The Clinical Respiratory Journal LETTER TO THE EDITOR
Red cell distribution width in patients with sarcoidosis
Dear Editor, We have read the article ‘Prognostic Value of Red Cell Distribution Width (RDW) in Patients with Sarcoidosis’ by Ozsu et al. (1). They aimed to investigate the role of RDW monitoring in predicting the prognosis and progression of sarcoidosis. They concluded that serial RDW follow up may be beneficial in predicting the progression of sarcoidosis. This study gives important information on this clinically relevant condition. The ready availability of this parameter at no additional cost may encourage its wider use in clinical practice in the future. Thanks to the authors for their contribution. Immunopathogenic mechanism is one of the most common factors causing organ damage in patients with sarcoidosis. Cytokines, soluble cytokine receptors, metabolites, enzymes, extracellular matrix components, soluble adhesion molecules and other serum components had been evaluated to serve as serological markers of sarcoidosis in a previous review (2). Additionally, in a previous study (3), the authors evaluated the diagnostic accuracy of inflammatory markers to predict respiratory severity in sarcoidosis. The authors concluded that some inflammatory markers appear to be useful for monitoring respiratory disease severity in sarcoidosis. In comparison of above markers, several routine, inexpensive, readily available haematology markers can analyse inflammatory conditions, RDW is available in most clinical settings. RDW is a quantitative measure of anisocytosis, the variability in size of circulating erythrocytes. RDW is frequently associated with nutritional deficiencies (i.e. iron, vitamin B12 and folic acid) and transfusion history. RDW independently predicts 1-year mortality in the setting of stable angina, acute coronary syndrome, coronary bypass surgery, heart failure, stroke, peripheral arterial disease, older age and in the patients with or without coronary artery disease (4). Furthermore, RDW may
Conflict of interest The authors have stated explicitly that there are no conflicts of interest in connection with this article. The authors alone are responsible for the content and writing of this paper.
(2014) • ISSN 1752-6981 The Clinical Respiratory Journal (2016) C 2014 V © 2014 John John Wiley Wiley && Sons Sons Ltd Ltd
also reflect ethnicity, neurohumoral activation, renal dysfunction, thyroid disease, hepatic dysfunction, bone marrow dysfunction, inflammatory diseases, chronic or acute systemic inflammation (5) and use of some medications (6). Additionally, the value of RDW is instrument dependent, forcing each laboratory to establish its own reference values. Finally, it would be better if the authors might define how much time they specified on measuring RDW levels because of the delaying blood sampling that can cause abnormal results in RDW measurements (7). As a conclusion, we hardly believe that those findings obtained from the current study will lead to further studies examining the relationship between RDW and sarcoidosis. 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. Sevket Balta1, Mehmet Aydogan2, Mustafa Aparci3, Cengiz Ozturk3 and Sait Demirkol3 1 Department of Cardiology, Etimesgut Military Hospital, Ankara, Turkey 2 Department of Pulmonary Medicine, Isparta Military Hospital, Isparta, Turkey 3 Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
References 1. Ozsu S, Ozcelik N, Oztuna F, Ozlu T. Prognostic value of red cell distribution width in patients with sarcoidosis. Clin Respir J. 2014; doi: 10.1111/crj.12101. 2. Müller-Quernheim J. Serum markers for the staging of disease activity of sarcoidosis and other interstitial lung diseases of unknown etiology. Sarcoidosis Vasc Diffus Lung Dis. 1998;15(1): 22–37. 3. Rothkrantz-Kos S, van Dieijen-Visser M, Mulder P, Drent M. Potential usefulness of inflammatory markers to monitor respiratory functional impairment in sarcoidosis. Clin Chem. 2003;49(9): 1510–7. 4. Balta S, Demirkol S, Aydogan M, Unlu M. Red cell distribution width is a predictor of mortality in patients
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undergoing coronary artery bypass surgery. Eur J Cardiothorac Surg. 2013;44(2): 396–7. 5. 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;31(6): 989–90. 6. Fici F, Celik T, Balta S, et al. Comparative effects of nebivolol and metoprolol on red cell distribution width
130 2
Balta al. Balta et et al.
and neutrophil/lymphocyte ratio in patients with newly diagnosed essential hypertension. J Cardiovasc Pharmacol. 2013;62(4): 388–93. 7. Demirkol S, Balta S, Cakar M, Unlu M, Arslan Z, Kucuk U. Red cell distribution width: a novel infl ammatory marker in clinical practice. Cardiol J. 2013;20(2): 209.
