3
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Hemogram parameters for predicting pulmonary embolism in patients with deep venous thrombosis

      ,

      Therapeutics and Clinical Risk Management

      Dove Medical Press

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Dear editor We read the article of Sevuk et al,1 published in the August 2015 issue of your journal, with great interest. The authors concluded that percentage change in serial measurements of mean platelet volume (MPV) and platelet-distribution width (PDW) is valuable in predicting the development of pulmonary thromboembolism in patients with a previous history of deep venous thrombosis (DVT). In a similar study conducted by Braekkan et al2 (Tromsø Study), MPV on admission was shown to predict pulmonary thromboembolism. In a study by Zorlu et al,3 red cell-distribution width (RDW) values >14%, which is another parameter included in complete blood count, were associated with increased risk of mortality in the early period after pulmonary thromboembolism. RDW can be easily measured in routine hemograms, and indicates changes in erythrocyte-distribution width.4 Certain inflammatory cytokines released in response to acute heart failure occurring in acute pulmonary embolism may cause an increase in RDW values through inhibition of erythrocyte maturation by affecting bone marrow.5–7 It is realized that the study by Sevuk et al1 did not include RDW in statistical analysis. Considering the fact that RDW has been previously documented to increase mortality in pulmonary thromboembolism,3 we suggest that RDW may be increased in patients with DVT due to acute pulmonary embolism and associated acute right heart failure and thus play a role in predicting the development of pulmonary embolism. In conclusion, RDW, which is measured in routine hemograms together with MPV and PDW, is an easy parameter to access, so authors might include RDW in statistical analysis. We think that if RDW levels were used for this study together with MPV and PDW, RDW might change the results of multivariate analysis and might be one of the predictors of pulmonary embolism in patients with DVT.

          Related collections

          Most cited references 8

          • Record: found
          • Abstract: found
          • Article: not found

          Inflammatory cytokine inhibition of erythropoiesis in patients implanted with a mechanical circulatory assist device.

          Mechanical circulatory assist devices (MCADs) are increasingly utilized independently of cardiac transplantation in the management of heart failure. Though MCAD use incorporates inherent mechanical risks, the inevitable onset of chronic anemia, with its associated morbidity and mortality, is also a significant concern. MCAD support has been correlated with elevated plasma levels of inflammatory cytokines TNF-alpha, IL-1beta, and IL-6, which have separately been found to inhibit erythropoietin (Epo)-induced erythrocyte (RBC) maturation. Previous analysis of hematological parameters for MCAD-supported patients concluded that an amplified inflammatory response impedes RBC proliferation and recovery from hemolytic anemia. Additional analysis may bolster this assertion. Hemoglobin concentration (HC), RBC distribution width (RDW), mean cell volume (MCV), and cardiac index were retrospectively analysed for 78 MCAD-supported patients implanted for greater than 30 days at the University of Arizona Health Sciences Center from 1996 to 2002. Analysis confirms that the HC, a conventional marker for anemia, declines with MCAD placement and remains below the clinically defined, minimum normal value. Inversely, the RDW rises above maximum normal measure, signifying an increased fraction of juvenile RBCs. The MCV remains unchanged and within normal limits, demonstrating adequate substrate for RBC formation. MCAD performance also stabilizes as adequate perfusion returns. These results further support our previously published conclusion that a sufficient response of erythropoiesis occurs in reaction to the onset of anemia by an increased production of immature RBCs. However, the cells never fully mature and join circulation. The patient's inflammatory cytokine response to the implanted device most likely mediates the chronic MCAD-induced anemia by inhibition of Epo effects.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Usefulness of red cell distribution width as a prognostic marker in pulmonary hypertension.

