letter to the editor Wien Klin Wochenschr (2014) 126:553–554 DOI 10.1007/s00508-014-0572-y
Red cell distribution width in pulmonary embolism Sevket Balta · Ibrahim Karademir · Mustafa Demir · Cengiz Ozturk · Turgay Celik · Sait Demirkol
Received: 10 April 2014 / Accepted: 18 June 2014 / Published online: 22 July 2014 © Springer-Verlag Wien 2014
Dear Editor, We have read the article “Is a complete blood cell count useful in determining the prognosis of pulmonary embolism (PE)?” by Sen et al. [1]. They aimed to assess the additional prognostic value of complete blood cell (CBC) count, oxygen saturation (SO2), renal function markers, C-reactive protein (CRP) and simplified pulmonary embolism severity index (sPESI) scoring system in predicting the 100-day mortality of normotensive patients diagnosed with a PE. They concluded that the red cell distribution width (RDW) and sPESI may be useful to predict 100-day mortality in patients with PE. 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. Non-invasive classic markers of inflammation such as leucocyte count, high sensitivity (hs)-CRP, erythrocyte sedimentation rate (ESR), are widely used. A complete blood count is an easy examination technique that gives us information about the patient’s blood contents. Newly formed inflammatory markers as in part of complete blood sample are considered a major risk factor predisposing to cardiovascular morbidity and mortality [2].
S. Balta, MD () Department of Cardiology, Eskis¸ehir Military Hospital, Vis¸nelik Mah., Atatürk Cd., Akarbas¸ı, 26020 Eskis¸ehir, Turkey e-mail: [email protected] I. Karademir, MD Department of Radiology, Eskis¸ehir Military Hospital, Eskis¸ehir, Turkey M. Demir, MD · C. Ozturk, MD · T. Celik, MD · S. Demirkol, MD Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
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RDW is a measure of the variability in size of circulating erythrocytes and is expressed as the coefficient of variation of the erythrocyte volume. As several routine haematology instruments can analyse erythrocyte volume, RDW is available in most clinical settings. Recently, the RDW has been widely used to determination the severity of inflammation in cardiovascular disease, heart failure, stroke, peripheral arterial disease, older age, malignancies, diabetes mellitus, hypertension and inflammatory disease [3]. The RDW is a cost effective, readily available, predictor of systemic inflammation [4]. Because of all of these interactions, aetiology of the relationships between RDW and PE may be inflammation and endothelial dysfunction. RDW may also reflect ethnicity, transfusion history, neurohumoural activation, renal dysfunction, thyroid disease, hepatic dysfunction, nutritional deficiencies (i.e. iron, vitamin B12 and folic acid), bone marrow dysfunction, inflammatory diseases, chronic or acute systemic inflammation [5] and use of some medications. Furthermore, in the present study, to determine the accuracy and respective best cut-off values of RDW for a prognostic cut-off value, the receiver-operating characteristic (ROC) curves were measured. However, the cut-off value of 16.25 % for RDW was associated with a prognostic sensitivity of 79.2 % and a specificity of 55.6 %. This result does not seem to give accurate count of prognostic cut-off value in these patients. So, the present results of the study may be useful, if the future studies increase the number of patients. Finally, because this study is a retrospective design, the authors might not define how much time they spent on measuring RDW levels. So, delaying blood sampling can cause abnormal results in RDW measurements. In conclusion, we strongly believe that those findings obtained from the current study will lead to further studies examining the relationship between RDW and PE. However, one should keep in mind that because RDW
Red cell distribution width in pulmonary embolism
553
letter to the editor
levels may change in many conditions [6], RDW itself alone without other inflammatory indicators may not give exact information to clinicians about the inflammatory status and prognostic indication of the patients. Conflict of Interest There is no conflict of interest.
References 1.
Sen HS, Abakay O, Tanrikulu AC, Sezgi C, Taylan M, Abakay A, et al. Is a complete blood cell count useful in determining the prognosis of pulmonary embolism? Wien Klin Wochenschr. 2014 Jun;126(11–12):347–54. 2. Balta S, Arslan Z, Unlu M, Demirkol S. The association between red cell distribution width and non-small-cell lung cancer. Eur J Cardiothorac Surg. 2014 May;45(5):954.
554 Red cell distribution width in pulmonary embolism
3. Fici F, Celik T, Balta S, Iyisoy A, Unlu M, Demitkol 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 Oct;62(4):388–93. 4. Demirkol S, Balta S, Celik T, Arslan Z, Unlu M, Cakar M, et al. Assessment of the relationship between red cell distribution width and cardiac syndrome X. Kardiol Pol. 2013 Jan;71(5):480–4. 5. 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 Jun;31(6):989–90. 6. Balta S, Aydogan M, Kurt O, Karaman M, Demirkol S, Akgul EO. Red cell distribution width as a novel, simple, inexpensive predictor of mortality in patients with chronic heart failure. Int J Cardiol. 2013 Oct 3;168(3):3049–50.
