Value of red blood cell distribution width in prediction of diastolic dysfunction in cirrhotic cardiomyopathy

doi:10.3748/wjg.v29.i15.2322

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World J Gastroenterol. Apr 21, 2023; 29(15): 2322-2335
Published online Apr 21, 2023. doi: 10.3748/wjg.v29.i15.2322

Table 1 Comparison of demographic and medical records in the study groups, n (%)

Variable	Group I (n = 105)	Group II (n = 175)	Group III (n = 139)	Group IV (n = 86)	F/χ²	P
Demographics
Age (yr)	66.20 ± 7.93	67.94 ± 7.41	67.74 ± 7.84	68.00 ± 7.86	1.344	0.259
Male	65 (61.9)	95 (54.3)	82 (59.0)	56 (65.1)	3.304	0.347
Smokers	29 (27.6)	49 (28.0)	51 (36.7)	32 (37.2)	4.697	0.195
Body-mass index (kg/m²)	23.11 ± 2.37	23.23 ± 3.95	23.75 ± 3.24	24.27 ± 3.52	2.520	0.057
Medical history
Hypertension	20 (19.0)	32 (18.3)	35 (25.2)	26 (30.2)	6.041	0.110
Hyperlipidemia	20 (19.0)	50 (28.6)	68 (48.9)	40 (46.5)	31.658	< 0.001
Diabetes mellitus	23 (21.9)	35 (20.0)	37 (26.6)	26 (30.2)	4.146	0.246
Atrial fibrillation	8 (7.6)	36 (20.6)	52 (37.4)	34 (39.5)	38.947	< 0.001
Stroke	3 (2.9)	5 (2.9)	4 (2.9)	4 (4.7)	0.908¹	0.864
Cirrhosis etiology
Fatty liver	17 (16.2)	22 (12.6)	17 (12.2)	17 (19.8)	3.277	0.351
Alcoholic liver	18 (17.1)	38 (21.7)	32 (23)	26 (30.2)	4.748	0.191
Viral hepatitis	53 (50.5)	100 (57.1)	75 (54)	36 (41.9)	5.695	0.127
Autoimmune liver disease	16 (15.2)	15 (8.6)	14 (10.1)	9 (10.5)	3.157	0.368
Liver cancer	5 (4.8)	8 (4.6)	7 (5)	4 (4.7)	0.151¹	1.000

¹Fisher’s exact test.

Table 2 Comparison of clinical data among groups, n (%)

