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Red blood cell distribution width is useful in discriminating adult onset Still's disease and sepsis within 24 hours after hospitalization

  • Park, Hee-Jin (Division of Rheumatology, Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine) ;
  • Song, Jungsik (Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Park, Yong-Beom (Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Lee, Soo-Kon (Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Lee, Sang-Won (Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine)
  • Received : 2016.03.10
  • Accepted : 2016.11.11
  • Published : 2018.11.01

Abstract

Background/Aims: Red blood cell distribution width (RDW) is a value representing the heterogeneity in the size of red blood cell, and it is usually used in distinguishing types of anaemia. Recently, it was reported that it could reflect the burden of inflammation in diverse diseases and their prognosis. Hence, in this study, we investigated whether RDW may contribute to discriminating adult onset Still's disease (AOSD) from sepsis in serious febrile patients within 24 hours after hospitalization. Methods: We reviewed the medical records and enrolled 21 AOSD patients, 27 sepsis patients and 30 matched healthy controls. We collected at least two laboratory results of variables including RDW within 24 hours after hospitalization, and we calculated their mean values. Results: Sepsis patients showed the significantly increased median white blood cell count, compared to AOSD patients ($14,390.0/mm^3$ vs. $12,390.0/mm^3$, p = 0.010). The median RDW in sepsis patients was higher than that in AOSD patients (15.0% vs. 13.3%, p = 0.001), and furthermore, the median RDW in both patient-groups was significantly higher than that in healthy controls. In contrast, the median ferritin level in sepsis patients was lower than that in AOSD patients (544.0 mg/dL vs. 3,756.6 mg/dL, p = 0.001). In multivariate analysis, RDW ${\geq}14.8%$ (odds ratio, 17.549) and ferritin < 2,251.0 mg/dL (odds ratio, 32.414) independently suggested sepsis more than AOSD in patients initially presenting with fever requiring hospitalization. Conclusions: RDW might be a rapid and helpful marker for a differential diagnosis between AOSD from sepsis at an early phase.

Keywords

Acknowledgement

Supported by : National Research Foundation of Korea (NRF), Korea Health Industry Development Institute

References

  1. Yamaguchi M, Ohta A, Tsunematsu T, et al. Preliminary criteria for classification of adult Still's disease. J Rheumatol 1992;19:424-430.
  2. Fautrel B, Zing E, Golmard JL, et al. Proposal for a new set of classification criteria for adult-onset still disease. Medicine (Baltimore) 2002;81:194-200. https://doi.org/10.1097/00005792-200205000-00003
  3. Cush JJ. Adult-onset Still's disease. Bull Rheum Dis 2000;49:1-4.
  4. Priori R, Colafrancesco S, Alessandri C, et al. Interleukin 18: a biomarker for differential diagnosis between adultonset Still's disease and sepsis. J Rheumatol 2014;41:1118-1123. https://doi.org/10.3899/jrheum.130575
  5. Klein Klouwenberg PM, Ong DS, Bonten MJ, Cremer OL. Classification of sepsis, severe sepsis and septic shock: the impact of minor variations in data capture and definition of SIRS criteria. Intensive Care Med 2012;38:811-819. https://doi.org/10.1007/s00134-012-2549-5
  6. Van Reeth C, Le Moel G, Lasne Y, et al. Serum ferritin and isoferritins are tools for diagnosis of active adult Still's disease. J Rheumatol 1994;21:890-895.
  7. Park HJ, Ha YJ, Pyo JY, Park YB, Lee SK, Lee SW. Delta neutrophil index as an early marker for differential diagnosis of adult-onset Still's disease and sepsis. Yonsei Med J 2014;55:753-759. https://doi.org/10.3349/ymj.2014.55.3.753
  8. Lee SW, Park YB, Song JS, Lee SK. The mid-range of the adjusted level of ferritin can predict the chronic course in patients with adult onset Still's disease. J Rheumatol 2009;36:156-162. https://doi.org/10.3899/jrheum.080537
  9. Evans TC, Jehle D. The red blood cell distribution width. J Emerg Med 1991;9 Suppl 1:71-74. https://doi.org/10.1016/0736-4679(91)90592-4
  10. Lorente L, Martin MM, Abreu-Gonzalez P, et al. Red blood cell distribution width during the first week is associated with severity and mortality in septic patients. PLoS One 2014;9:e105436. https://doi.org/10.1371/journal.pone.0105436
  11. Dabbah S, Hammerman H, Markiewicz W, Aronson D. Relation between red cell distribution width and clinical outcomes after acute myocardial infarction. Am J Cardiol 2010;105:312-317. https://doi.org/10.1016/j.amjcard.2009.09.027
  12. Pouchot J, Sampalis JS, Beaudet F, et al. Adult Still's disease: manifestations, disease course, and outcome in 62 patients. Medicine (Baltimore) 1991;70:118-136. https://doi.org/10.1097/00005792-199103000-00004
  13. Scharte M, Fink MP. Red blood cell physiology in critical illness. Crit Care Med 2003;31(12 Suppl):S651-S657. https://doi.org/10.1097/01.CCM.0000098036.90796.ED
  14. Ghaffari S. Oxidative stress in the regulation of normal and neoplastic hematopoiesis. Antioxid Redox Signal 2008;10:1923-1940. https://doi.org/10.1089/ars.2008.2142
  15. Lippi G, Targher G, Montagnana M, Salvagno GL, Zoppini G, Guidi GC. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med 2009;133:628-632.