Relation Between Red Blood Cell Distribution Width and Inflammatory Biomarkers in a Large Cohort of Unselected Outpatients by ProQuest


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									     Relation Between Red Blood Cell Distribution Width
      and Inflammatory Biomarkers in a Large Cohort of
                   Unselected Outpatients
  Giuseppe Lippi, MD; Giovanni Targher, MD; Martina Montagnana, MD; Gian Luca Salvagno, MD; Giacomo Zoppini, MD;
                                               Gian Cesare Guidi, MD

● Context.—A strong independent association has been re-               RDW quartiles, there were strong, graded increases of ESR
cently observed between elevated red blood cell distribu-              and hsCRP (P .001), both parameters being up to 3-fold
tion width (RDW) and increased incidence of cardiovas-                 higher in the fourth versus the first quartile. Accordingly,
cular events.                                                          the percentages of those with hsCRP greater than 3 mg/L
   Objective.—To assess whether RDW is associated with                 (from 28% to 63%; P        .001) and ESR greater than 40
plasma markers of inflammation since the mechanism(s)                   mm/h (from 8% to 40%; P           .001) increased steadily
underlying this association remain unknown.                            across RDW quartiles. In multivariable regression analysis,
   Design.—We retrospectively analyzed results of RDW,                 ESR and hsCRP predicted RDW independently of age, sex,
hemoglobin, mean corpuscular volume, ferritin, high-sen-               mean corpuscular volume, hemoglobin, and ferritin.
sitivity C-reactive protein (hsCRP), and erythrocyte sedi-                Conclusions.—To our knowledge, our study demon-
mentation rate (ESR) in a large cohort of unselected adult             strates for the first time a strong, graded association of
outpatients who were consecutively referred by general                 RDW with hsCRP and ESR independent of numerous con-
practitioners for routine medical check-up.                            founding factors. If confirmed in future follow-up studies,
   Results.—Cumulative results of RDW and other factors                this association might provide a rationale to introduce the
were retrieved from the database of our laboratory infor-              easy, inexpensive RDW in algorithms for cardiovascular
mation system for 3845 adult outpatients during a 3-year               risk prediction.
period. When participants were grouped according to                       (Arch Pathol Lab Med. 2009;133:628–632)

R   ecent investigations of atherosclerosis have focused on
     inflammation, providing new insight into mecha-
nisms of disease.1 In particular, current views regard ath-
                                                                       ma has been recently revisited, with observations from
                                                                       our group and several others suggesting that CRP plays a
                                                                       key role in promoting atherosclerotic processes and en-
erosclerosis as a dynamic and progressive disease arising              dothelial cell activation and inflammation.4
from the combination of endothelial dysfunction and in-                   Circulating blood cells, including red blood cells
flammation.2 Accumulating evidence suggests that circu-                 (RBCs), white blood cells, and platelets, are counted and
lating high-sensitivity C-reactive protein (hsCRP) repre-              sized electronically by modern instruments. The electronic
sents one of the strongest predictors of cardiovascular                counters not only register the total cell count but also es-
morbidity and mortality in a number of settings. Indeed,               timate the average cell volume and the variation in cell
hsCRP is currently the best validated inflammatory bio-                 size. In the context of RBCs, for example, these measure-
marker, since it appears to be a stronger predictor than               ments are referred to as the mean corpuscular volume
total cholesterol, and it adds prognostic value to the Fra-            (MCV) and the RBC distribution width (RDW), respec-
mingham risk score assessment.1,3 The link between hsCRP               tively.5 Red blood cell distribution width is an automati-
and atherosclerosis was initially suggested to be that of a            cally measured index of the heterogeneity of the eryth-
biomarker versus a mediator of atherosclerosis. This dog-              rocytes that is calculated by dividing the standard devia-
                                                                       tion (SD) of RBC volume by MCV and multiplying by 100
                                                                       to express the result as a percentage.6 A high RDW is gen-
   Accepted for publication July 29, 2008.                             erally set at greater than 14%, which corresponds to the
   From the Sezione di Chimica Clinica, Dipartimento di Scienze Mor-   95th percentile of RDW for the reference population in the
fologico-Biomediche (Drs Lippi, Montagnana, Salvagno, and Guidi),
and the Sezione di Endocrinologia e Malattie del Metabolismo, Dipar-   National Health and Nutrition Examination Survey III
timento di Scienze Biomediche e Chirurgiche (Drs Targher and Zop-      study.6 Elevated RDW indicates a greater difference in size
pini), Universita degli Studi di Verona, Verona, Italy.
                `                                                      among RBCs, and when accompanied by a low MCV is
   The authors have no relevant financial interest in the products or   indicative of iron deficiency, where
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