563639 research-article2014
PRF0010.1177/0267659114563639PerfusionBalta et al.
Letter to the Editor
Red cell distribution width in acute mesenteric ischemia
Perfusion 1–2 © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0267659114563639 prf.sagepub.com
S Balta,1 M Aparci,2 C Ozturk,3 S Demirkol3 and A Iyisoy3
Sir, We have read the article “Prognostic significance of red cell distribution width (RDW) in acute mesenteric ischemia (AMI)” by Bilgic et al.1 They aimed to investigate the association between RDW and mortality in patients with AMI. They concluded that increased RDW at admission was a predictor of the extent of necrosis and mortality in AMI patients. Further prospective studies are necessary to more accurately assess the importance of RDW in these patients. This study gives important information on this clinically relevant condition. The ready availability of this parameter at no additional cost may encourage its wider use in clinical practice in the future. Thanks to the authors for their contribution. New inflammatory markers are considered to predict the cardiovascular morbidity and mortality. RDW is a measure of the variability in the size of circulating red blood cells and is a part of the complete blood count panel. Recently, a number of studies have reported that elevated RDW levels are associated with poor prognosis in the setting of coronary artery disease, heart failure, stroke, peripheral arterial disease and older age.2 It is commonly used as a method for the differential diagnosis of anemia and could be elevated in any conditions where reticulocytes are released into the circulation. RDW values are strongly related to signs of ineffective erythropoiesis, inflammation, renal dysfunction and nutritional deficiencies (i.e. iron, vitamin B12 and folic acid). However, RDW may also reflect ethnicity, neurohumoral activation, thyroid disease, bone marrow dysfunction, inflammatory diseases, chronic or acute systemic inflammation3 and the use of some medications.4 RDW is also independently associated with mortality in both the general population and in certain diseases. Liver damage and excessive alcohol intake may lead to macrocytosis and increased RDW. On the other hand, the RDW value was higher in chronic obstructive
pulmonary disease patients compared with those of the control group.5 Therefore, if the authors gave information about hepatic function tests and respiratory condition, the results of the present study may be different and stronger. The level of RDW is instrument dependent, forcing each laboratory to establish its own reference values. Finally, it would be better if the authors define how much time they specified on measuring RDW levels, because delaying blood sampling can cause abnormal results in RDW measurements.6 Additionally, not only RDW, but also mean platelet volume, neutrophil lymphocyte ratio,7 c-reactive protein (CRP) and uric acid are easy methods to evaluate the mortality in patients with AMI.8 These markers might be useful in clinical practice.9 In conclusion, we strongly believe that those findings obtained from the current study will lead to further studies evaluating the relationship between RDW and AMI. However, one should keep in mind that RDW alone without other inflammatory indicators may not provide information to clinicians about the inflammatory status and prognostic indication of the patients. So, from that point of view, we think that it should be evaluated accompanied by other serum inflammatory markers.
1Department
of Cardiology, Eskişehir Military Hospital, Eskişehir/ Turkey 2Department of Cardiology, Etimesgut Military Hospital, Ankara/ Turkey 3Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey Corresponding author: Dr Sevket Balta Department of Cardiology Eskişehir Military Hospital Vişnelik Mah. Atatürk Cd. 26020 Akarbaşı/ Eskişehir Turkey. Email: [email protected]
Downloaded from prf.sagepub.com at Selcuk Universitesi on February 7, 2015
2
Perfusion
Declaration of conflicting interest There is no conflict of interests
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
References 1. Bilgiç I, Dolu F, Senol K, Tez M. Prognostic significance of red cell distribution width in acute mesenteric ischemia. Perfusion 2014 May 13; pii: 0267659114534289. [Epub ahead of print] 2. Balta S, Demirkol S, Aydogan M, Unlu M. Red cell distribution width is a predictor of mortality in patients undergoing coronary artery bypass surgery. Eur J Cardiothorac Surg 2013; 44: 396–397. 3. Balta S, Demirkol S, Hatipoglu M, Ardic S, Arslan Z, Celik T. Red cell distribution width is a predictor of mortality in patients with severe sepsis and septic shock. Am J Emerg Med 2013 ; 31: 989–990.
4. Fici F, Celik T, Balta S, et al. Comparative effects of nebivolol and metoprolol on red cell distribution width and neutrophil/lymphocyte ratio in patients with newly diagnosed essential hypertension. J Cardiovasc Pharmacol 2013; 62: 388–393. 5. Balta S, Aydogan M, Demirkol S, Cakar M, Akgul EO, Sarlak H. Red cell distribution width: a novel and simple predictor of mortality in chronic obstructive pulmonary disease. COPD 2014; 11: 475–476. 6. Demirkol S, Balta S, Cakar M, Unlu M, Arslan Z, Kucuk U. Red cell distribution width: a novel inflammatory marker in clinical practice. Cardiol J 2013; 20: 209. 7. Balta S, Demirkol S, Kucuk U, Celik T, Ozturk C, Iyisoy A. The relationship between neutrophil-lymphocyte ratio and coronary collateral circulation. Perfusion 2014; 29: 367–368. 8. Demirkol S, Balta S, Unlu M, et al. Evaluation of the mean platelet volume in patients with cardiac syndrome X. Clinics (Sao Paulo) 2012; 67: 1019–1022. 9. Demirkol S, Balta S, Unlu M, et al. Neutrophils/lymphocytes ratio in patients with cardiac syndrome X and its association with carotid intima-media thickness. Clin Appl Thromb Hemost 2014; 20: 250–255.