Variable	Group I (n = 105)	Group II (n = 175)	Group III (n = 139)	Group IV (n = 86)	F/χ²	P
Clinical feature
Haematemesis	6 (5.7)	12 (6.9)	16 (11.5)	16 (18.6)	11.588	0.009
Edema	2 (1.9)	12 (6.9)	20 (14.4)	33 (38.4)	65.284	< 0.001
SBP	1 (1.0)	4 (2.3)	11 (7.9)	13 (15.1)	23.486	< 0.001
Hyponatremia	3 (2.9)	21 (12.0)	31 (22.3)	31 (36.0)	42.806	< 0.001
Hepatic encephalopathy	5 (4.8)	10 (5.7)	14 (10.1)	19 (22.1)	21.565	< 0.001
Refractory ascites	2 (1.9)	4 (2.3)	15 (10.8)	21 (24.4)	44.367	< 0.001
Jaundice	12 (11.4)	13 (7.4)	15 (10.8)	20 (23.3)	14.120	0.003
MELD score	8.74 ± 1.54	8.64 ± 1.57	17.04 ± 1.96^a^,^b	25.19 ± 2.15^a^,^b^,^c	2081.425	< 0.001
Laboratory index
RDW (%)	12.54 ± 0.85	13.29 ± 1.19^a	14.3 ± 1.96^a^,^b	16.25 ± 2.13^a^,^b^,^c	101.958	< 0.001
TBIL (μmol/L)	12.3 (10.9, 13.45)	11.5 (9.8, 14.5)	12.8 (10.7, 17.5)^b	16.3 (13.18,24.95)^a^,^b^,^c	57.344	< 0.001
ALB (g/L)	45.91 ± 3.83	44.92 ± 5.19^a	37.85 ± 4.71^a^,^b	33.50 ± 5.65^a^,^b^,^c	159.072	< 0.001
ALT (IU/L)	24 (18, 32)	27 (21, 34)^a	32 (23, 37)^a^,^b	35 (26, 75)^a^,^b^,^c	40.591	< 0.001
AST (IU/L)	26 (19.5, 33)	28 (21, 35)	30 (22, 36)^a	34 (25, 62)^a^,^b	25.257	< 0.001
γ-GT (IU/L)	32 (20, 44)	30 (22, 41)	35 (26, 43)	37 (26, 47)^a^,^b	14.96	0.002
ALP (IU/L)	65 (52, 84)	74 (53, 88)	69 (54, 87)	69 (58, 84)	3.535	0.316
WBC count (× 10⁹/L)	5.64 ± 1.51	5.36 ± 1.40	5.76 ± 1.16^b	6.10 ± 1.55^a^,^b	5.695	0.001
Hemoglobin (g/L)	122.86 ± 15.53	121.10 ± 15.30	107.92 ± 16.33^a^,^b	99.28 ± 18.15^a^,^b^,^c	52.186	< 0.001
Platelet count (× 10⁹/L)	190.15 ± 62.47	174.98 ± 41.71^a	101.09 ± 27.46^a^,^b	90.38 ± 32.33^a^,^b	165.715	< 0.001
INR	0.91 (0.59, 1.27)	1.21 (0.61, 1.80)^a	1.58 (0.86, 2.41)^a^,^b	1.37 (1.17, 2.22)^a^,^b	57.797	< 0.001
NT-proBNP (pg/mL)	72 (61, 84)	76 (61, 98)	354 (127, 653)^a^,^b	647 (364, 1430)^a^,^b^,^c	242.974	< 0.001
eGFR (ml/min/1.73 m²)	62.35 ± 11.09	60.87 ± 13.52	59.07 ± 15.94	43.31 ± 11.39^a^,^b^,^c	40.691	< 0.001
Drug information
Diuretic	3 (2.9)	7 (4)	20 (14.4)	32 (37.2)	69.996	< 0.001
Spirolactone	3 (2.9)	7 (4)	17 (12.2)	26 (30.2)	50.491	< 0.001
ACEI/ARB	7 (6.7)	23 (13.1)	22 (15.8)	23 (26.7)	15.690	0.001
β-blocker	6 (5.7)	13 (7.4)	23 (16.5)	22 (25.6)	23.776	< 0.001

^aP < 0.05 when compared with Group I.

^bP < 0.05 when compared with Group II.

^cP < 0.05 when compared with Group III.

ACEI: Angiotensin converting enzyme inhibitor; ALB: Albumin; ALP: Alkaline phosphatase; ALT: Alanine transaminase; ARB: Angiotensin receptor blocker; AST: Aspartic transaminase; eGFR: Estimated glomerular filtration rate; INR: International normalized ratio; NT-proBNP: N-terminal pro-brain natriuretic peptide; RDW: Red blood cell distribution width; SBP: Spontaneous bacterial peritonitis; TBIL: Total bilirubin; WBC: White blood cell; γ-GT: γ-glutamyl transferase.

Table 3 Multiple logistics regression analysis for each group and the control group

