loadingWJGDOI: 10.3748/wjg.v25.i32.4739
World Journal ofGastroenterologyWorld J Gastroenterol 2019 August 28; 25(32): 4739-4748
ISSN 1007-9327 (print) ISSN 2219-2840 (online)
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ORIGINAL ARTICLE
Retrospective Study
Prognostic value of red blood cell distribution width for severe acutepancreatitis
Fang-Xiao Zhang, Zhi-Liang Li, Zhi-Dan Zhang, Xiao-Chun Ma
ORCID number: Fang-Xiao Zhang
(0000-0003-2188-6501); Zhi-Liang Li(0000-0002-8868-9855); Zhi-DanZhang (0000-0002-3150-1428); Xiao-Chun Ma (0000-0003-0340-584X).
Fang-Xiao Zhang, Zhi-Liang Li, Zhi-Dan Zhang, Xiao-Chun Ma, Department of Critical CareMedicine, First Affiliated Hospital of China Medical University, Shenyang 110001, LiaoningProvince, China
Corresponding author: Zhi-Dan Zhang, Doctor, Department of Critical Care Medicine, FirstAffiliated Hospital of China Medical University, No. 155, Nanjing North Street, HepingDistrict, Shenyang 110001, Liaoning Province, China. 13998318999@163.comTelephone: +86-139-9831-8999
Author contributions: Zhang FX,
Ma XC, and Zhang ZD designedthe research; Zhang FX and Li ZLperformed the research; Li ZL
contributed new reagents/analytictools; Zhang FX, Li ZL, and ZhangZD analyzed the data; Zhang FXand Zhang ZD wrote the paper.
Abstract
BACKGROUND
Severe acute pancreatitis (SAP) is a common condition in the intensive care unit(ICU) and has a high mortality. Early evaluation of the severity and prognosis isvery important for SAP therapy. Recently, red blood cell distribution (RDW) wasassociated with mortality of sepsis patients and could be used as a predictor ofprognosis. Similarly, RDW may be associated with the prognosis of SAP patientsand be used as a prognostic indicator for SAP patients.AIM
To investigate the prognostic value of RDW for SAP patients.
METHODS
We retrospectively enrolled SAP patients admitted to the ICU of the FirstAffiliated Hospital of China Medical University from June 2015 to June 2017.According to the prognosis at 90 d, SAP patients were divided into a survivalgroup and a non-survival group. RDW was extracted from a routine blood test.Demographic parameters and RDW were recorded and compared between thetwo groups. The receiver operator characteristic (ROC) curve was constructedand Cox regression analysis was performed to investigate the prognostic value ofRDW for SAP patients.
RESULTS
In this retrospective cohort study, 42 SAP patients were enrolled, of whom 22survived (survival group) and 20 died (non-survival group). The baseline
parameters were comparable between the two groups. The coefficient of variationof RDW (RDW-CV), standard deviation of RDW (RDW-SD), Acute Physiologyand Chronic Health Evaluation II (APACHE II) score, and Sequential OrganFailure Assessment (SOFA) score were significantly higher in the non-survivalgroup than in the survival group (P < 0.05). The RDW-CV and RDW-SD weresignificantly correlated with the APACHE II score and SOFA score, respectively.
Supported by Health and Birth
Control Committee of LiaoningProvince, China.
Institutional review boardstatement: The study was
reviewed and approved by theMedical Science Ethics Committeeof First Affiliated Hospital of ChinaMedical University.
Informed consent statement: All
study participants, or their legalguardian, provided informedwritten consent prior to studyenrollment.
Conflict-of-interest statement: All
the authors have no conflict ofinterest related to the manuscript.
