Value Of Red Cell Distribution Width In Diagnosis And Prognosis Of Partial Children's Disease

Objectives The red blood cell distribution width(RDW)is a simple and inexpensive parameter,which reflects the degree of heterogeneity of erythrocyte volume,and is traditionally used in laboratory hematology for differential diagnosis of anemias.Nonetheless,recent evidence attests that anisocytosis is commonplace in human disorders such as cardiovascular disease,venous thromboembolism,cancer,diabetes,community-acquired pneumonia,chronic obstructive pulmonary disease,liver and kidney failure,as well as in other acute or chronic conditions.An increased RDW has a high negative predictive value for diagnosing a variety of disorders,and also conveys important information for short-and long-term prognosis.Children's disease is more complex,and is difficult to cooperate with all kinds of tests.Thus,it is urgent to need more convenient diagnostic and predictive indicators.For this purpose,this study discussed the value of RDW in the diagnosis and prognosis of several common pediatric diseases,including children severe pneumonia,infant iron deficiency,acute rheumatic valvular disease and epistaxis in children.Methods 1.Red blood cell distribution width with short-term prognosis in children severe pneumonia: A retrospective analysis of clinical,laboratory and imaging data of children with severe pneumonia was performed.The patients were divided into improvement group and deterioration group according to the prognosis at the time of discharge.And patients were divided into high RDW group and low RDW group according to the mean value of RDW at admission.2.Red blood cell distribution width with iron-deficient infantile: The clinical and laboratory data of 400 children aged 6 months-3 years in the outpatient department were collected.The levels of RDW were compared in infantile with iron deficiency(ID),iron deficiency anaemia(IDA)and adequate iron.3.Red blood cell distribution width with acute rheumatic valvular disease in children: A total of 100 pediatric patients diagnosed with acute rheumatic carditis and 110 health controls were retrospectively analyzed.At the time of diagnosis and after 2 months of medical therapy,we reviewed the RDW,valvalar involvement and acute phase reactants.4.Red blood cell distribution width with epistaxis in children: A total of 110 children with epistaxia and 100 sex-and age-matched control were retrospectively analyzed.The RDW and MPV values were compared between two groups.Results 1.Red blood cell volume distribution width with short-term prognosis in children severe pneumonia: Compared with improvement group,the age in the deterioration group was smaller,and the RDW increased significantly(P<0.05).The CT features and semi-quantitative analysis results of the patients were consistent with the prognosis of the disease.Spearman correlation analysis showed that there was a positive correlation between RDW and the change of CT semi-quantitative scores.Logistic regression analysis showed that only the RDW was the risk factor for deterioration of children with severe pneumonia.Compared with lower RDW group,the age,CRP and PMN in the higher RDW group were lower.ROC curve analysis showed that the RDW level predicted a ROC AUC of 0.829,and the sensitivity of 76.7%,the specificity of 84.4% with the best diagnosis cut-off point of 50.7%.2.Red blood cell distribution width with in iron-deficient infantile: RDW was inversely correlated with derum ferritin and not associated with C-reactiove protein.Calculated cut-of values for RDW to detect ID and IDA gave a relatively low sensitivity(53.1% and 57.1%,respectively)and specifcity(64.7% and 69.9%,respectively).Anaemic children with a RDW >14.3% had a 2.7 higher odds to be iron defcient,compared to anaemic children with a RDW <14.3%.3.Red blood cell distribution width with acute rheumatic valvular disease in children: WBC,PLT and RDW were found to be significantly higher in patient group compared with controls at the time of diagnosis,prior to the onset of treatment.RDW values after the medical treatment were still significantly higher compared with controls.RDW values were significantly higher in patients with multiple valvular involvement both prior to and after the treatment.Moreover,we found a significant and positive correlation between the RDW and the severity of mitral regurgitation in our patients.4.Red blood cell distribution width with epistaxis in children: RDW values were found significantly(P< 0.05)lower in the group with epistaxis than in the control group(11.95 ± 1.31 vs.12.74 ± 1.21).There were no significant difference in the level of MPV,PMN,WBC and CRP between two groups(P > 0.05).Conclusion 1.The level of RDW may be an independent risk factor for the poor prognosis of children with severe pneumonia.It can be used to estimate the prognosis of children.2.RDW can be helpful for identifying ID as the cause of anaemia in 0.5-3 year old children,but not as primary biomarker of ID(A).3.High levels of RDW after initial medical treatment may indicate an ongoing subtle inflammatory process that leads to future stenotic valvular lesions.However,long-term follow-up studies are needed involving adulthood period to support this hypothesis.4.There were no notable relation between RDW and epistaxis in children.