Red Blood Cell Distribution Width Can Predict Vasculitis Activity and Poor Prognosis in Granulomatosis with Polyangiitis

Abstract

PurposeWe investigated whether red blood cell distribution width (RDW) predicts vasculitis activity based on Birmingham vasculitis activity score (BVAS) or BVAS for granulomatosis with polyangiitis (GPA) at diagnosis and poor prognosis during follow-up in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).Materials and MethodsWe reviewed the medical records of 150 patients with AAV. We defined severe GPA as BVAS for GPA ≥7 (the highest quartile). Correlation and standardised correlation coefficients were analysed by linear regression tests. The differences between groups were evaluated by Mann-Whitney test. Relative risk (RR) was assessed by chi square test and Cox hazards model.ResultsRDW was correlated only with the vasculitis activity of GPA among patients with AAV. An increase in RDW was associated with the absence of ear nose throat (ENT) manifestation, but not proteinase 3-ANCA. Significant differences were noted in cumulative refractory free survival according to RDW ≥15.4% (p=0.007) and the absence of ENT manifestation (p=0.036). Multivariate Cox hazards analysis identified RDW ≥15.4% as the only significant predictor of refractory disease in GPA (RR 17.573).ConclusionRDW predicts vasculitis activity in GPA, and RDW ≥15.4% at diagnosis may increase the risk of severe GPA at diagnosis and predict refractory diseases during follow-up.

Relationship Between Gender and 1-Year Mortality in ANCA-Associated Vasculitis Patients: A Single-Center Retrospective Analysis and Meta-Analysis

“…In addition, NLR also played a positive role in renal damage, and a higher baseline NLR led to a worse renal prognosis ( 45 ). RDW is a routine measurement of the heterogeneity of circulating red blood cell size and is clinically used to distinguish different types of anemia, especially iron-deficiency anemia and chronic anemia ( 46 ). Kim et al found that RDW≥15.4% at diagnosis might increase the risk of severe GPA and predict refractory disease type ( 46 ), and this might be related to the presence of a large number of pro-inflammatory factors in patients with AAV during disease activity, while pro-inflammatory factors were associated with the development of anemia in various diseases ( 47 ).…”

Assessment of the association between red blood cell distribution width and disease activity in patients with systemic vasculitis

“…Zhu et al ( 27 ) indicated that RDW was increased in patients with TA with anemia compared with patients with TA without anemia and control subjects, which was consistent with the present study. However, Kim et al ( 30 ) indicated that RDW was not significantly associated with HB, which may be related to the sex and age variations between the enrolled cohorts.…”

Serological Biomarkers and Indices for the Current Activity and Prognosis of ANCA-Associated Vasculitis: Experience in a Single Centre in Korea

“…Among three subtypes of AAV, RDW at diagnosis could estimate the current activity of GPA and also, predict refractory disease of GPA during follow-up. 60 Next, as for indices containing two to four variables of the initial routine laboratory tests, CRP/serum albumin ratio (CAR) is a formula using two acute-phase reactants that are in the reciprocal direction. CAR at diagnosis was calculated in 170 Korean AAV patients in both SHAVE and retrospective cohorts.…”