Letter to the Editor
Red cell distribution width is a predictor of mortality in patients with major bleeding
A largura de distribuição dos eritrócitos é um preditor de mortalidade em pacientes com hemorragia grave
Sevket Balta
, Sait Demirkol, Murat Unlu, Turgay Celik
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Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
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true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Reply to the Letter to the Editor “Contrast-enhanced multidetector computed tomography: A new prognosticator in acute pulmonary embolism?”" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "841" "paginaFinal" => "842" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Resposta à Carta ao Editor «Angiografia pulmonar por tomografia computadorizada: uma nova ferramenta prognóstica na tromboembolia pulmonar aguda?»" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Rui Baptista, Rogério Teixeira, Elisabete Jorge, Pedro Monteiro" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Rui" "apellidos" => "Baptista" ] 1 => array:2 [ "nombre" => "Rogério" "apellidos" => "Teixeira" ] 2 => array:2 [ "nombre" => "Elisabete" "apellidos" => "Jorge" ] 3 => array:2 [ "nombre" => "Pedro" "apellidos" => "Monteiro" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255113002163?idApp=UINPBA00004E" "url" => "/08702551/0000003200000010/v1_201311090028/S0870255113002163/v1_201311090028/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Red cell distribution width is a predictor of mortality in patients with major bleeding" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "843" "paginaFinal" => "844" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Sevket Balta, Sait Demirkol, Murat Unlu, Turgay Celik" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Sevket" "apellidos" => "Balta" "email" => array:1 [ 0 => "drsevketb@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Sait" "apellidos" => "Demirkol" ] 2 => array:2 [ "nombre" => "Murat" "apellidos" => "Unlu" ] 3 => array:2 [ "nombre" => "Turgay" "apellidos" => "Celik" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "A largura de distribuição dos eritrócitos é um preditor de mortalidade em pacientes com hemorragia grave" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have read with great enthusiasm the recently published article entitled “Impact of red blood cell distribution width on risk for bleeding events in patients with non-ST elevation acute coronary syndromes” by Gonçalves et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In this well-presented article they aimed to determine the prognostic value of red blood cell distribution width (RDW) in patients with non-ST segment elevation acute coronary syndromes (NSTE-ACS), particularly regarding the risk of major bleeding. They concluded that RDW was an independent predictor of major bleeding in patients with non-ST segment elevation myocardial infarction (NSTEMI). They suggested that higher RDW values were associated with greater in-hospital mortality and were an independent predictor of in-hospital major bleeding in patients with NSTE-ACS. The ready availability of this parameter at no additional cost may encourage its wider use in clinical practice in the future. We thank the authors for their contribution.</p><p id="par0010" class="elsevierStylePara elsevierViewall">It is known that anemia is an important predictor of short- and medium-term mortality after ACS.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In the present study, there were significant differences between the third tertile of RDW compared to the other groups. Anemia can be an independent risk factor of ACS patients with major bleeding in the present study. RDW is a standard laboratory parameter that shows variation in red blood cell size on a standard hemogram and is usually used in assessing blood diseases. It has recently been reported as an independent predictor of all-cause long-term mortality in patients with coronary artery disease.