Open-Access: This is an open-access article that was selected byan in-house editor and fully peer-reviewed by external reviewers. Itis distributed in accordance withthe Creative Commons AttributionNon Commercial (CC BY-NC 4.0)license, which permits others todistribute, remix, adapt, build
upon this work non-commercially,and license their derivative workson different terms, provided the
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August 28, 2019Volume 25Issue 32
Zhang FX et al. Prognostic value of RDW for SAPoriginal work is properly cited andthe use is non-commercial. See:http://creativecommons.org/licenses/by-nc/4.0/
Manuscript source: Unsolicited
manuscript
Received: April 28, 2019
Peer-review started: April 28, 2019First decision: May 30, 2019Revised: July 2, 2019Accepted: July 19, 2019
Article in press: July 19, 2019
Published online: August 28, 2019P-Reviewer: Chen YW,
Goldaracena N, Snowdon VKS-Editor: Yan JPL-Editor: Wang TQE-Editor: Zhang YL
The areas under the ROC curves (AUCs) of RDW-CV and RDW-SD were allgreater than those of the APACHE II score and SOFA score, among which, theAUC of RDW-SD was the greatest. The results demonstrated that RDW hadbetter prognostic value for predicting the mortality of SAP patients. When theRDW-SD was greater than 45.5, the sensitivity for predicting prognosis was
77.8% and the specificity was 70.8%. Both RDW-CV and RDW-SD could be usedas independent risk factors to predict the mortality of SAP patients in
multivariate logistic regression analysis and univariate Cox proportional hazardsregression analysis, similar to the APACHE II and SOFA scores.
CONCLUSION
The RDW is greater in the non-surviving SAP patients than in the survivingpatients. RDW is significantly correlated with the APACHE II and SOFA scores.RDW has better prognostic value for SAP patients than the APACHE II andSOFA scores and could easily be used by clinicians for the treatment of SAPpatients.
Key words: Red blood cell distribution width; Severe acute pancreatitis; Prognosis; AcutePhysiology and Chronic Health Evaluation II score; Sequential Organ Failure Assessmentscore
?The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.Core tip: Our study aimed to investigate the prognostic value of red blood cell
distribution (RDW) for severe acute pancreatitis (SAP) patients. We retrospectivelyenrolled 42 SAP patients admitted to the intensive care unit in two years. The resultssuggested that RDW is greater in the non-surviving SAP patients than in the survivingpatients. RDW is significantly correlated with the Acute Physiology and Chronic HealthEvaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores.RDW has better prognostic value for SAP patients than the APACHE II and SOFAscores and could easily be used by clinicians for the treatment of SAP patients.
Citation: Zhang FX, Li ZL, Zhang ZD, Ma XC. Prognostic value of red blood cell distributionwidth for severe acute pancreatitis. World J Gastroenterol 2019; 25(32): 4739-4748URL: https://www.wjgnet.com/1007-9327/full/v25/i32/4739.htmDOI: https://dx.doi.org/10.3748/wjg.v25.i32.4739
INTRODUCTION
Acute pancreatitis (AP) is an inflammatory process of the pancreas that often leads tolocal and systemic complications[1]. It is also the most common pancreatic diseaseworldwide[2]. According to the 2012 revised Atlanta classification for AP, severe AP(SAP) has been redefined as AP with persistent organ failure (organ failure lasting formore than 48 hours), whose mortality rate is between 20%-50%[3,4]. There are twophases during AP; systemic inflammatory response syndrome and the resultant organfailure dominate the early phase. There are currently no effective drugs available totreat AP, and thus most care is supportive[1]. Thus, rapid assessment of diseaseseverity and the evaluation of prognosis are pivotal to determine therapeuticstrategies as effective treatment could significantly decrease mortality in patients withSAP[5].
The red blood cell distribution width (RDW) is a part of the routine complete bloodcount and can easily be obtained by clinicians. RDW is a means of evaluating thevariability in the size of erythrocytes and has been used widely in the differentialdiagnosis of anemia[6]. Recently, RDW was shown to be associated with inflammatoryreactions and has been used as a prognostic biomarker in hypertension[7], coronarydisease[8,9], stroke[10], pulmonary hypertension[11], and acute kidney injury[12]. RDW wasfurther demonstrated to be an independent predictor of in-hospital mortality inelderly patients with sepsis[13]. For patients with AP, RDW was shown to be positivelyassociated with AP severity, and is likely a useful predictive parameter for APseverity[14]. However, it is not yet clear whether RDW is associated with the prognosisof SAP patients or whether it can be used as a prognostic indicator for SAP patients.
