Utility of Red Cell Distribution Width (RDW) as a Noninvasive Biomarker for the Diagnosis of Acute Appendicitis: A Systematic Review and Meta-Analysis of 5222 Cases

Abstract

Background: Despite great advances in medicine, numerous available laboratory markers, and radiological imaging, the diagnosis of acute appendicitis (AA) in some cases still remains controversial and challenging for clinicians. Because of that, clinicians are still looking for an ideal marker that would be specific to AA. The red blood cell distribution width (RDW) has been recently investigated in several studies as a potential biomarker for AA. The aim of this systematic review and meta-analysis was to systematically summarize and compare all relevant data on RDW as a diagnostic biomarker for AA. Methods: This systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Scientific databases (PubMed, Scopus, Web of Science, and Excerpta Medica database—EMBASE) were systematically searched for relevant comparative studies by two independent researches using keywords ((red cell distribution width) OR rdw) AND (appendicitis). An independent assessment of the methodological quality was performed by two authors using the Downs and Black scale. RevMan 5.4 software was used to perform the meta-analysis. Results: Fifteen studies were included in the final meta-analysis; the majority of the studies was retrospective. Nine studies compared the RDW values between AA and non-AA; four studies compared the same between AA and healthy controls, while two studies compared the RDW values among all three groups. The estimated heterogeneity among the studies for all outcome was statistically significant (I2 = 92–99%, p < 0.00001). The pooling the data demonstrated no statistically significant difference in the RDW values (weighted mean difference (WMD) = 0.03, 95% CI = (−0.46, 0.52), p = 0.91) between AA and healthy controls as well as between AA and non-AA cases (WMD = 0.23, 95%CI = (–0.19, 0.65), p = 0.28). A separate subanalysis was performed to evaluate the utility of this biomarker for the pediatric age group. Pooling the data demonstrated no significant difference among the AA and non-AA groups in terms of the RDW values (WMD = 0.99, 95% CI = (–0.35, 2.33), p = 0.15). Conclusion: The RDW value difference demonstrated no statistically significant difference in AA versus healthy individuals and AA versus non-AA individuals. At the moment, there is no evidence of RDW utility in diagnostic testing of AA. Further research with prospective, multicenter studies and studies targeting special patient groups with a large sample size are needed in this field.

Hyponatremia—A New Diagnostic Marker for Complicated Acute Appendicitis in Children: A Systematic Review and Meta-Analysis

“…For the diagnosis of complicated appendicitis, Duman et al and Besli et al designated a cut-off value for serum sodium of <137 mmol/L and ≤138 mmol/L, respectively [ 18 , 20 ]. Several other laboratory markers have recently been investigated, such as hyperbilirubinemia, MPV, RDW, and interleukins, but none of these have the same levels of sensitivity and specificity as hyponatremia in the detection of complicated appendicitis [ 57 , 58 , 59 , 60 ].…”

IL-6 Serum Levels Can Enhance the Diagnostic Power of Standard Blood Tests for Acute Appendicitis

“…Recently, some studies have investigated the sensitivity of other laboratory markers in detecting the presence of AA in children. Anand et al reviewed the literature on red cell distribution width and mean platelet volume in separate systemic reviews, without identifying a clear role in diagnosing pediatric AA [ 34 , 35 , 36 ], whereas the pooling data showed significantly elevated levels of pentraxin-3 in AA compared to healthy controls [ 34 ]. In another meta-analysis, the same authors highlighted hyponatremia as an independent prognosticator of CAA [ 18 ].…”

Diagnostic Value of IGFBP-2 in Predicting Preeclampsia before 20 Weeks of Pregnancy: A Prospective Nested Case-Control Study

“…In this study, the red blood cell count, red blood cell distribution width, and prothrombin time in the PE group were higher in comparison to those in the normal group. Reportedly, the increase in RBC distribution width is due to the influence of inflammatory factors on RBC production and deformation ability [ 26 , 27 ]. This study found that red blood cell count in the PE group increased significantly in early pregnancy, which might be due to the compensatory response caused by microcirculation ischemia and hypoxia in the body.…”