Clinical significance of red blood cell distribution width in systemic lupus erythematosus patients

Abstract

Background Systemic lupus erythematosus (SLE) is a multi-organ autoimmune disorder with wide variety of clinical presentations. Recently, red blood cell distribution width (RDW) has been used as an inflammatory marker, similar to the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) where systemic inflammation has been linked to increased RDW. Many researches have assessed independently selective different hematological markers that may reflect disease activity. Our study aims to examine a number of hematological parameters that could reflect disease activity and to assess if there is a relationship between different hematological parameter (RDW, neutrophils and lymphocytes) to reflect SLE activity using Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Results The study comprised 60 SLE patients (52 females and 8 males) with a mean age of 34.53 years and mean disease duration was 4.085 years. The RDW values were significantly higher (p < 0.001) when comparing active patients (16.64 ± 4.7) versus inactive patients (13.16 ± 2.67) and controls (12.7 ± 1.13). Otherwise, insignificant differences were reported when comparing inactive SLE patients versus the control group (p = 0.242). There were no significant correlations (p > 0.05) between neutrophil count and lymphocyte count with C3, C4, SLEDAI score, 24 h urinary proteins, platelets count but significant only with hemoglobin level (p = 0.001). Conclusion Increased RDW is connected with active disease status of SLE patients. RDW could be used as a surrogate marker of the inflammation rather than neutrophil and lymphocyte count. It is a simple and easy testing included in CBC thus RDW could be used as a possible indicator to assess disease activity.

Association between Red Cell Distribution Width to Platelet Ratio and Disease Activity among Iraqi Patients with Systemic Lupus Erythematosus

“…Xie et al[20] described the first two values as being higher. Mohamed et al found similar results, with a mean age of 34.53 years, female forms in 86.6 percent of patients, and a mean disease duration of 4.085 years[13]. In this regard, Ibrahim et al discovered that SLE patients ranged in age from 16 to 45, that 80% of them were females, and that the disease duration was 3.63 years[22].…”

“…Previous studies proved that RDW was associated with the increased severity of inflammatory bowel disease (IBD), RA [10], and psoriatic arthritis [11]. Another recent study has also concluded that RDW was increased in patients with SLE [12,13]. Due to the effect of inflammatory cytokines, there is a release of premature erythrocytes into the circulation and a resultant increase in RBC distribution width [14].…”

High Red Cell Distribution Width and Low Absolute Lymphocyte Count Associate With Subsequent Mortality in HCV Infection

“…Here we observed at the time of performance of TE that persons with RDW of 14% or above had lower subsequent survival probability, even after adjusting for age, TE score, sex, race, and ASCVD score. We have previously shown that the RDW correlates with pro-inflammatory cytokines [ 24 ], though the specific mechanism for the RDW association with survival remains unclear [ 25 – 27 ]. Immunologic parameters associated with cirrhosis (sCD14, ATX, Mac2BP, MCP-1) might be expected to associate with RDW since RDW was found here to associate with TE score (a measure of fibrosis).…”

Red blood cell distribution width: a promising index for estimating disease activity of Systemic lupus erythematosus

“…These findings are parallel to the observation of some groups of authors. 12,[25][26] In Multivariate logistic regression analysis showed a significant association among RDW, ESR and active disease (SLEDAI score >9). Like other inflammatory marker (i.e., ESR) increased RDW was 5 times more risk of developing active disease than inactive SLE.…”

“…11 The red blood cell distribution width (RDW) is widely available, inexpensive and easily repeatable, novel, accurate inflammatory biomarker which are easily measured and sensitive to changes in disease activity. 12…”