Red Cell Distribution Width and Other Red Blood Cell Parameters in Patients with Cancer: Association with Risk of Venous Thromboembolism and Mortality

Abstract

BackgroundCancer patients are at high risk of developing venous thromboembolism (VTE). Red cell distribution width (RDW) has been reported to be associated with arterial and venous thrombosis and mortality in several diseases. Here, we analyzed the association between RDW and other red blood cell (RBC) parameters with risk of VTE and mortality in patients with cancer.MethodsRBC parameters were measured in 1840 patients with cancers of the brain, breast, lung, stomach, colon, pancreas, prostate, kidney; lymphoma, multiple myeloma and other tumor sites, that were included in the Vienna Cancer and Thrombosis Study (CATS), which is an ongoing prospective, observational cohort study of patients with newly diagnosed or progressive cancer after remission. Primary study outcome is occurrence of symptomatic VTE and secondary outcome is death during a maximum follow-up of 2 years.ResultsDuring a median follow-up of 706 days, 131 (7.1%) patients developed VTE and 702 (38.2%) died. High RDW (>16%) was not associated with a higher risk of VTE in the total study cohort; in competing risk analysis accounting for death as competing variable the univariable subhazard ratio (SHR) was 1.34 (95% confidence interval [CI]: 0.80–2.23, p = 0.269). There was also no significant association between other RBC parameters and risk of VTE. High RDW was associated with an increased risk of mortality in the total study population (hazard ratio [HR, 95% CI]: 1.72 [1.39–2.12], p<0.001), and this association prevailed after adjustment for age, sex, hemoglobin, leukocyte and platelet count (HR [95% CI]: 1.34 [1.06–1.70], p = 0.016).ConclusionsRDW and other RBC parameters were not independently associated with risk of VTE in patients with cancer and might therefore not be of added value for estimating risk of VTE in patients with cancer. We could confirm that high RDW is an independent predictor of poor overall survival in cancer.

Red cell distribution width and cancer

“…The cumulative probability of survival in patients with high RDW (>16%) was 78.5% after 6 months, 66.2% after 1 year and 41.3% after 2 years. In comparison, patients with RDW levels ≤16% had a cumulative survival probability of 88.7% after 6 months, 75.1% after one year and 66.2% after 2 years (Log-rank P<0.001) (12). The authors observed that high RDW was associated with an increased risk of cancer-related mortality (HR, 1.72; 95% CI, 1.39-2.12; P<0.001), and this association persisted after adjustment for age, sex, hemoglobin, leukocyte and platelet count (HR, 1.34; 95% CI, 1.06-1.70; P=0.016).…”

“…Several studies have demonstrated that RDW is higher not only in patients affected by CVD but also in patients affected by solid tumors and hematological cancer compared to healthy individuals (12)(13)(14). As well as mortality, in these patients increased RDW has been shown to predict advanced stage and worse prognosis (15).…”

The Relation Between Preoperative Red Cell Distribution Width and Early Postoperative Mortality in Patients with Gastric Cancer

“…Son yıllarda popüler olmaya başlayan özellikle çeşitli kanser tiplerinin sağ kalım sürelerinin tayin edilmesinde preoperatif dönemde elde edilen hematolojik parametrelerin preoperatif operabiliteyi veya metastatik hastalığı saptamakta faydalı olup olmayacağı araştırılmaya başlan-mıştır. Bu hematolojik parametreler içerisinde en sık çalışılanları nötrofil/lenfosit oranı (NLO), eritrosit dağılım genişliği (RDW) ve platelet/lenfosit oranıdır (PLO) [7][8][9] . RDW, kırmızı kan hücrelerinin (RBC) boyut ve hacim değişkenliğini gösteren ve anizositozu işaret eden parametredir.…”

“…Yılmaz ve arkadaşları RDW'yi pankreas kanserinde morbidite ve mortaliteyi öngörmede, kolay ulaşılabilir, ucuz ve basit bir prediktif belirteç olarak bildirdiler 21 . Riedl ve arkadaşları ise, yüksek RDW düzeyle-rinin yanında artmış RDW ile birlikte görülen klinik durumlardan biri olan aneminin kanser sağ kalımında kötü prognostik faktör olduğu sonucuna vardılar 8 . Patel ve arkadaşları her %1'lik RDW artışına karşılık, mortalitede %14 artış bildirdiler, ancak bu artışın ileri yaş ve hemoglobin konsantrasyonuna bağlı olduğunun altını çizdiler 22 .…”

Relationship between the red blood cell distribution width (RDW) and erythrocyte values in anemic and non-anemic cats

“…This suggests that RDW may represent an erythrocyte value for early identification of cases of masked anemia (e.g., dehydration). It has been suggested in several human medical studies (RIEDL et al, 2014;TSELIOU et al, 2014;SALVAGNO et al, 2015) that such alterations may be due to other diseases in addition to anemia masked by dehydration; this remains unproven in domestic species (GUGLIELMINI et al, 2013;SWANN et al, 2014). According to Salvagno et al (2015), an increase in RDW reflects a breakdown in erythrocyte homeostasis involving both impaired erythropoiesis and survival of abnormal red blood cells.…”