Red cell distribution width in organophosphate exposure patients Sevket Balta MD, Mustafa Aparci MD, Cengiz Ozturk MD, Sait Demirkol MD, Turgay Celik MD PII: DOI: Reference:
S0735-6757(14)00400-8 doi: 10.1016/j.ajem.2014.05.032 YAJEM 54315
To appear in:
American Journal of Emergency Medicine
Received date: Accepted date:
5 May 2014 19 May 2014
Please cite this article as: Balta Sevket, Aparci Mustafa, Ozturk Cengiz, Demirkol Sait, Celik Turgay, Red cell distribution width in organophosphate exposure patients, American Journal of Emergency Medicine (2014), doi: 10.1016/j.ajem.2014.05.032
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Red Cell Distribution Width in Organophosphate Exposure Patients
RI P
T
*Sevket BALTA, MD
**Mustafa APARCI, MD, Associate Professor of Cardiology
SC
***Cengiz OZTURK, MD, Associate Professor of Cardiology
MA NU
***Sait DEMIRKOL, MD, Associate Professor of Cardiology
Department of Cardiology, Eskişehir Military Hospital, Eskişehir/TURKEY
**
Department of Cardiology, Etimesgut Military Hospital,Ankara/TURKEY Department of Cardiology, Gulhane Medical Academy Ankara/TURKEY
AC
CE
***
PT
*
ED
***Turgay CELIK, MD, Professor of Cardiology
Address for correspondence and reprints Dr Sevket BALTA Department of Cardiology Eskisehir Military Hospital, Vişnelik Mah., Atatürk Cd. 26020 Akarbaşı/ Eskişehir, Turkey Tel: +90 222 220 45 30 Fax: +90 222 230 34 33 E-mail: [email protected] There is no conflict of interests
ACCEPTED MANUSCRIPT Red Cell Distribution Width in Organophosphate Exposure Patients
T
Dear Editor,
RI P
We have read the article “Red cell distribution width(RDW) as a predictor of mortality in
SC
organophosphate insecticide(OPI) poisoning” by Changwoo Kang et al(1). They aimed to investigate the relationship between the RDW and 30-day mortality during OPI poisoning.
MA NU
They concluded that RDW is an independent predictor of 30-day mortality in patients with OPI poisoning. This study gives important information on this clinically relevant condition. Thanks to the authors for their contribution.
ED
The ready availability of this parameter at no additional cost may encourage its wider use in clinical practice in the future. However, we think that some points should be discussed.
PT
Recently, high-sensitivity C-reactive protein, natriuretic peptides, neurohormones can be
CE
helpful and are reliable markers for diagnosis and prognosis. However, we cannot evaluate these markers anytime or anywhere because these markers are expensive and not easy to
AC
obtain. In this respect, recently, some markers as routine, easy, inexpensive are considered to assess morbidity and mortality in many conditions(2). RDW has been identified and proposed to be a relevant marker in many conditions as mortality indicators. Elevated RDW can be observed many conditions and mechanism. Recently, a number of studies have demonstrated that elevated RDW levels are associated with poor prognosis in the setting of coronary artery disease, heart failure, stroke, peripheral arterial disease, older age (3).Also, RDW may also reflect ethnicity, neurohumoral activation, renal dysfunction, thyroid disease, hepatic dysfunction, nutritional deficiencies (i.e. iron, vitamin B12, and folic acid), bone marrow dysfunction, inflammatory diseases, chronic or acute systemic inflammation(4) and use of some medications(5). The most common hypothesis for increased RDW is chronic subclinical
ACCEPTED MANUSCRIPT inflammation by a variety of mechanisms, including direct myelosuppression of erythroid precursors, reduced renal erythropoietin production and iron bioavailability, increased
T
erythropoietin resistance in erythroid precursor cell lines, the promotion of cell apoptosis, and
RI P
RBC membrane deformability, all factors.
SC
In the present study, the optimal cut-off value of RDW for predicting 30-day mortality was identified from the ROC curve analysis. When the RDW was more than 13.5%, the sensitivity
MA NU
was 57.1%, and the specificity was 84.0%. However, this cut-off value is relatively low. So, it cannot accurate information about predicting 30-day mortality in patients with OPI poisoning. Finally, because the present study is a retrospective study, it would be better if the authors might define how much time they specified on measuring RDW levels, because of the
PT
ED
delaying blood sampling can cause abnormal results in RDW measurements(6).
As a conclusion, not only RDW but also mean platelet volume, neutrophil lymphocyte ratio,
CE
CRP and uric acid are easy methods to evaluate the cardiovascular disease of the patients(7).