The Clinical Clinical Respiratory Respiratory Journal Journal (2014) (2016) •• ISSN ISSN 1752-6981 1752-6981 The C 2014 John Wiley & Sons Ltd V © 2014 John Wiley & Sons Ltd
Red cell distribution width in patients with sarcoidosis
Dear Editor, We have read the article ‘Prognostic Value of Red Cell Distribution Width (RDW) in Patients with Sarcoidosis’ by Ozsu et al. (1). They aimed to investigate the role of RDW monitoring in predicting the prognosis and progression of sarcoidosis. They concluded that serial RDW follow up may be beneficial in predicting the progression of sarcoidosis. This study gives important information on this clinically relevant condition. The ready availability of this parameter at no additional cost may encourage its wider use in clinical practice in the future. Thanks to the authors for their contribution. Immunopathogenic mechanism is one of the most common factors causing organ damage in patients with sarcoidosis. Cytokines, soluble cytokine receptors, metabolites, enzymes, extracellular matrix components, soluble adhesion molecules and other serum components had been evaluated to serve as serological markers of sarcoidosis in a previous review (2). Additionally, in a previous study (3), the authors evaluated the diagnostic accuracy of inflammatory markers to predict respiratory severity in sarcoidosis. The authors concluded that some inflammatory markers appear to be useful for monitoring respiratory disease severity in sarcoidosis. In comparison of above markers, several routine, inexpensive, readily available haematology markers can analyse inflammatory conditions, RDW is available in most clinical settings. RDW is a quantitative measure of anisocytosis, the variability in size of circulating erythrocytes. RDW is frequently associated with nutritional deficiencies (i.e. iron, vitamin B12 and folic acid) and transfusion history. RDW independently predicts 1-year mortality in the setting of stable angina, acute coronary syndrome, coronary bypass surgery, heart failure, stroke, peripheral arterial disease, older age and in the patients with or without coronary artery disease (4). Furthermore, RDW may
Conflict of interest The authors have stated explicitly that there are no conflicts of interest in connection with this article. The authors alone are responsible for the content and writing of this paper.
(2014) • ISSN 1752-6981 The Clinical Respiratory Journal (2016) C 2014 V © 2014 John John Wiley Wiley && Sons Sons Ltd Ltd
also reflect ethnicity, neurohumoral activation, renal dysfunction, thyroid disease, hepatic dysfunction, bone marrow dysfunction, inflammatory diseases, chronic or acute systemic inflammation (5) and use of some medications (6). Additionally, the value of RDW is instrument dependent, forcing each laboratory to establish its own reference values. Finally, it would be better if the authors might define how much time they specified on measuring RDW levels because of the delaying blood sampling that can cause abnormal results in RDW measurements (7). As a conclusion, we hardly believe that those findings obtained from the current study will lead to further studies examining the relationship between RDW and sarcoidosis. 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. Sevket Balta1, Mehmet Aydogan2, Mustafa Aparci3, Cengiz Ozturk3 and Sait Demirkol3 1 Department of Cardiology, Etimesgut Military Hospital, Ankara, Turkey 2 Department of Pulmonary Medicine, Isparta Military Hospital, Isparta, Turkey 3 Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
References 1. Ozsu S, Ozcelik N, Oztuna F, Ozlu T. Prognostic value of red cell distribution width in patients with sarcoidosis. Clin Respir J. 2014; doi: 10.1111/crj.12101. 2. Müller-Quernheim J. Serum markers for the staging of disease activity of sarcoidosis and other interstitial lung diseases of unknown etiology. Sarcoidosis Vasc Diffus Lung Dis. 1998;15(1): 22–37. 3. Rothkrantz-Kos S, van Dieijen-Visser M, Mulder P, Drent M. Potential usefulness of inflammatory markers to monitor respiratory functional impairment in sarcoidosis. Clin Chem. 2003;49(9): 1510–7. 4. Balta S, Demirkol S, Aydogan M, Unlu M. Red cell distribution width is a predictor of mortality in patients
1 129
Letter to to the the editor editor Letter
undergoing coronary artery bypass surgery. Eur J Cardiothorac Surg. 2013;44(2): 396–7. 5. 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;31(6): 989–90. 6. Fici F, Celik T, Balta S, et al. Comparative effects of nebivolol and metoprolol on red cell distribution width
130 2
Balta al. Balta et et al.
and neutrophil/lymphocyte ratio in patients with newly diagnosed essential hypertension. J Cardiovasc Pharmacol. 2013;62(4): 388–93. 7. Demirkol S, Balta S, Cakar M, Unlu M, Arslan Z, Kucuk U. Red cell distribution width: a novel infl ammatory marker in clinical practice. Cardiol J. 2013;20(2): 209.
The Clinical Clinical Respiratory Respiratory Journal Journal (2014) (2016) •• ISSN ISSN 1752-6981 1752-6981 The C 2014 John Wiley & Sons Ltd V © 2014 John Wiley & Sons Ltd
