Implementation of Red Cell Distribution Width and Renal Function Into National Early Warning Scoring System (NEWS) to Develop a More Accurate Risk Stratification Tool for Ward Patients

Background. Hemoglobin/red cell distribution width (HR) and platelet/lymphocyte (PLR) ratios are considered effective prognostic markers in various cancers. We have proposed a new prognostic parameter: HR+PLR. The aim of this study is to explore the prognostic value of the HR+PLR scoring system in patients with gastric cancer liver metastasis. Methods. This study retrospectively analyzed the clinical data of 306 patients with gastric cancer liver metastases admitted to our hospital from 2007 to 2014. According to the size of HR value and PLR value, we will divide the patients into three groups, namely, HR+PLR: (1) 0 points: HR > 1.02 and PLR < 128 ; (2) 1 point: HR > 1.02 and PLR > 128 and HR < 1.02 and PLR < 128 ; and (3) 2 points: HR < 1.02 and PLR > 128 . Results. The HR+PLR score was statistically different from age ( P = 0.049 ), T stage ( P < 0.001 ), N stage ( P = 0.017 ), number of liver metastases ( P = 0.018 ), gastrectomy ( P < 0.001 ), hepatectomy ( P = 0.001 ), peritoneal metastasis ( P = 0.012 ), prognostic nutritional index (PNI) ( P = 0.028 ), and neutrophil/lymphocyte ratio (NLR) ( P = 0.045 ). The HR+PLR scoring system has a higher area under the ROC curve (AUC value) than PNI, PLR, HR, and PLR ( AUC = 0.798 , P < 0.001 ). In multivariate analysis, gastrectomy ( P = 0.001 ), hepatectomy ( P < 0.001 ), chemotherapy ( P = 0.014 ), and HR+PLR score ( P < 0.001 ) were considered independent prognostic factors. Conclusion. For patients with gastric cancer liver metastasis, the HR+PLR score is a simple, reliable, and economic prognostic marker.

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Abstract 10960: Red Cell Distribution Width and Mortality in Cardiorenal Anemia Syndrome

Circulation ◽

10.1161/circ.132.suppl_3.10960 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Yu Lun Cheng

Keyword(s):

Heart Failure ◽

Renal Function ◽

Left Ventricular ◽

Red Cell Distribution Width ◽

Disease Stage ◽

Left Ventricular Ejection ◽

Red Cell ◽

Cell Distribution ◽

Distribution Width ◽

Study Results

Introduction: The interaction between heart failure, renal insufficiency and anemia has been termed as cardiorenal anemia (CRA) syndrome. Red cell distribution width (RDW) hasn’t been clarified of the prognostic impacts in acute heart failure (HF) with cardiorenal anemia syndrome. Hypothesis: RDW remained its prognostic predictive power in patient with cardiorenal anemia syndrome Methods: A total of 978 patients (age 75±14 years, 70% men) hospitalized for AHF were enrolled. National Death Registry was linked for the clinical outcomes of all-cause mortality. We collected data of past medical history, biochemistry profiles, and echocardiographic on admission. Results: Among the study population, 419 (43%) subjects had cardiorenal anemia syndrome. Across the tertiles of RDW distribution, high RDW was associated with lower left ventricular ejection fraction (LVEF) and hemoglobin levels, and higher serum creatinine levels. During a median follow-up duration of 31 months, 472 subjects (43%) died. The post-discharge mortality increased along with the tertiles of RDW(Figure). After accounting for age, gender, co-morbidities, hemoglobin, renal function, and sodium level, RDW remained an independent predictor of mortality (HR and 95% CI for 1% increase of RDW: 1.11; 1.07-1.15). With further adjustment of NT-proBNP, RDW still was an independent prognostic factor. With adjustments for age, sex and hemoglobin in subgroup analysis, RDW was associated with mortality in patients with chronic kidney disease stage I/II (1.09; 1.03-1.15), III (1.12; 1.06-1.19), and IV/V (1.07; 1.00-1.14). Furthermore, in patients with CRA syndrome, RDW was still related to mortality (1.07; 1.02-1.12). Conclusions: Elevated RDW is independently associated with mortality in patients hospitalized for acute HF, despite anemia status, renal function, or CRA syndrome status. Giving RDW an easily accessible marker, the study results may support RDW to improve the risk stratification of acute HF.

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