Clinical Hemorheology and Microcirculation 59 (2015) 379–385 DOI 10.3233/CH-141862 IOS Press
379
Influence of inflammatory and lipidic parameters on red blood cell distribution width in a healthy population Amparo Vay´aa,∗ , Ana Sarnagoa , Oscar Fustera , Rafael Alisb,c and Marco Romagnolib,d a
Hemorheology and Haemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain b Research University Institute “Dr. Vi˜na Giner”, Molecular and Mitochondrial Medicine, Catholic University of Valencia, “San Vicente Mártir”, Valencia, Spain c Faculty of Medicine, Catholic University of Valencia, “San Vicente M´artir”, Valencia, Spain d Department of Physical Education and Sports, Catholic University of Valencia “San Vicente Mártir”, Valencia, Spain
Abstract. Red blood cell distribution width (RDW) is a routine red blood cell count parameter which has been shown to be associated with inflammatory parameters. Recently, some authors proposed that RDW seems to be a marker of an adverse lipidic profile. In order to clarify whether RDW is related to inflammation, plasma lipids, or both, we determined anthropometric, hematimetric, inflammatory and lipidic parameters in 1111 healthy subjects. RDW correlated directly with age, body mass index (BMI), inflammatory parameters (plasma viscosity, erythrocyte sedimentation rate (ESR), fibrinogen, leukocyte and neutrophil count), and inversely with iron and hematimetric parameters (P < 0.05). When subjects were divided according to gender, RDW correlated inversely with triglycerides only in women (P < 0.05). When subjects were classified into RDW-quartiles, increased RDW values were accompanied by decreased serum iron levels and hematimetric indices (P < 0.01), whereas age and inflammatory markers increased according to RDW-quartiles (P < 0.001 and P < 0.05, respectively). However, plasma lipids did not change with increasing RDW-quartiles (P > 0.05). In the linear regression analysis, age, hemoglobin, MCV (beta coefficient: 0.202, −0.234, −0.316, P < 0.001) and fibrinogen (beta coefficient: 0.059, P = 0.048) were the only independent predictors of RDW. The present study indicates that RDW is associated with inflammatory markers and hematimetric indices, but not with plasma lipid levels in a healthy population. Keywords: Red blood cell distribution width, inflammatory markers, lipids
1. Introduction Red blood cell distribution width (RDW) is a routine blood cell count parameter that reflects size variations in erythrocytes, indicating the degree of anisocytosis [6]. RDW has been used traditionally in the differential diagnosis of microcytic anemia, although increased RDW is also commonly found in iron, folate and vitamin B12 deficiency [3, 4, 6] In the last few years, high RDW values have been reported in several cardiovascular disorders such as ischemic heart disease [26], acute and chronic heart failure [7, 8], and stroke [1], inflammatory diseases [13, 23] and it has been shown to be associated with all-cause, cardiac and non-cardiac mortality [2, 18, 19]. However, the pathogenic mechanism under∗ Corresponding author: Amparo Vay´a, MD, PhD, Hemorheology and Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Avda. de Campanar, 21, 46009, Valencia, Spain. Tel./Fax: +34 963862714; E-mail: vaya [email protected].
1386-0291/15/$35.00 © 2015 – IOS Press and the authors. All rights reserved
380
A. Vay´a et al. / Influence of inflammatory and lipidic parameters
lying RDW with several of the above-mentioned clinical situations is not established. Some authors suggest that RDW may be considered an inflammatory biomarker as it has been correlated with several inflammatory parameters, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), in a large cohort of unselected outpatients [16]. The same author, in a recent paper, found that high RDW is associated with a globally unfavorable lipid profile as it correlates inversely with HDL-cholesterol in both men and women, and directly with hypertriglyceridemia, and with the COL/HDL ratio only in women [15]. In order to clarify whether RDW is related to inflammation, plasma lipids, or both, we analyzed RDW along with anthropometric, hematimetric, inflammatory and lipidic parameters in a healthy Mediterranean population.
