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Red cell distribution width and other red blood cell parameters in patients with cancer: association with risk of venous thromboembolism and mortality.

Riedl J, Posch F, Königsbrügge O, Lötsch F, Reitter EM, Eigenbauer E, Marosi C, Schwarzinger I, Zielinski C, Pabinger I, Ay C - PLoS ONE (2014)

Bottom Line: High RDW (>16%) was not associated with a higher risk of VTE in the total study cohort; in competing risk analysis accounting for death as competing variable the univariable subhazard ratio (SHR) was 1.34 (95% confidence interval [CI]: 0.80-2.23, p = 0.269).There was also no significant association between other RBC parameters and risk of VTE.High RDW was associated with an increased risk of mortality in the total study population (hazard ratio [HR, 95% CI]: 1.72 [1.39-2.12], p<0.001), and this association prevailed after adjustment for age, sex, hemoglobin, leukocyte and platelet count (HR [95% CI]: 1.34 [1.06-1.70], p = 0.016).

View Article: PubMed Central - PubMed

Affiliation: Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria.

ABSTRACT

Background: Cancer patients are at high risk of developing venous thromboembolism (VTE). Red cell distribution width (RDW) has been reported to be associated with arterial and venous thrombosis and mortality in several diseases. Here, we analyzed the association between RDW and other red blood cell (RBC) parameters with risk of VTE and mortality in patients with cancer.

Methods: RBC parameters were measured in 1840 patients with cancers of the brain, breast, lung, stomach, colon, pancreas, prostate, kidney; lymphoma, multiple myeloma and other tumor sites, that were included in the Vienna Cancer and Thrombosis Study (CATS), which is an ongoing prospective, observational cohort study of patients with newly diagnosed or progressive cancer after remission. Primary study outcome is occurrence of symptomatic VTE and secondary outcome is death during a maximum follow-up of 2 years.

Results: During a median follow-up of 706 days, 131 (7.1%) patients developed VTE and 702 (38.2%) died. High RDW (>16%) was not associated with a higher risk of VTE in the total study cohort; in competing risk analysis accounting for death as competing variable the univariable subhazard ratio (SHR) was 1.34 (95% confidence interval [CI]: 0.80-2.23, p = 0.269). There was also no significant association between other RBC parameters and risk of VTE. High RDW was associated with an increased risk of mortality in the total study population (hazard ratio [HR, 95% CI]: 1.72 [1.39-2.12], p<0.001), and this association prevailed after adjustment for age, sex, hemoglobin, leukocyte and platelet count (HR [95% CI]: 1.34 [1.06-1.70], p = 0.016).

Conclusions: RDW and other RBC parameters were not independently associated with risk of VTE in patients with cancer and might therefore not be of added value for estimating risk of VTE in patients with cancer. We could confirm that high RDW is an independent predictor of poor overall survival in cancer.

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Related in: MedlinePlus

Cumulative incidence of venous thromboembolism (VTE), accounting for competing risk (death of any cause) in patients with solid tumors, grouped into patients with red cell distribution width (RDW)>16% and below (≤16%), respectively.The probability of VTE was higher in patients with high RDW (>16%) compared to patients with lower RDW (Gray's test p = 0.051). Numbers in parentheses indicate numbers of VTE events in the respective group and time period.
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pone-0111440-g002: Cumulative incidence of venous thromboembolism (VTE), accounting for competing risk (death of any cause) in patients with solid tumors, grouped into patients with red cell distribution width (RDW)>16% and below (≤16%), respectively.The probability of VTE was higher in patients with high RDW (>16%) compared to patients with lower RDW (Gray's test p = 0.051). Numbers in parentheses indicate numbers of VTE events in the respective group and time period.

Mentions: As our study population consists of a very heterogeneous group of patients with different cancer sites, including hematological malignancies or brain tumors, we conducted a subgroup analysis of patients with solid tumors only. In this subgroup high RDW was associated with an 80% increase in risk of VTE compared to lower RDW (SHR [95% CI]: 1.80 [0.99–3.26], p = 0.053). However, in multivariable analyses (adjusting for the same variables as in our analyses conducted in the total study cohort) we did not observe a significant association between RDW and risk of VTE (data are shown in table 3). The cumulative probability of VTE in patients with high RDW was 8.3% after 6 months, 10.0% after one year and 11.0% after two years in comparison to 4.5%, 5.5% and 6.4%, respectively in those patients who had a lower RDW (Gray's test p = 0.051; Figure 2).