Downloaded from prf.sagepub.com at Selcuk Universitesi on February 7, 2015
PRF0010.1177/0267659114563639PerfusionBalta et al.
Letter to the Editor
Red cell distribution width in acute mesenteric ischemia
Perfusion 1–2 © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0267659114563639 prf.sagepub.com
S Balta,1 M Aparci,2 C Ozturk,3 S Demirkol3 and A Iyisoy3
Sir, We have read the article “Prognostic significance of red cell distribution width (RDW) in acute mesenteric ischemia (AMI)” by Bilgic et al.1 They aimed to investigate the association between RDW and mortality in patients with AMI. They concluded that increased RDW at admission was a predictor of the extent of necrosis and mortality in AMI patients. Further prospective studies are necessary to more accurately assess the importance of RDW in these patients. This study gives important information on this clinically relevant condition. The ready availability of this parameter at no additional cost may encourage its wider use in clinical practice in the future. Thanks to the authors for their contribution. New inflammatory markers are considered to predict the cardiovascular morbidity and mortality. RDW is a measure of the variability in the size of circulating red blood cells and is a part of the complete blood count panel. Recently, a number of studies have reported that elevated RDW levels are associated with poor prognosis in the setting of coronary artery disease, heart failure, stroke, peripheral arterial disease and older age.2 It is commonly used as a method for the differential diagnosis of anemia and could be elevated in any conditions where reticulocytes are released into the circulation. RDW values are strongly related to signs of ineffective erythropoiesis, inflammation, renal dysfunction and nutritional deficiencies (i.e. iron, vitamin B12 and folic acid). However, RDW may also reflect ethnicity, neurohumoral activation, thyroid disease, bone marrow dysfunction, inflammatory diseases, chronic or acute systemic inflammation3 and the use of some medications.4 RDW is also independently associated with mortality in both the general population and in certain diseases. Liver damage and excessive alcohol intake may lead to macrocytosis and increased RDW. On the other hand, the RDW value was higher in chronic obstructive
pulmonary disease patients compared with those of the control group.5 Therefore, if the authors gave information about hepatic function tests and respiratory condition, the results of the present study may be different and stronger. The level of RDW is instrument dependent, forcing each laboratory to establish its own reference values. Finally, it would be better if the authors define how much time they specified on measuring RDW levels, because delaying blood sampling can cause abnormal results in RDW measurements.6 Additionally, not only RDW, but also mean platelet volume, neutrophil lymphocyte ratio,7 c-reactive protein (CRP) and uric acid are easy methods to evaluate the mortality in patients with AMI.8 These markers might be useful in clinical practice.9 In conclusion, we strongly believe that those findings obtained from the current study will lead to further studies evaluating the relationship between RDW and AMI. However, one should keep in mind that RDW alone without other inflammatory indicators may not provide information to clinicians about the inflammatory status and prognostic indication of the patients. So, from that point of view, we think that it should be evaluated accompanied by other serum inflammatory markers.
1Department
of Cardiology, Eskişehir Military Hospital, Eskişehir/ Turkey 2Department of Cardiology, Etimesgut Military Hospital, Ankara/ Turkey 3Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey Corresponding author: Dr Sevket Balta Department of Cardiology Eskişehir Military Hospital Vişnelik Mah. Atatürk Cd. 26020 Akarbaşı/ Eskişehir Turkey. Email: [email protected]
Downloaded from prf.sagepub.com at Selcuk Universitesi on February 7, 2015
2
Perfusion
Declaration of conflicting interest There is no conflict of interests
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
References 1. Bilgiç I, Dolu F, Senol K, Tez M. Prognostic significance of red cell distribution width in acute mesenteric ischemia. Perfusion 2014 May 13; pii: 0267659114534289. [Epub ahead of print] 2. Balta S, Demirkol S, Aydogan M, Unlu M. Red cell distribution width is a predictor of mortality in patients undergoing coronary artery bypass surgery. Eur J Cardiothorac Surg 2013; 44: 396–397. 3. Balta S, Demirkol S, Hatipoglu M, Ardic S, Arslan Z, Celik T. Red cell distribution width is a predictor of mortality in patients with severe sepsis and septic shock. Am J Emerg Med 2013 ; 31: 989–990.
4. Fici F, Celik T, Balta S, et al. Comparative effects of nebivolol and metoprolol on red cell distribution width and neutrophil/lymphocyte ratio in patients with newly diagnosed essential hypertension. J Cardiovasc Pharmacol 2013; 62: 388–393. 5. Balta S, Aydogan M, Demirkol S, Cakar M, Akgul EO, Sarlak H. Red cell distribution width: a novel and simple predictor of mortality in chronic obstructive pulmonary disease. COPD 2014; 11: 475–476. 6. Demirkol S, Balta S, Cakar M, Unlu M, Arslan Z, Kucuk U. Red cell distribution width: a novel inflammatory marker in clinical practice. Cardiol J 2013; 20: 209. 7. Balta S, Demirkol S, Kucuk U, Celik T, Ozturk C, Iyisoy A. The relationship between neutrophil-lymphocyte ratio and coronary collateral circulation. Perfusion 2014; 29: 367–368. 8. Demirkol S, Balta S, Unlu M, et al. Evaluation of the mean platelet volume in patients with cardiac syndrome X. Clinics (Sao Paulo) 2012; 67: 1019–1022. 9. Demirkol S, Balta S, Unlu M, et al. Neutrophils/lymphocytes ratio in patients with cardiac syndrome X and its association with carotid intima-media thickness. Clin Appl Thromb Hemost 2014; 20: 250–255.
Downloaded from prf.sagepub.com at Selcuk Universitesi on February 7, 2015