2. Patients and methods Between 2007 and 2013, 1111 healthy volunteers were examined in our laboratory. The group comprised 549 men and 562 women, aged 44 ± 14 and 45 ± 14, respectively. They belonged to our hospital staff and came to the Preventive Medicine service for a routine check-up. Subjects were from the same geographical area (Eastern Spain) and were all Caucasians. Exclusion criteria were organic, malignant, hematological, infectious or inflammatory diseases, previous history of ischemic heart disease or stroke and previous thrombo-embolism. Thirty-eight subjects (7 men and 31 women) were anemic (3.4%), according to the WHO criteria; i.e., hemoglobin
379
Influence of inflammatory and lipidic parameters on red blood cell distribution width in a healthy population Amparo Vay´aa,∗ , Ana Sarnagoa , Oscar Fustera , Rafael Alisb,c and Marco Romagnolib,d a
Hemorheology and Haemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Valencia, Spain b Research University Institute “Dr. Vi˜na Giner”, Molecular and Mitochondrial Medicine, Catholic University of Valencia, “San Vicente Mártir”, Valencia, Spain c Faculty of Medicine, Catholic University of Valencia, “San Vicente M´artir”, Valencia, Spain d Department of Physical Education and Sports, Catholic University of Valencia “San Vicente Mártir”, Valencia, Spain
Abstract. Red blood cell distribution width (RDW) is a routine red blood cell count parameter which has been shown to be associated with inflammatory parameters. Recently, some authors proposed that RDW seems to be a marker of an adverse lipidic profile. In order to clarify whether RDW is related to inflammation, plasma lipids, or both, we determined anthropometric, hematimetric, inflammatory and lipidic parameters in 1111 healthy subjects. RDW correlated directly with age, body mass index (BMI), inflammatory parameters (plasma viscosity, erythrocyte sedimentation rate (ESR), fibrinogen, leukocyte and neutrophil count), and inversely with iron and hematimetric parameters (P < 0.05). When subjects were divided according to gender, RDW correlated inversely with triglycerides only in women (P < 0.05). When subjects were classified into RDW-quartiles, increased RDW values were accompanied by decreased serum iron levels and hematimetric indices (P < 0.01), whereas age and inflammatory markers increased according to RDW-quartiles (P < 0.001 and P < 0.05, respectively). However, plasma lipids did not change with increasing RDW-quartiles (P > 0.05). In the linear regression analysis, age, hemoglobin, MCV (beta coefficient: 0.202, −0.234, −0.316, P < 0.001) and fibrinogen (beta coefficient: 0.059, P = 0.048) were the only independent predictors of RDW. The present study indicates that RDW is associated with inflammatory markers and hematimetric indices, but not with plasma lipid levels in a healthy population. Keywords: Red blood cell distribution width, inflammatory markers, lipids
1. Introduction Red blood cell distribution width (RDW) is a routine blood cell count parameter that reflects size variations in erythrocytes, indicating the degree of anisocytosis [6]. RDW has been used traditionally in the differential diagnosis of microcytic anemia, although increased RDW is also commonly found in iron, folate and vitamin B12 deficiency [3, 4, 6] In the last few years, high RDW values have been reported in several cardiovascular disorders such as ischemic heart disease [26], acute and chronic heart failure [7, 8], and stroke [1], inflammatory diseases [13, 23] and it has been shown to be associated with all-cause, cardiac and non-cardiac mortality [2, 18, 19]. However, the pathogenic mechanism under∗ Corresponding author: Amparo Vay´a, MD, PhD, Hemorheology and Hemostasis Unit, Service of Clinical Pathology, La Fe University Hospital, Avda. de Campanar, 21, 46009, Valencia, Spain. Tel./Fax: +34 963862714; E-mail: vaya [email protected].
1386-0291/15/$35.00 © 2015 – IOS Press and the authors. All rights reserved
380
A. Vay´a et al. / Influence of inflammatory and lipidic parameters
lying RDW with several of the above-mentioned clinical situations is not established. Some authors suggest that RDW may be considered an inflammatory biomarker as it has been correlated with several inflammatory parameters, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), in a large cohort of unselected outpatients [16]. The same author, in a recent paper, found that high RDW is associated with a globally unfavorable lipid profile as it correlates inversely with HDL-cholesterol in both men and women, and directly with hypertriglyceridemia, and with the COL/HDL ratio only in women [15]. In order to clarify whether RDW is related to inflammation, plasma lipids, or both, we analyzed RDW along with anthropometric, hematimetric, inflammatory and lipidic parameters in a healthy Mediterranean population.
2. Patients and methods Between 2007 and 2013, 1111 healthy volunteers were examined in our laboratory. The group comprised 549 men and 562 women, aged 44 ± 14 and 45 ± 14, respectively. They belonged to our hospital staff and came to the Preventive Medicine service for a routine check-up. Subjects were from the same geographical area (Eastern Spain) and were all Caucasians. Exclusion criteria were organic, malignant, hematological, infectious or inflammatory diseases, previous history of ischemic heart disease or stroke and previous thrombo-embolism. Thirty-eight subjects (7 men and 31 women) were anemic (3.4%), according to the WHO criteria; i.e., hemoglobin