AC
These markers might be useful in clinical practice(8). However, one should keep in mind that RDW itself alone without other inflammatory indicators may not give exact information to clinicians about the inflammatory status and prognostic indication of the patients. So, from that point of view we think that it should be evaluated accompanied with other serum inflammatory markers.
ACCEPTED MANUSCRIPT References Kang C, Park IS, Kim DH, Kim SC, Jeong JH, Lee SH, et al. Red cell distribution width as a predictor of mortality in organophosphate insecticide poisoning. Am J Emerg Med. Elsevier Inc.; 2014 Mar 6;
2.
Balta S, Demirkol S, Hatipoglu M, Ardic S, Aydogan M, Celik T. Other inflammatory indicators should be kept in mind when assessing red cell distribution width in patients with pneumonia. Am J Emerg Med. 2013 Jul;31(7):1144–5.
3.
Balta S, Demirkol S, Aydogan M, Unlu M. Red cell distribution width is a predictor of mortality in patients undergoing coronary artery bypass surgery. Eur J Cardiothorac Surg. 2013 Feb 21;Epub ahead of print.
4.
Balta S, Demirkol S, Hatipoglu M, Ardic S, Arslan Z, Celik T. Red cell distribution width is a predictor of mortality in patients with severe sepsis and septic shock. Am J Emerg Med. 2013 Apr 12;
5.
Fici F, Celik T, Balta S, Iyisoy A, Unlu M, Demitkol S, et al. Comparative effects of nebivolol and metoprolol on red cell distribution width and neutrophil/lymphocyte ratio in patients with newly diagnosed essential hypertension. J Cardiovasc Pharmacol. 2013 Oct;62(4):388–93.
6.
Balta S, Demir M, Kurtoglu E, Demirkol S. Red cell distribution width in patients with nonalcoholic fatty liver disease. Eur J Gastroenterol Hepatol. 2014 Mar;26(3):361.
7.
Demirkol S, Balta S, Celik T, Arslan Z, Unlu M, Cakar M, et al. Assessment of the relationship between red cell distribution width and cardiac syndrome X. Kardiol Pol. 2013 Jan;71(5):480–4.
8.
Balta S, Demirkol S, Cakar M, Ardic S, Celik T, Demirbas S. Red cell distribution width: a novel and simple predictor of mortality in acute pancreatitis. Am J Emerg Med. 2013 Jun;31(6):991–2.
AC
CE
PT
ED
MA NU
SC
RI P
T
1.
S0735-6757(14)00400-8 doi: 10.1016/j.ajem.2014.05.032 YAJEM 54315
To appear in:
American Journal of Emergency Medicine
Received date: Accepted date:
5 May 2014 19 May 2014
Please cite this article as: Balta Sevket, Aparci Mustafa, Ozturk Cengiz, Demirkol Sait, Celik Turgay, Red cell distribution width in organophosphate exposure patients, American Journal of Emergency Medicine (2014), doi: 10.1016/j.ajem.2014.05.032
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Red Cell Distribution Width in Organophosphate Exposure Patients
RI P
T
*Sevket BALTA, MD
**Mustafa APARCI, MD, Associate Professor of Cardiology
SC
***Cengiz OZTURK, MD, Associate Professor of Cardiology
MA NU
***Sait DEMIRKOL, MD, Associate Professor of Cardiology
Department of Cardiology, Eskişehir Military Hospital, Eskişehir/TURKEY
**
Department of Cardiology, Etimesgut Military Hospital,Ankara/TURKEY Department of Cardiology, Gulhane Medical Academy Ankara/TURKEY
AC
CE
***
PT
*
ED
***Turgay CELIK, MD, Professor of Cardiology
Address for correspondence and reprints Dr Sevket BALTA Department of Cardiology Eskisehir Military Hospital, Vişnelik Mah., Atatürk Cd. 26020 Akarbaşı/ Eskişehir, Turkey Tel: +90 222 220 45 30 Fax: +90 222 230 34 33 E-mail: [email protected] There is no conflict of interests
ACCEPTED MANUSCRIPT Red Cell Distribution Width in Organophosphate Exposure Patients
T
Dear Editor,
RI P
We have read the article “Red cell distribution width(RDW) as a predictor of mortality in
SC
organophosphate insecticide(OPI) poisoning” by Changwoo Kang et al(1). They aimed to investigate the relationship between the RDW and 30-day mortality during OPI poisoning.
MA NU
They concluded that RDW is an independent predictor of 30-day mortality in patients with OPI poisoning. This study gives important information on this clinically relevant condition. Thanks to the authors for their contribution.
ED
The ready availability of this parameter at no additional cost may encourage its wider use in clinical practice in the future. However, we think that some points should be discussed.