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> However, conditions in the differential diagnosis of anemias can affect RDW and so this parameter might change in the presence of abnormalities such as thyroid disease, renal or hepatic dysfunction (creatinine >1.5 mg/dl or aspartate aminotransferase and alanine transaminase more than twice the upper limit of normal, respectively), inflammatory diseases, and use of medications which could influence RDW. On the other hand, it is also reported that an increased RDW is associated with nutritional deficiency (of iron, vitamin B<span class="elsevierStyleInf">12</span>, and folic acid) and ethnicity.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Recent clinical studies have considered the importance of bleeding events in the prognosis in patients with ACS. In fact, the risk for cardiovascular complications associated with bleeding is similar to that of a myocardial infarction (MI). Some bleeding risk scores are now available that dependably quantify the likelihood of an ACS patient experiencing a bleeding complication. There is a strong relationship between bleeding and some conditions including older age,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> renal impairment, female gender, and an invasive management approach. Although patients who tend to bleed frequently have more comorbidities than their non-bleeding counterparts, several lines of experimental and clinical evidence suggest an independent causal pathway for bleeding-associated cardiovascular risk. When possible, bleeding should be avoided, and strategies such as use of risk scores, novel antithrombotics (such as bivalirudin and fondaparinux), vascular closure devices and radial access may decrease major bleeding.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Reduced glomerular filtration rate (GFR) may be also associated with adverse outcomes in patients with cardiovascular disease. The authors used the Cockcroft-Gault (CG) equation for GFR. However, compared to the Modification of Diet in Renal Disease (MDRD) formula, the CG equation can give lower GFR measurements in younger age groups but higher GFR measurements in older individuals. The value of GFR in predicting various cardiovascular endpoints in patients with MI is established. Compared to the CG formula, the MDRD formula is significantly more accurate in predicting the severity of coronary artery disease and two-year cardiovascular risk in patients admitted to the intensive care unit with MI.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> For this reason, it can be useful, and the results of the study might have been different if the authors had also used the MDRD formula.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In a previous study it was found that elevated levels of inflammatory molecules are markers of in-hospital major bleeding and also indicate an increased risk for the progression of NSTEMI. These molecules can be reduced by medications including antihypertensive therapy<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and aspirin. Additionally, as well as RDW, neutrophil/lymphocyte ratio, gamma-glutamyltransferase, C-reactive protein, mean platelet volume and uric acid are also easy methods to assess patients’ cardiovascular disease.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Moreover, hypoalbuminemia on admission is also a strong independent predictor of long-term mortality and development of advanced HF in patients with STEMI undergoing percutaneous coronary intervention.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> These markers might be useful in clinical practice.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Finally, it would have been better if the authors had defined how much time they specified for measuring RDW levels, since delaying blood sampling can cause abnormal results in RDW measurements.