. Statistically significant differences between both groups concerned percentage of OKT4 (HBV+-67.7%; HBV--58.4%), and complement component C4 (0.32 and 0.48 g/L, respectively). Moreover, a significant decrease in percentage of T-cell and significant increase in IgG, IgA, IgM, and immunological complexes levels were noted when comparing with normal values. Results indicate, that the immunopathological reactions resulting from action of the two most frequent, harmful, hepatotropic, factors, i.e. alcohol and HBV, are different.     

Expression and distribution of the prolactin receptor in normal rat liver and in experimental liver cirrhosis.

Recent results have suggested a role for prolactin (PRL) as a regeneration factor in the liver. In order to investigate the involvement of prolactin in the pathogenesis of liver cirrhosis, we studied the expression of the prolactin receptor (PRLR) and PRL during the development of cirrhosis in an animal model. 30 male rats were exposed to CCl4 by inhalation. Phenobarbitone was added to the drinking water to accelerate the formation of toxic metabolites by enzyme induction. Two control groups of 30 animals each were treated with phenobarbitone only or received no treatment. 10 animals of each group were sacrificed 35, 55, and 70 days after initiation of treatment. Liver tissue was subjected to histological examination, which demonstrated fibrosis of different grades and cirrhosis in the CCl4-treated rats. Expression of PRLR mRNA was investigated by mRNA extraction, RT-PCR and computer-supported densitometric evaluation. Compared to control liver, PRLR mRNA was expressed at a higher level in fibrotic and cirrhotic liver specimens. In normal tissue, immunohistochemical staining showed a high concentration of PRLR around the central vein and in the epithelium of the bile ducts. This pattern of distribution was lost in fibrosis and cirrhosis. An accumulation of PRLR was demonstrated within the damaged cells. Neither PRL nor PRL mRNA was detectable in normal, fibrotic, or cirrhotic liver. We conclude that PRLR is distributed in normal rat liver in a typical pattern which is lost with increasing fibrosis. PRL is not produced by rat liver, indicating that PRL does not act through autocrine or paracrine mechanisms.     

Geographic and ethnic distribution of some red cell enzymes

Summary In the literature widely scattered data on the gene frequency of the 4 polymorphic red cell enzyme systems adenosine deaminase (ADA), adenylate kinase (AK), phosphoglucomutase (PGM₁), acid phosphatase (AP) have been compiled. In addition the results of another German sample, taken from the population around Gießen, are given. Certain trends in the distribution are discussed.

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Zusammenfassung Die in der Literatur weit verstreuten Daten über die ethnische und geographische Verteilung der Allele in den 4 polymorphen Erythrocytensystemen Adenosindeaminase (ADA), Adenylatkinase (AK), Phosphoglucomutase (PGM₁), saure Phosphatase (AP) wurden gesammelt. Zusätzlich werden eigene Ergebnisse an einer Stichprobe aus Deutschland (Raum Gießen) mitgeteilt. Erkennbare Besonderheiten der Häufigkeitsverteilung werden diskutiert.

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Director: Prof. Dr. W. Fuhrmann

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Supported by the Alexander von Humboldt-Stiftung.