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Zhang FX et al. Prognostic value of RDW for SAP
The main aim of our study was to examine the difference in RDW between thesurviving and non-surviving SAP patients and to evaluate the prognostic value ofRDW for SAP patients.
MATERIALS AND METHODS
Patients
This retrospective cohort study enrolled 42 patients diagnosed with SAP who wereadmitted to the intensive care unit (ICU) of the First Affiliated Hospital of ChinaMedical University from June 2015 to June 2017. Patients were diagnosed as havingAP by meeting two out of the following three criteria: (1) Typical clinical symptomswith consistent abdominal pain; (2) Serum amylase and/or lipase greater than 3 timesthe upper limit of normal; (3) Characteristic findings from abdominalultrasonography and/or computed tomography. Based on the 2012 revised Atlantaclassification criteria, SAP was defined as AP with persistent single or multiple organfailure which lasted at least 48 hours, or a Marshall score greater than 2[3].
The exclusion criteria included any of the following: (1) The time from abdominalpain onset to hospital admission ≥ 72 h; (2) Age younger than 18 years; (3) Pancreatitisinduced by trauma; (4) Chronic pancreatitis; (5) Unavailable laboratory measurementsor medical records; (6) Patients with anemia; (7) Advanced malignant tumors ormalignant tumors with chemotherapy and radiotherapy; (8) Pregnancy; and (9)Expected stay in ICU shorter than 24 h. The study was conducted according to theprinciples of the Declaration of Helsinki. Informed consent from individual patientswas not obtained since all data were retrieved retrospectively from the laboratory testinformation system without additional blood samples or laboratory analysis.
Records and assays
Laboratory data were obtained from the blood screening test at ICU admission,including RDW, C reactive protein (CRP), white blood cells, serum albumin, serumcalcium, platelet distribution width (PDW), and neutrophil to lymphocyte ratio(NLR). RDW was implied as RDW-CV (coefficient of variation of RDW) and RDW-SD(standard deviation of RDW), respectively, both of which are indicators ofinhomogeneity of red blood cells. The electronic medical records and paper charts ofall enrolled SAP patients were reviewed for information on demographics,physiologic variables, and disease severity, including the Acute Physiology andChronic Health Evaluation II (APACHE II) score, Sequential Organ FailureAssessment (SOFA) score, and length of stay in the ICU (LOS-ICU). The prognosis at90 d of all enrolled SAP patients was recorded. According to the prognosis at 90 d, thepatients were divided into a survival group and a non-survival group. The RDWvalue was compared between the two groups. We used receiver operatorcharacteristic (ROC) curves and Cox regression analysis to verify the prognostic valueof RDW for SAP patients.
Statistical analysis
Continuous variables are presented as the mean and standard derivation. Categoricaldata are reported as number (frequency). Student’s t-test and Mann-Whitney U testwere used to evaluate the difference in baseline characteristics between the twogroups. Multiple group comparisons were performed using the Chi-square test forcategorical variables and the Kruskal-Wallis test for continuous data. ROC curveswere constructed to evaluate the prognostic value of different parameters inpredicting prognosis. Multivariate logistic regression analysis and univariate Coxproportional hazards regression analysis were used to evaluate the risk factors forpredicting mortality in SAP patients. Hazard ratios and 95% confidence intervals arepresented. A P-value < 0.05 was considered statistically significant. Statistical analyseswere performed using SPSS version 24.0 software package (SPSS Inc, Chicago IL,United States).
RESULTS
Clinical characteristics of the study population
Forty-two SAP patients were enrolled in this retrospective cohort study. The clinicalcharacteristics of these patients are summarized in Table 1. According to theprognosis at 90 d, the patients were divided into a survival group (n = 22) and a non-survival group (n = 20). There was no difference in gender, age, or BMI between thetwo groups, suggesting baseline comparability (Table 2). There was also no difference
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