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion, we strongly believe that the findings of the current study will lead to further large-scale studies examining the relationship between RDW and in-hospital major bleeding in patients presenting with ACS. However, one should keep in mind that RDW alone, without other inflammatory markers, may not give precise information to clinicians about their patients’ inflammatory condition and prognostic indication. So, on this basis we think that it should be evaluated together with other serum inflammatory markers.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">At the time of publication, the authors of the article had not responded to requests for a response.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of red blood cell distribution width on risk for bleeding events in patients with non-ST elevation acute coronary syndromes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. 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[Epub ahead of print]" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000003200000010/v1_201311090028/S0870255113002175/v1_201311090028/en/main.assets" "Apartado" => array:4 [ "identificador" => "19305" "tipo" => "SECCION" "pt" => array:2 [ "titulo" => "Cartas ao Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "pt" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003200000010/v1_201311090028/S0870255113002175/v1_201311090028/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255113002175?idApp=UINPBA00004E" ]
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| 2021 Fevereiro | 67 | 14 | 81 |
| 2021 Janeiro | 31 | 6 | 37 |
| 2020 Dezembro | 22 | 5 | 27 |
| 2020 Novembro | 21 | 6 | 27 |
| 2020 Outubro | 14 | 6 | 20 |
| 2020 Setembro | 35 | 18 | 53 |
| 2020 Agosto | 19 | 6 | 25 |
| 2020 Julho | 24 | 2 | 26 |
| 2020 Junho | 26 | 3 | 29 |
| 2020 Maio | 37 | 2 | 39 |
| 2020 Abril | 27 | 7 | 34 |
| 2020 Maro | 29 | 7 | 36 |
| 2020 Fevereiro | 46 | 22 | 68 |
| 2020 Janeiro | 20 | 4 | 24 |
| 2019 Dezembro | 33 | 5 | 38 |
| 2019 Novembro | 29 | 4 | 33 |
| 2019 Outubro | 18 | 5 | 23 |
| 2019 Setembro | 45 | 8 | 53 |
| 2019 Agosto | 37 | 3 | 40 |
| 2019 Julho | 29 | 14 | 43 |
| 2019 Junho | 61 | 9 | 70 |
| 2019 Maio | 43 | 15 | 58 |
| 2019 Abril | 31 | 13 | 44 |
| 2019 Maro | 109 | 18 | 127 |
| 2019 Fevereiro | 74 | 10 | 84 |
| 2019 Janeiro | 81 | 4 | 85 |
| 2018 Dezembro | 68 | 7 | 75 |
| 2018 Novembro | 64 | 11 | 75 |
| 2018 Outubro | 247 | 12 | 259 |
| 2018 Setembro | 37 | 9 | 46 |
| 2018 Agosto | 40 | 11 | 51 |
| 2018 Julho | 23 | 6 | 29 |
| 2018 Junho | 33 | 6 | 39 |
| 2018 Maio | 49 | 6 | 55 |
| 2018 Abril | 39 | 10 | 49 |
| 2018 Maro | 66 | 10 | 76 |
| 2018 Fevereiro | 35 | 5 | 40 |
| 2018 Janeiro | 23 | 5 | 28 |
| 2017 Dezembro | 63 | 21 | 84 |
| 2017 Novembro | 22 | 4 | 26 |
| 2017 Outubro | 24 | 11 | 35 |
| 2017 Setembro | 27 | 8 | 35 |
| 2017 Agosto | 42 | 3 | 45 |
| 2017 Julho | 36 | 4 | 40 |
| 2017 Junho | 36 | 22 | 58 |
| 2017 Maio | 33 | 14 | 47 |
| 2017 Abril | 14 | 7 | 21 |
| 2017 Maro | 34 | 7 | 41 |
| 2017 Fevereiro | 32 | 7 | 39 |
| 2017 Janeiro | 28 | 8 | 36 |
| 2016 Dezembro | 27 | 11 | 38 |
| 2016 Novembro | 14 | 10 | 24 |
| 2016 Outubro | 29 | 8 | 37 |
| 2016 Setembro | 18 | 7 | 25 |
| 2016 Agosto | 10 | 3 | 13 |
| 2016 Julho | 7 | 7 | 14 |
| 2016 Junho | 13 | 4 | 17 |
| 2016 Maio | 0 | 8 | 8 |
| 2016 Abril | 28 | 2 | 30 |
| 2016 Maro | 60 | 23 | 83 |
| 2016 Fevereiro | 63 | 25 | 88 |
| 2016 Janeiro | 52 | 14 | 66 |
| 2015 Dezembro | 54 | 19 | 73 |
| 2015 Novembro | 49 | 16 | 65 |
| 2015 Outubro | 36 | 13 | 49 |
| 2015 Setembro | 48 | 14 | 62 |
| 2015 Agosto | 61 | 19 | 80 |
| 2015 Julho | 49 | 7 | 56 |
| 2015 Junho | 19 | 5 | 24 |
| 2015 Maio | 40 | 6 | 46 |
| 2015 Abril | 30 | 9 | 39 |
| 2015 Maro | 23 | 3 | 26 |
| 2015 Fevereiro | 26 | 5 | 31 |
| 2015 Janeiro | 31 | 9 | 40 |
| 2014 Dezembro | 35 | 15 | 50 |
| 2014 Novembro | 50 | 10 | 60 |
| 2014 Outubro | 56 | 7 | 63 |
| 2014 Setembro | 76 | 16 | 92 |
| 2014 Agosto | 29 | 5 | 34 |
| 2014 Julho | 56 | 7 | 63 |
| 2014 Junho | 61 | 12 | 73 |
| 2014 Maio | 51 | 7 | 58 |
| 2014 Abril | 65 | 11 | 76 |
| 2014 Maro | 80 | 12 | 92 |
| 2014 Fevereiro | 54 | 17 | 71 |
| 2014 Janeiro | 95 | 15 | 110 |
| 2013 Dezembro | 72 | 23 | 95 |
| 2013 Novembro | 61 | 16 | 77 |
Mostrar tudo
