Evaluation of Red Cell Distribution Width as a Screening Marker for Right Ventricular Dysfunction in Stable COPD Patients
D. Chatterjee, A.K. Janmeja, J.R. Kashyap, D. Aggarwal, A. Tahlan, S. Ragaselvi
Keywords :
Red cell distribution width, Chronic obstructive pulm onary disease, TAPSE, S velocity, Right ventricular dysfunction
Citation Information :
Chatterjee D, Janmeja A, Kashyap J, Aggarwal D, Tahlan A, Ragaselvi S. Evaluation of Red Cell Distribution Width as a Screening Marker for Right Ventricular Dysfunction in Stable COPD Patients. Indian J Chest Dis Allied Sci 2020; 62 (1):9-12.
Objective: Right ventricular (RV) dysfunction is a commonly overlooked; but prognostically important complication of chronic obstructive pulmonary disease (COPD). Red cell distribution width (RDW) is a potential blood parameter that may have a role in the detection of RV dysfunction. The present study was conducted to evaluate the role of RDW as a screening marker for RV dysfunction in COPD.
Methods: A total of 80 consecutive stable COPD patients were enrolled. After initial spirometry, patients were screened for RV dysfunction using RDW measurement. Thereafter, two-dimensional (2D) transthoracic echocardiography (2D-TTE) was performed to confirm the RV dysfunction by measuring tricuspid annular plane systolic excursion (TAPSE) and RV lateral wall tissue doppler systolic velocity (S velocity). Sensitivity, specificity and positive and negative predictive values of RDW was calculated using 2D-TTE as the reference standard.
Results: The study cohort of COPD patients mainly comprised of middle-aged males (mean age: 57.1+9.3 years; M:F=6:1). Out of 80 patients, 26 (32.5%) had RDW above the cut-off value of 14%. On comparing them with the 10 patients (12.5%), diagnosed on 2D-TTE, RDW showed a sensitivity and specificity of 90% and 75%, respectively in detecting RV dysfunction. On multivariate logistic regression analysis, RDW was the only independent parameter predicting RV dysfunction (OR: 4.04; 95% CI: 1.5-10.5; p= 0.004) in COPD patients.
Conclusion: Red cell distribution width is a sensitive screening marker of RV dysfunction that may be incorporated in the in diagnostic algorithm of COPD patients.
Murthy KJR, Sastry JG. Economic burden of chronic obstructive pulmonary disease. In: Background Papers: Burden of Disease in India. New Delhi: National Commission on Macroeconomics and Health Ministry of Health and Family Welfare, Government of India. 2005;pp.265–74.
de Miguel-Diez J, Carrasco-Garrido P, Rejas-Gutierrez J, Martín- Centeno A, Gobartt-Vázquez E, Hernandez-Barrera V, et al. The influence of heart disease on characteristics, quality of life, use of health resources, and costs of COPD in primary care settings. BMC Cardiovasc Disord 2010;10:8.
Janda S, Shahidi N, Gin K, Swiston J. Diagnostic accuracy of echocardiography for pulmonary hypertension: a systematic review and meta-analysis. Heart 2011;97:612–22.
S alvagno GL, Sanchis-Gomar F, Picanza A, Lippi G. Red blood cell distribution width: a simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci 2015;52:86–105.
C authen CA, Tong W, Jain A, Tang WH. Progressive rise in red cell distribution width is associated with disease progression in ambulatory patients with chronic heart failure. J Card Fail 2012;18:146–52.
Hampole CV, Mehrotra AK, Thenappan T, Gomberg-Maitland M, Shah SJ. Usefulness of red cell distribution width as a prognostic marker in pulmonary hypertension. Am J Cardiol 2009;104:868–72.
O zsu S, Abul Y, Gulsoy A, Bulbul Y, Yaman S, Ozlu T. Red cell distribution width in patients with obstructive sleep apnea syndrome. Lung 2012;190:319–26.
Kos M, Hocazade C, Kos FT, Uncu D, Karakas E, Dogan M, et al. Evaluation of the effects of red blood cell distribution width on survival in lung cancer patients. Contemp Oncol (Pozn) 2016;20:153–7.
Nathan SD, Reffett T, Brown AW, Fischer CP, Shlobin OA, Ahmad S, et al. The red cell distribution width as a prognostic indicator in idiopathic pulmonary fibrosis. Chest 2013;143:1692–8.
Meynaar IA, Knook AH, Coolen S, Le H, Bos MM, van der Dijs F, et al. Red cell distribution width as predictor for mortality in critically ill patients. Neth J Med 2013;71:488–93.
S incer I, Zorlu A, Yilmaz MB, Dogan OT, Ege MR, Amioglu G, et al. Relationship between red cell distribution width and right ventricular dysfunction in patients with chronic obstructive pulmonary disease. Heart Lung 2012;41:238–43.
Bujang MA, Adnan TH. Requirements for minimum sample size for sensitivity and specificity analysis. J Clin Diagn Res 2016;10:YE01–YE6.
Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J 2005;26:319–38.
Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) [Internet]. 2015. [cited 2015 Oct 12]. Available from URL: http://www.goldcopd.org/. Accessed on October 12, 2015.
Evans TC, Jehle D. The red blood cell distribution width. J Emerg Med 1991; 9 (Suppl.1):71–4.
Marsh WL, Jr, Bishop JW, Darcy TP. Evaluation of red cell volume distribution width (RDW). Hematol Pathol 1987;1:117–23.
Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 2010;23:685–713.
O zgul G, Seyhan EC, Ozgul MA, Gunluoglu MZ. Red blood cell distribution width in patients with chronic obstructive pulmonary disease and healthy subjects. Arch Bronconeumol 2017;53:107–13.
T ertemiz KC, Ozgen Alpaydin A, Sevinc C, Ellidokuz H, Acara AC, Cimrin A. Could “red cell distribution width” predict COPD severity? Rev Port Pneumol (2006) 2016;22:196–201.
S eyhan EC, Ozgul MA, Tutar N, Omur I, Uysal A, Altin S. Red blood cell distribution and survival in patients with chronic obstructive pulmonary disease. COPD 2013;10:416–24.