Part	Variable	B	SE	Wald	P	OR (95%Cl)
Part I	RDW (%)	0.777	0.173	20.141	< 0.001	2.175 (1.549, 3.054)
	TBIL (μmol/L)	-0.086	0.051	2.810	0.094	0.918 (0.83, 1.015)
	ALB (g/L)	-0.060	0.035	2.973	0.085	0.942 (0.879, 1.008)
	ALT (IU/L)	0.122	0.067	3.350	0.067	1.129 (0.991, 1.287)
	AST (IU/L)	-0.108	0.060	3.178	0.075	0.898 (0.798, 1.011)
	γ-GT (IU/L)	0.004	0.011	0.117	0.733	1.004 (0.982, 1.026)
	WBC count (× 10⁹/L)	0.026	0.107	0.059	0.808	1.026 (0.832, 1.265)
	Hemoglobin (g/L)	0.012	0.010	1.294	0.255	1.012 (0.992, 1.032)
	Platelet count (× 10⁹/L)	-0.006	0.003	3.638	0.056	0.994 (0.988, 1.000)
	INR	0.418	0.290	2.074	0.150	1.519 (0.86, 2.683)
	NT-proBNP (pg/mL)	0.001	0.002	0.417	0.518	1.001 (0.997, 1.005)
	eGFR (mL/min/1.73 m²)	-0.009	0.012	0.598	0.439	0.991 (0.967, 1.015)
	Hyperlipidemia	-0.074	0.346	0.046	0.831	0.929 (0.471, 1.830)
	Atrial fibrillation	-0.402	0.602	0.448	0.503	0.669 (0.206, 2.174)
	Haematemesis	-0.730	0.711	1.054	0.305	0.482 (0.12, 1.942)
	Edema	0.105	1.196	0.008	0.930	1.111 (0.107, 11.580)
	SBP	1.623	2.242	0.524	0.469	5.07 (0.063, 410.934)
	Hyponatremia	-1.682	0.934	3.243	0.072	0.186 (0.030, 1.16)
	Hepatic encephalopathy	-0.161	0.804	0.040	0.842	0.852 (0.176, 4.119)
	Jaundice	-1.044	1.264	0.683	0.409	0.352 (0.030, 4.188)
	Refractory ascites	0.256	1.498	0.029	0.864	1.292 (0.069, 24.324)
Part II	RDW (%)	0.895	0.294	9.265	0.002	2.447 (1.375, 4.354)
	TBIL (μmol/L)	-0.028	0.083	0.116	0.733	0.972 (0.825, 1.145)
	ALB (g/L)	-0.723	0.140	26.552	< 0.001	0.485 (0.369, 0.639)
	ALT (IU/L)	0.337	0.087	15.167	< 0.001	1.401 (1.182, 1.660)
	AST (IU/L)	-0.390	0.087	19.883	< 0.001	0.677 (0.571, 0.804)
	γ-GT (IU/L)	0.037	0.018	4.313	0.038	1.037 (1.002, 1.074)
	WBC count (× 10⁹/L)	0.592	0.253	5.464	0.019	1.807 (1.100, 2.969)
	Hemoglobin (g/L)	-0.057	0.026	4.929	0.026	0.944 (0.898, 0.993)
	Platelet count (× 10⁹/L)	-0.055	0.010	32.104	< 0.001	0.947 (0.929, 0.965)
	INR	1.894	0.563	11.321	0.001	6.643 (2.205, 20.018)
	NT-proBNP (pg/mL)	0.008	0.003	8.203	0.004	1.008 (1.003, 1.014)
	eGFR (mL/min/1.73 m²)	0.062	0.027	5.365	0.021	1.064 (1.010, 1.121)
	Hyperlipidemia	-1.173	0.658	3.174	0.075	0.309 (0.085, 1.125)
	Atrial fibrillation	0.365	1.006	0.132	0.717	1.441 (0.201, 10.345)
	Haematemesis	2.282	1.499	2.318	0.128	9.792 (0.519, 184.678)
	Edema	3.004	1.778	2.855	0.091	20.159 (0.618, 657.095)
	SBP	4.715	4.750	0.985	0.321	111.572 (0.010, 1231574.165)
	Hyponatremia	-0.424	1.259	0.113	0.736	0.655 (0.055, 7.724)
	Hepatic encephalopathy	-1.850	1.290	2.057	0.151	0.157 (0.013, 1.970)
	Jaundice	1.862	2.392	0.606	0.436	6.437 (0.059, 699.588)
	Refractory ascites	-1.431	3.819	0.140	0.708	0.239 (0, 425.671)
Part III	RDW (%)	1.582	0.341	21.541	< 0.001	4.863 (2.493, 9.483)
	TBIL (μmol/L)	-0.080	0.090	0.787	0.375	0.923 (0.774, 1.101)
	ALB (g/L)	-0.910	0.150	37.020	< 0.001	0.402 (0.300, 0.539)
	ALT (IU/L)	0.350	0.087	16.273	< 0.001	1.419 (1.197, 1.682)
	AST (IU/L)	-0.410	0.088	21.725	< 0.001	0.664 (0.559, 0.789)
	γ-GT (IU/L)	0.032	0.018	3.226	0.072	1.033 (0.997, 1.070)
	WBC count (× 10⁹/L)	0.763	0.292	6.798	0.009	2.144 (1.208, 3.803)
	Hemoglobin (g/L)	-0.070	0.029	5.697	0.017	0.932 (0.880, 0.988)
	Platelet count (× 10⁹/L)	-0.077	0.013	35.070	< 0.001	0.926 (0.902, 0.950)
	INR	1.828	0.621	8.661	0.003	6.224 (1.842, 21.031)
	NT-proBNP (pg/mL)	0.008	0.003	7.937	0.005	1.008 (1.002, 1.014)
	eGFR (mL/min/1.73 m²)	-0.005	0.033	0.018	0.892	0.995 (0.932, 1.063)
	Hyperlipidemia	-0.404	0.764	0.280	0.597	0.667 (0.149, 2.986)
	Atrial fibrillation	0.417	1.132	0.135	0.713	1.517 (0.165, 13.954)
	Haematemesis	3.164	1.693	3.493	0.062	23.67 (0.857, 653.530)
	Edema	3.826	1.882	4.132	0.042	45.891 (1.147, 1836.043)
	SBP	5.570	4.815	1.339	0.247	262.503 (0.021, 3291299.144)
	Hyponatremia	-0.376	1.364	0.076	0.783	0.687 (0.047, 9.940)
	Hepatic encephalopathy	-1.949	1.468	1.763	0.184	0.142 (0.008, 2.530)
	Jaundice	0.527	2.529	0.043	0.835	1.694 (0.012, 240.821)
	Refractory ascites	-0.538	3.896	0.019	0.890	0.584 (0, 1210.714)

