Red Cell Distribution Width (RDW) as a Marker of Subclinical Inflammation in Children with Familial Mediterranean Fever

Abstract

Aims: To probe whether RDW can be used as a reliable indicator of subclinical disease in FMF patients. Background: Familial Mediterranean fever (FMF) is an auto inflammatory disease with potentially devastating effects on the kidney, and the chronic subclinical inflammation may also be deleterious. Further, proteinuria has been associated with chronic inflammatory states. Objective: To probe whether RDW can be used as a reliable indicator of subclinical disease in FMF patients. Method: Ninety-nine children with FMF, according to the new pediatric FMF criteria, were included in the present study. All were attack-free at the time of the study. They were compared with 44 healthy age-matched controls. For all patients and controls, the following tests were done: Complete blood count (in the form of red cell count, leukocyte count, platelet count, hemoglobin, RDW and MCV), CRP, ESR, creatinine and an estimated glomerular filtration rate (e-GFR). For patients, serum and urine albumin and albumin/creatinine ratio were also determined. Result: Group 1 consisted of 61 patients, who were not suffering from microalbuminuria, and Group 2 consisted of 38 patients who had confirmed albuminuria. RDW and ESR were significantly higher in patients with FMF without microalbuminuria than in controls, while MCV was smaller in controls (p<0.05). Conclusion: RDW and ESR can be used as indicators of subclinical inflammation in children with FMF. The tests are easy to perform and cheaper than more sophisticated tests. Microalbuminuria may be silent and occur on the background of normal levels of acute phase reactants. All cases must be routinely checked for microalbuminuria. Other: It is worth mentioning that, in developing countries sophisticated tests are often too costly. Improving the availability of simple, low cost laboratory tests continues to be an important issue that needs addressing.

Fibrinogen-to-Albumin Ratio in Familial Mediterranean Fever: Association with Subclinical Inflammation

“…It is critical to determine SI with simple, inexpensive and easy methods compared to the analysis of inflammatory cytokines mentioned above. Therefore, to date, some new inflammatory markers have been investigated in the evaluation of SI in FMF [1,3,23,27].…”

“…We also revealed that MPV was not associated with SI in our patients with FMF. Marzouk et al [23] concluded that RDW was a reliable marker for SI. Özer et al [27] reported that the PLR levels could be used to assess SI in FMF.…”

“…It is reported that subclinical inflammation (SI) persists in nearly 30 % of patients during symptom-free periods and triggers the development of amyloidosis in the long term [7,34]. To date, simple inflammation-based scores; e. g., the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), mean platelet volume (MPV), and red cell distribution width (RDW) have been used to investigate the presence of SI in FMF [1,3,23,27].…”

Predictive Value of Red Blood Cell Distribution Width in Chronic Obstructive Pulmonary Disease Patients with Pulmonary Embolism

“…To date, the relationship between RDW and the occurrence of PE in COPD patients is a relatively uninvestigated area. RDW is associated with several inflammatory markers, such as acute-phase reactants C-reactive protein (CRP), erythrocyte sedimentation rate, and platelet count [ 18 , 19 ]. Studies have shown that markers of systemic inflammation, such as CRP, IL-6, IL-8, and TNF- α , contribute to the development of thrombotic events [ 20 ].…”

Relationship between C-reactive Protein/Albumin Ratio and Subclinical Inflammation in Patients with Familial Mediterranean Fever

“…In some patients, subclinical inflammation (SI) may progress during attack-free intervals in FMF and triggers amyloidosis despite colchicine therapy [10,11]. Recently, inflammation during the symptom-free periods of FMF has been reported to correlate with simple inflammatory-based scores, including the mean platelet volume (MPV), red cell width distribution (RDW), neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) [12][13][14][15][16]. The CRP/serum albumin ratio (CAR) is a new inflammation score used as a marker of chronic inflammation and prognosis in solid tumours [17], critically ill patients [18], rheumatoid arthritis [19], and ANCA-associated vasculitis [20].…”