            Red blood cell distribution width (RDW), a widely available biomarker, independently predicts adverse outcomes in left-sided heart failure. The relation between RDW and death in pulmonary hypertension (PH) is unknown. In a prospective study of 162 consecutive patients with PH, RDW was recorded during initial diagnostic right-sided cardiac catheterization, and patients were followed for 2.1 +/- 0.8 years to determine vital status. Demographic, clinical, laboratory, and hemodynamic variables were compared by tertile of RDW. Cox proportional-hazards models were used to determine whether RDW was independently associated with death, and the prognostic utility of RDW was compared to that of other laboratory predictors, including N-terminal-pro-B-type natriuretic peptide (NT-pro-BNP). Of the 162 study patients, 78% were women, and 62% had pulmonary arterial hypertension. The mean age was 53 +/- 15 years, and most patients had severe PH (mean pulmonary artery pressure 48 +/- 13 mm Hg). The highest tertile of RDW predicted death (univariate hazard ratio 4.86, 95% confidence interval 1.37 to 17.29, p = 0.015; multivariate hazard ratio 2.4, 95% confidence interval 1.02 to 5.84, p = 0.045, after adjusting for age, gender, diabetes mellitus, connective tissue disease, diuretic use, phosphodiesterase inhibitor use, hemoglobin, mean corpuscular volume, and blood urea nitrogen [BUN]). Of the laboratory data, only RDW, BUN, and NT-pro-BNP were associated with death on univariate analysis. When RDW, BUN, and NT-pro-BNP were entered into a multivariate model, only RDW was still associated with death (p = 0.037 for RDW, p = 0.18 for BUN, and p = 0.39 for NT-pro-BNP). Adding NT-pro-BNP to RDW did not improve the prediction of mortality. In conclusion, RDW is independently associated with death in patients with PH and performs better as a prognostic indicator than NT-pro-BNP.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Usefulness of admission red cell distribution width as a predictor of early mortality in patients with acute pulmonary embolism.

              Red cell distribution width (RDW) is strongly associated with prognosis in cardiopulmonary disorders such as coronary artery disease, acute myocardial infarction, acute and chronic heart failure, and pulmonary hypertension. However, its prognostic significance in acute pulmonary embolism (PE) is unknown. The aim of this study was to investigate the relation between admission RDW and early mortality in patients with acute PE. One hundred sixty-five patients with confirmed acute PE were included. Patients with previous treatment for anemia, malignancy, or chronic liver disease, those with dialysis treatment for chronic renal failure, and those who received erythrocyte suspension for any reason were excluded. A total of 136 consecutive patients with acute PE were evaluated prospectively. According to receiver-operating characteristic curve analysis, the optimal cut-off value of RDW to predict early mortality was >14.6%, with 95.2% sensitivity and 53% specificity. Patients were categorized prospectively as having unchanged (group 1) or increased (group 2) RDW on the basis of a cut-off value of 14.6%. The mean age of patients was 63 ± 15 years. The mean follow-up duration was 11 ± 7 days, and 21 patients died. Among these 21 patients, 1 (1.6%) was in group 1 and 20 (27%) were in group 2 (p 14.6% on admission, age, presence of shock, heart rate, oxygen saturation, and creatinine level were found to have prognostic significance in univariate Cox proportional-hazards analysis. Only increased RDW >14.6% on admission (hazard ratio 15.465, p = 0.012) and the presence of shock (hazard ratio 9.354, p <0.001) remained associated with increased risk for acute PE-related early mortality in a multivariate Cox proportional-hazards model. In conclusion, high RDW was associated with worse hemodynamic parameters, and RDW seems to aid in the risk stratification of patients with acute PE. Copyright © 2012 Elsevier Inc. All rights reserved.
                Bookmark

                Author and article information

                Journal
                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                2015
                06 November 2015
                : 11
                : 1683-1685
                Affiliations
                Department of Cardiology, Cumhuriyet University Medical School, Sivas, Turkey
                [1 ]Department of Cardiovascular Surgery, Diyarbakır Gazi Yaşargil Education and Research Hospital, Dicle University, Diyarbakır, Turkey
                [2 ]Department of General Surgery, Dicle University, Diyarbakır, Turkey
                [3 ]Department of Cardiology, Diyarbakır Gazi Yaşargil Education and Research Hospital, Diyarbakır, Turkey
                [4 ]Department of General Surgery, Diyarbakır Gazi Yaşargil Education and Research Hospital, Diyarbakır, Turkey
                [5 ]Department of Cardiovascular Surgery, Liv Hospital, Ankara, Turkey
                Author notes
                Correspondence: Hakki Kaya, Department of Cardiology, Cumhuriyet University Medical School, Yenişehir Mahallesi, Kayseri Caddesi, 58140 Sivas, Turkey, Tel +90 346 258 1807, Fax +90 346 219 1268, Email drhakkikaya84@ 123456gmail.com
                Correspondence: Utkan Sevuk, Diyarbakir Gazi Yasargil Egitim ve Arastirma Hastanesi, Kalp ve Damar Cerrahisi Klinigi, 3 kat, Uckuyular, Diyarbakir 21010, Turkey, Tel +90 505 530 7095, Email utkansevuk@ 123456gmail.com
                Article
                tcrm-11-1683
                10.2147/TCRM.S96694
                4644164
                © 2015 Kaya and Kurt. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Letter

                Medicine

                Comments

                Comment on this article