The multiple logistics regression reference group was Group I. Child-Pugh group assignment: Group I = 0, Group II = 1, Group III = 2, Group IV = 3. Every count indicator was set to 0 if unavailable and 1 if available. ALB: Albumin; ALT: Alanine transaminase; AST: Aspartic transaminase; eGFR: Estimated glomerular filtration rate; INR: International normalized ratio; NT-proBNP: N-Terminal pro-brain natriuretic peptide; RDW: Red blood cell distribution width; SBP: Spontaneous bacterial peritonitis; TBIL: Total bilirubin; WBC: White blood cell; γ-GT: γ-glutamyl transferase.

Table 4 Pearson correlation analysis between red blood cell distribution width and each index

		Child-Pugh score	MELD score	NT-proBNP
RDW	r value	0.642	0.592	0.715
RDW	P value	< 0.001	< 0.001	< 0.001

MELD score: Model for End-Stage Liver Disease score; NT-proBNP: N-terminal pro-brain natriuretic peptide; RDW: Red blood cell distribution width.

Table 5 Receiver operating characteristic curve analysis of key indexes among groups

Variable	AUC (95%Cl)	SE	P	Critical value	Sensitivity	Specificity	Youden index
RDW	0.686 (0.624, 0.748)	0.032	< 0.001	13.05	56.0%	71.4%	0.274
NTproBNP	0.556 (0.490, 0.623)	0.034	0.114	95.50	28.0%	89.5%	0.175

AUC: Area under the curve; CI: Confidence interval; NT-proBNP: N-terminal pro-brain natriuretic peptide; RDW: Red blood cell distribution width.

Citation: Chen YL, Zhao ZW, Li SM, Guo YZ. Value of red blood cell distribution width in prediction of diastolic dysfunction in cirrhotic cardiomyopathy. World J Gastroenterol 2023; 29(15): 2322-2335
URL: https://www.wjgnet.com/1007-9327/full/v29/i15/2322.htm
DOI: https://dx.doi.org/10.3748/wjg.v29.i15.2322