Vol 9, No 3 (2020)
Research paper
Published online: 2020-05-27

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Correlation of red cell distribution width with inflammatory markers and its prognostic value in patients with diabetes and coronary artery disease

Afrasyab Altaf1, Miqdad Ali Khan1, Aftab Alam1, Momin Khan1, Mazhar Mahmood1, Hammad Shah1, Naveed Danish1, Momin Salahuddin1
Clin Diabetol 2020;9(3):174-178.


Background. Recent studies have shown red blood cell distribution width (RDW) as a marker for severity and prognosis in coronary artery disease patients. Other studies have also correlated RDW with diabetes mellitus and inflammation. However, such correlation and prognosis in patients with concomitant coronary artery disease and diabetes after percutaneous intervention remains unclear.

Material and methods. Our study group comprised of 730 subjects including 700 patients (cases) and 30 normal subjects (control group). Patients who presented with coronary artery disease were divided into diabetic and non-diabetic groups. All patients had RDW measured at admission and percutaneous intervention was done. Follow-up for adverse events was carried out between 6 to 12 months.

Results. RDW was elevated in patients as compared to control group (p < 0.05). RDW correlated well with inflammatory markers including erythrocyte sedimen­tation rate, C-reactive protein, HbA1c, white blood cells and troponin. RDW was higher with more severe atherosclerosis based on SYNTAX and Gensini scores (p < 0.05). Prognosis was found to be worse in patients with high RDW as well as in diabetics.

Conclusions. RDW has positive correlation with other inflammatory marker. It may be used as a marker in determining the severity and prognosis in diabetic patients with coronary artery disease.

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  1. 2017 ESC Guidelines for the Management of Acute Myocardial Infarction in Patients Presenting With ST-Segment Elevation: The Task Force for the Management of Acute Myocardial Infarction in Patients Presenting With ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J 2017;Aug 26:[Epub ahead of print].
  2. Hansson G. Inflammation, Atherosclerosis, and Coronary Artery Disease. New England Journal of Medicine. 2005; 352(16): 1685–1695.
  3. Baysal E1, Çetin M, Yaylak B. et.al. Roles of the red cell distribution width and neutrophil/lymphocyte ratio in predicting thrombolysis failure in patients with an ST-segment elevation myocardial infarction. Blood Coagul Fibrinolysis. 2015 Apr. ; 26(3): 274–8.
  4. Xanthopoulos A, Giamouzis G, Melidonis A, et al. Red blood cell distribution width as a prognostic marker in patients with heart failure and diabetes mellitus. Cardiovascular Diabetology. 2017; 16(1).
  5. Bessman J, Gilmer P, Gardner F. Improved Classification of Anemias by MCV and RDW. American Journal of Clinical Pathology. 1983; 80(3): 322–326.
  6. Perlstein T, Weuve J, Pfeffer M, et al. Red Blood Cell Distribution Width and Mortality Risk in a Community-Based Prospective Cohort. Archives of Internal Medicine. 2009; 169(6): 588.
  7. Jaman MS, Rahman MS, Swarna RR, et al. Diabetes and red blood cell parameters. Ann Clin Endocrinol Metabol. 2018; 2: 001–009.
  8. Van de, Bax J, Betriu A, et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: The Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J. 2008; 29: 2909–2945.
  9. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 2011; 35(Supplement_1): S64–S71.
  10. Fedder D, Koro C, L’Italien G. New National Cholesterol Education Program III Guidelines for Primary Prevention Lipid-Lowering Drug Therapy. Circulation. 2002; 105(2): 152–156.
  11. Weiss G, Goodnough L. Anemia of Chronic Disease. New England Journal of Medicine. 2005; 352(10): 1011–1023.
  12. Aysun Erdem, Ufuk Sadik Ceylan, Aycan Esen, et.al. Clinical usefulness of red cell distribution width to angiographic severity and coronary stent thrombosis. Int J Gen Med. 2016; 9: 319–324.
  13. Tziakas D, Chalikias G, Grapsa A, et al. Red blood cell distribution width – a strong prognostic marker in cardiovascular disease – is associated with cholesterol content of erythrocyte membrane. Clinical Hemorheology and Microcirculation. 2012; 51(4): 243–254.
  14. Lippi G, Filippozzi L, Montagnana M, et al. Clinical usefulness of measuring red blood cell distribution width on admission in patients with acute coronary syndromes. Clin Chem Lab Med. 2009; 47(3): 353–357.
  15. Azab B, Torbey E, Hatoum H, et al. Usefulness of red cell distribution width in predicting all-cause long-term mortality after non-ST-elevation myocardial infarction. Cardiology. 2011; 119: 72–80.
  16. Fatemi O, Paranilam J, Rainow A, et al. Red cell distribution width is a predictor of mortality in patients undergoing percutaneous coronary intervention. Journal of Thrombosis and Thrombolysis. 2012; 35(1): 57–64.
  17. Wen Y. High red cell distrubition width is closely associated with risk of carotid artery atherosclerosis in patients with hypertension. Exp Clin Cardiol. 2010; 15(3): 37–40.
  18. Osadnik T, Strzelczyk J, Hawranek M, et al. Red cell distribution width is associated with long-term prognosis in patients with stable coronary artery disease. BMC Cardiovascular Disorders. 2013; 13(1).
  19. Nada A. Red cell distribution width in type 2 diabetic patients. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2015: 525.
  20. Engström G, Smith JG, Persson M, et al. Red cell distribution width, haemoglobin A1c and incidence of diabetes mellitus. Journal of Internal Medicine. 2014; 276(2): 174–183.
  21. Subhashree AR. Red cell distribution width and serum BNP level correlation in diabetic patients with cardiac failure: a cross—sectional study. J Clin Diagn Res. 2014; 8(6): FC01–3.
  22. Malandrino N, Wu WC, Taveira TH, et al. Association between red blood cell distribution width and macrovascular and microvascular complications in diabetes. Diabetologia. 2012; 55(1): 226–35.
  23. Lippi G, Targher G, Montagnana M, et al. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med. 2009; 133(4): 628–32.
  24. Sherif HRN, Radwan M, Hamdy E, et al. Red cell distribution width as a marker of inflammation in type 2 diabetes mellitus. Life Sci J. 2013; 10(3): 1501–7.
  25. Desouky OS. Rheological and electrical behaviour of erythrocytes in patients with diabetes mellitus. Rom J Biophys. 2009; 19(4): 239–250.
  26. Soma P, Pretorius E. Interplay between ultrastructural findings and atherothrombotic complications in type 2 diabetes mellitus. Cardiovascular Diabetology. 2015; 14(1).
  27. Nigra A, Monesterolo N, Rivelli J, et al. Alterations of hemorheological parameters and tubulin content in erythrocytes from diabetic subjects. The International Journal of Biochemistry & Cell Biology. 2016; 74: 109–120.
  28. Singh M, Shin S. Changes in erythrocyte aggregation and deformability in diabetes mellitus: a brief review. Indian J Exp Biol. 2009; 47(1): 7–15.