Red cell distribution width and other red blood cell parameters in patients with cancer: association with risk of venous thromboembolism and mortality.

Riedl J, Posch F, Königsbrügge O, Lötsch F, Reitter EM, Eigenbauer E, Marosi C, Schwarzinger I, Zielinski C, Pabinger I, Ay C - PLoS ONE (2014)

Cumulative incidence of venous thromboembolism (VTE), accounting for competing risk (death of any cause) in patients with solid tumors, grouped into patients with red cell distribution width (RDW)>16% and below (≤16%), respectively.The probability of VTE was higher in patients with high RDW (>16%) compared to patients with lower RDW (Gray's test p = 0.051). Numbers in parentheses indicate numbers of VTE events in the respective group and time period.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4210186&req=5

pone-0111440-g002: Cumulative incidence of venous thromboembolism (VTE), accounting for competing risk (death of any cause) in patients with solid tumors, grouped into patients with red cell distribution width (RDW)>16% and below (≤16%), respectively.The probability of VTE was higher in patients with high RDW (>16%) compared to patients with lower RDW (Gray's test p = 0.051). Numbers in parentheses indicate numbers of VTE events in the respective group and time period.
Mentions: As our study population consists of a very heterogeneous group of patients with different cancer sites, including hematological malignancies or brain tumors, we conducted a subgroup analysis of patients with solid tumors only. In this subgroup high RDW was associated with an 80% increase in risk of VTE compared to lower RDW (SHR [95% CI]: 1.80 [0.99–3.26], p = 0.053). However, in multivariable analyses (adjusting for the same variables as in our analyses conducted in the total study cohort) we did not observe a significant association between RDW and risk of VTE (data are shown in table 3). The cumulative probability of VTE in patients with high RDW was 8.3% after 6 months, 10.0% after one year and 11.0% after two years in comparison to 4.5%, 5.5% and 6.4%, respectively in those patients who had a lower RDW (Gray's test p = 0.051; Figure 2).

Bottom Line: High RDW (>16%) was not associated with a higher risk of VTE in the total study cohort; in competing risk analysis accounting for death as competing variable the univariable subhazard ratio (SHR) was 1.34 (95% confidence interval [CI]: 0.80-2.23, p = 0.269).There was also no significant association between other RBC parameters and risk of VTE.High RDW was associated with an increased risk of mortality in the total study population (hazard ratio [HR, 95% CI]: 1.72 [1.39-2.12], p<0.001), and this association prevailed after adjustment for age, sex, hemoglobin, leukocyte and platelet count (HR [95% CI]: 1.34 [1.06-1.70], p = 0.016).

View Article: PubMed Central - PubMed

Affiliation: Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria.

ABSTRACT

Background: Cancer patients are at high risk of developing venous thromboembolism (VTE). Red cell distribution width (RDW) has been reported to be associated with arterial and venous thrombosis and mortality in several diseases. Here, we analyzed the association between RDW and other red blood cell (RBC) parameters with risk of VTE and mortality in patients with cancer.

Methods: RBC parameters were measured in 1840 patients with cancers of the brain, breast, lung, stomach, colon, pancreas, prostate, kidney; lymphoma, multiple myeloma and other tumor sites, that were included in the Vienna Cancer and Thrombosis Study (CATS), which is an ongoing prospective, observational cohort study of patients with newly diagnosed or progressive cancer after remission. Primary study outcome is occurrence of symptomatic VTE and secondary outcome is death during a maximum follow-up of 2 years.

Results: During a median follow-up of 706 days, 131 (7.1%) patients developed VTE and 702 (38.2%) died. High RDW (>16%) was not associated with a higher risk of VTE in the total study cohort; in competing risk analysis accounting for death as competing variable the univariable subhazard ratio (SHR) was 1.34 (95% confidence interval [CI]: 0.80-2.23, p = 0.269). There was also no significant association between other RBC parameters and risk of VTE. High RDW was associated with an increased risk of mortality in the total study population (hazard ratio [HR, 95% CI]: 1.72 [1.39-2.12], p<0.001), and this association prevailed after adjustment for age, sex, hemoglobin, leukocyte and platelet count (HR [95% CI]: 1.34 [1.06-1.70], p = 0.016).

Conclusions: RDW and other RBC parameters were not independently associated with risk of VTE in patients with cancer and might therefore not be of added value for estimating risk of VTE in patients with cancer. We could confirm that high RDW is an independent predictor of poor overall survival in cancer.

Show MeSH
Related in: MedlinePlus