PT
Recently, high-sensitivity C-reactive protein, natriuretic peptides, neurohormones can be
CE
helpful and are reliable markers for diagnosis and prognosis. However, we cannot evaluate these markers anytime or anywhere because these markers are expensive and not easy to
AC
obtain. In this respect, recently, some markers as routine, easy, inexpensive are considered to assess morbidity and mortality in many conditions(2). RDW has been identified and proposed to be a relevant marker in many conditions as mortality indicators. Elevated RDW can be observed many conditions and mechanism. Recently, a number of studies have demonstrated that elevated RDW levels are associated with poor prognosis in the setting of coronary artery disease, heart failure, stroke, peripheral arterial disease, older age (3).Also, RDW may also reflect ethnicity, neurohumoral activation, renal dysfunction, thyroid disease, hepatic dysfunction, nutritional deficiencies (i.e. iron, vitamin B12, and folic acid), bone marrow dysfunction, inflammatory diseases, chronic or acute systemic inflammation(4) and use of some medications(5). The most common hypothesis for increased RDW is chronic subclinical
ACCEPTED MANUSCRIPT inflammation by a variety of mechanisms, including direct myelosuppression of erythroid precursors, reduced renal erythropoietin production and iron bioavailability, increased
T
erythropoietin resistance in erythroid precursor cell lines, the promotion of cell apoptosis, and
RI P
RBC membrane deformability, all factors.
SC
In the present study, the optimal cut-off value of RDW for predicting 30-day mortality was identified from the ROC curve analysis. When the RDW was more than 13.5%, the sensitivity
MA NU
was 57.1%, and the specificity was 84.0%. However, this cut-off value is relatively low. So, it cannot accurate information about predicting 30-day mortality in patients with OPI poisoning. Finally, because the present study is a retrospective study, it would be better if the authors might define how much time they specified on measuring RDW levels, because of the
PT
ED
delaying blood sampling can cause abnormal results in RDW measurements(6).
As a conclusion, not only RDW but also mean platelet volume, neutrophil lymphocyte ratio,
CE
CRP and uric acid are easy methods to evaluate the cardiovascular disease of the patients(7).
AC
These markers might be useful in clinical practice(8). However, one should keep in mind that RDW itself alone without other inflammatory indicators may not give exact information to clinicians about the inflammatory status and prognostic indication of the patients. So, from that point of view we think that it should be evaluated accompanied with other serum inflammatory markers.
ACCEPTED MANUSCRIPT References Kang C, Park IS, Kim DH, Kim SC, Jeong JH, Lee SH, et al. Red cell distribution width as a predictor of mortality in organophosphate insecticide poisoning. Am J Emerg Med. Elsevier Inc.; 2014 Mar 6;
2.
Balta S, Demirkol S, Hatipoglu M, Ardic S, Aydogan M, Celik T. Other inflammatory indicators should be kept in mind when assessing red cell distribution width in patients with pneumonia. Am J Emerg Med. 2013 Jul;31(7):1144–5.
3.
Balta S, Demirkol S, Aydogan M, Unlu M. Red cell distribution width is a predictor of mortality in patients undergoing coronary artery bypass surgery. Eur J Cardiothorac Surg. 2013 Feb 21;Epub ahead of print.
4.
Balta S, Demirkol S, Hatipoglu M, Ardic S, Arslan Z, Celik T. Red cell distribution width is a predictor of mortality in patients with severe sepsis and septic shock. Am J Emerg Med. 2013 Apr 12;
5.
Fici F, Celik T, Balta S, Iyisoy A, Unlu M, Demitkol S, et al. Comparative effects of nebivolol and metoprolol on red cell distribution width and neutrophil/lymphocyte ratio in patients with newly diagnosed essential hypertension. J Cardiovasc Pharmacol. 2013 Oct;62(4):388–93.
6.
Balta S, Demir M, Kurtoglu E, Demirkol S. Red cell distribution width in patients with nonalcoholic fatty liver disease. Eur J Gastroenterol Hepatol. 2014 Mar;26(3):361.
7.
Demirkol S, Balta S, Celik T, Arslan Z, Unlu M, Cakar M, et al. Assessment of the relationship between red cell distribution width and cardiac syndrome X. Kardiol Pol. 2013 Jan;71(5):480–4.
8.
Balta S, Demirkol S, Cakar M, Ardic S, Celik T, Demirbas S. Red cell distribution width: a novel and simple predictor of mortality in acute pancreatitis. Am J Emerg Med. 2013 Jun;31(6):991–2.
AC
CE
PT
ED
MA NU
SC
RI P
T
1.
