Brief Report: Elevated Red Cell Distribution Width Identifies Elevated Cardiovascular Disease Risk in Patients With HIV Infection

Al‐Kindi, Sadeer G.; Kim, Chang H H; Morris, Sherri J.; Freeman, Michael L.; Funderburg, Nicholas T.; Rodríguez, Benigno; McComsey, Grace A.; Dalton, Jarrod E.; Simon, Daniel I.; Lederman, Michael M.; Longenecker, Chris T.; Zidar, David A.

doi:10.1097/qai.0000000000001231

Cited by 17 publications

(11 citation statements)

References 36 publications

(31 reference statements)

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“…47,48,49,50 Multiple groups, including our own, have identified relatively strong associations between RDW and clinical outcomes in a variety of populations. 51,52,53 An elevated RDW may reflect chronic inflammation, ultimately leading to altered iron homeostasis and erythropoietin resistence. 54,55 Associations between RDW and interleukin 6 have been demonstrated in heart failure 56 and in participants with human immunodeficiency virus infection, 57 and RDW was associated with tumor necrosis factor in those with sepsis.…”

Section: Discussionmentioning

confidence: 99%

Association of Lymphopenia With Risk of Mortality Among Adults in the US General Population

et al. 2019

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Section: Discussionmentioning

confidence: 99%

Association of Lymphopenia With Risk of Mortality Among Adults in the US General Population

et al. 2019

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“…Al-Kindi et al[40] used a large commercial database including electronic health records of many participating hospitals, with the aim of identifying patients aged 18 years or older with a diagnosis of HIV and who had at least one available RDW measurement. The search allowed the extraction of a total number of 46720 records (mean or median follow-up period for development of cardiovascular complications is unavailable in the article).…”

Section: Description Of Studies Outcomementioning

confidence: 99%

Red blood cell distribution width: A marker of anisocytosis potentially associated with atrial fibrillation

Lippi

Cervellin

Sanchís-Gomar

2019

WJC

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The incorporation of biomarkers in the actually used risk scores seem to be helpful for early identifying atrial fibrillation (AF) patients at higher risk. The aim of this critical review of the scientific literature is to investigate the potential clinical significance of red blood cell distribution width (RDW) in AF. A systematic electronic search was carried out to identify all articles describing an epidemiological association between RDW and AF in adult human populations. Data abstraction was conducted on a final number of 35 articles (13 cross-sectional, 12 prospective and 10 retrospective studies). The results of these epidemiological investigations were all virtually concordant to emphasize that an enhanced RDW value is not only a predictive factor and a marker of AF but its measurement may also be helpful for predicting the risk of developing many adverse complications in patients with AF, such as recurrence and duration of AF, hospitalization for heart failure, bleeding, left atrial thrombosis and stasis, thromboembolic events and mortality. AF patients with RDW values exceeding the local reference range may be more aggressively investigated and managed, in order to identify and attenuate the impact of possible underlying disorders causing both anisocytosis and AF.

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“…It has been postulated that increased RDW may reflect ineffective erythropoiesis that results from inflammation, oxidative stress, bone marrow failure, or nutritional deficiencies. Cross-sectional studies have shown that RDW correlates with markers of inflammation (eg TNF alpha, IL-6, and C-reactive protein) [6, 13, 14] in HIV-uninfected cohorts. To our knowledge, the association between RDW and immune activation in HIV has not been studied before.…”

Section: Introductionmentioning

confidence: 99%

Association of Anisocytosis with Markers of Immune Activation and Exhaustion in Treated HIV

Al‐Kindi

Zidar

McComsey

et al. 2017

PAI

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Background Treated HIV infection is associated with heightened inflammation which can contribute to increased risk of cardiovascular disease (CVD). We have previously shown that anisocytosis, as measured by red cell distribution width (RDW), is independently associated with prevalent CVD in people living with HIV (PLHIV). In this study, we sought to identify immune correlates of RDW in PLHIV receiving antiretroviral therapy. Methods We performed a cross-sectional and longitudinal analysis of 147 virally-suppressed PLHIV, who had LDL < 130 mg/dL and evidence of heightened inflammation, in a randomized trial of statin therapy. A complete blood count and biomarkers of inflammation and immune activation/exhaustion were measured in peripheral blood at entry and after 24 and 48 weeks. Associations with RDW were estimated using linear regression and linear mixed models. Results The median age (IQR) for the cohort at enrollment was 46 (40–53) years; 78% were male and 68% were African American. The median RDW for the cohort was 13.4% (12.9–14.0). Compared with the lowest RDW tertile, patients in the highest tertile were less likely to be male, and more likely to be African American, have lower hemoglobin, lower mean corpuscular volume, and higher platelet counts (all P < 0.05). At baseline, RDW weakly correlated with C-reactive protein (r = 0.196), d-dimer (r = 0.214), fibrinogen (r = 0.192), IL-6 (r = 0.257), CD4+DR+38+ T cells (r = 0.195), and CD4+PD1+ T cells (r = 0.227), all P < 0.05. Only IL-6, CD4+38+DR+ T cells, and CD4+PD1+ T_cells remained associated after adjustment for clinical factors known to affect RDW in the general population. Over 48 weeks, RDW did not change and there was no significant effect of statin (P = 0.45). After adjustment for clinical parameters, RDW remained positively associated with CD4+38+DR+ and CD4+PD1+ T cells across all time points (P = 0.05). Conclusion In this population of treated HIV+ subjects, anisocytosis was associated with biomarkers of inflammation and T-cell activation/exhaustion over time and independent of clinical confounders. Therefore, RDW may be a useful prognostic biomarker of cardiovascular risk that partially reflects chronic inflammation and immune exhaustion in PLHIV receiving antiretroviral therapy.

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Brief Report: Elevated Red Cell Distribution Width Identifies Elevated Cardiovascular Disease Risk in Patients With HIV Infection

Cited by 17 publications

References 36 publications

Association of Lymphopenia With Risk of Mortality Among Adults in the US General Population

Association of Lymphopenia With Risk of Mortality Among Adults in the US General Population

Red blood cell distribution width: A marker of anisocytosis potentially associated with atrial fibrillation

Association of Anisocytosis with Markers of Immune Activation and Exhaustion in Treated HIV

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