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Red cell distribution width in pulmonary embolism Sevket Balta · Ibrahim Karademir · Mustafa Demir · Cengiz Ozturk · Turgay Celik · Sait Demirkol
Received: 10 April 2014 / Accepted: 18 June 2014 / Published online: 22 July 2014 © Springer-Verlag Wien 2014
Dear Editor, We have read the article “Is a complete blood cell count useful in determining the prognosis of pulmonary embolism (PE)?” by Sen et al. [1]. They aimed to assess the additional prognostic value of complete blood cell (CBC) count, oxygen saturation (SO2), renal function markers, C-reactive protein (CRP) and simplified pulmonary embolism severity index (sPESI) scoring system in predicting the 100-day mortality of normotensive patients diagnosed with a PE. They concluded that the red cell distribution width (RDW) and sPESI may be useful to predict 100-day mortality in patients with PE. 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. Non-invasive classic markers of inflammation such as leucocyte count, high sensitivity (hs)-CRP, erythrocyte sedimentation rate (ESR), are widely used. A complete blood count is an easy examination technique that gives us information about the patient’s blood contents. Newly formed inflammatory markers as in part of complete blood sample are considered a major risk factor predisposing to cardiovascular morbidity and mortality [2].
S. Balta, MD () Department of Cardiology, Eskis¸ehir Military Hospital, Vis¸nelik Mah., Atatürk Cd., Akarbas¸ı, 26020 Eskis¸ehir, Turkey e-mail: [email protected] I. Karademir, MD Department of Radiology, Eskis¸ehir Military Hospital, Eskis¸ehir, Turkey M. Demir, MD · C. Ozturk, MD · T. Celik, MD · S. Demirkol, MD Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
13
RDW is a measure of the variability in size of circulating erythrocytes and is expressed as the coefficient of variation of the erythrocyte volume. As several routine haematology instruments can analyse erythrocyte volume, RDW is available in most clinical settings. Recently, the RDW has been widely used to determination the severity of inflammation in cardiovascular disease, heart failure, stroke, peripheral arterial disease, older age, malignancies, diabetes mellitus, hypertension and inflammatory disease [3]. The RDW is a cost effective, readily available, predictor of systemic inflammation [4]. Because of all of these interactions, aetiology of the relationships between RDW and PE may be inflammation and endothelial dysfunction. RDW may also reflect ethnicity, transfusion history, neurohumoural activation, renal dysfunction, thyroid disease, hepatic dysfunction, nutritional deficiencies (i.e. iron, vitamin B12 and folic acid), bone marrow dysfunction, inflammatory diseases, chronic or acute systemic inflammation [5] and use of some medications. Furthermore, in the present study, to determine the accuracy and respective best cut-off values of RDW for a prognostic cut-off value, the receiver-operating characteristic (ROC) curves were measured. However, the cut-off value of 16.25 % for RDW was associated with a prognostic sensitivity of 79.2 % and a specificity of 55.6 %. This result does not seem to give accurate count of prognostic cut-off value in these patients. So, the present results of the study may be useful, if the future studies increase the number of patients. Finally, because this study is a retrospective design, the authors might not define how much time they spent on measuring RDW levels. So, delaying blood sampling can cause abnormal results in RDW measurements. In conclusion, we strongly believe that those findings obtained from the current study will lead to further studies examining the relationship between RDW and PE. However, one should keep in mind that because RDW
Red cell distribution width in pulmonary embolism
553
letter to the editor
levels may change in many conditions [6], RDW itself alone without other inflammatory indicators may not give exact information to clinicians about the inflammatory status and prognostic indication of the patients. Conflict of Interest There is no conflict of interest.
References 1.
Sen HS, Abakay O, Tanrikulu AC, Sezgi C, Taylan M, Abakay A, et al. Is a complete blood cell count useful in determining the prognosis of pulmonary embolism? Wien Klin Wochenschr. 2014 Jun;126(11–12):347–54. 2. Balta S, Arslan Z, Unlu M, Demirkol S. The association between red cell distribution width and non-small-cell lung cancer. Eur J Cardiothorac Surg. 2014 May;45(5):954.
554 Red cell distribution width in pulmonary embolism
3. Fici F, Celik T, Balta S, Iyisoy A, Unlu M, Demitkol 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 Oct;62(4):388–93. 4. Demirkol S, Balta S, Celik T, Arslan Z, Unlu M, Cakar M, et al. Assessment of the relationship between red cell distribution width and cardiac syndrome X. Kardiol Pol. 2013 Jan;71(5):480–4. 5. 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 Jun;31(6):989–90. 6. Balta S, Aydogan M, Kurt O, Karaman M, Demirkol S, Akgul EO. Red cell distribution width as a novel, simple, inexpensive predictor of mortality in patients with chronic heart failure. Int J Cardiol. 2013 Oct 3;168(3):3049–50.
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