Red cell distribution width and common disease onsets in 240,477 healthy volunteers followed for up to 9 years.
Red cell distribution width and common disease onsets in 240,477 healthy volunteers followed for up to 9 years.
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DOI：
10.1371/journal.pone.0203504
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Melzer D
中科院分区：
文献类型：
--
作者：
Pilling LC;Atkins JL;Kuchel GA;Ferrucci L;Melzer D
较高的红细胞分布宽度（RDW或红细胞大小不均）可预测冠心病（CAD）以及全因和心血管死亡率，但其对健康志愿者其他常见疾病的预测价值尚不清楚。我们的目的是确定RDW和无基线疾病的参与者的常见疾病之间的短期和长期相关性，随访9年。我们对240，477名基线时年龄在40-70岁之间的健康英国生物样本库研究志愿者进行了RDW%的前瞻性分析，并在随访期间（≤9年）确定了结局。参与者在基线时没有贫血、CAD、2型糖尿病、中风、高血压、COPD和任何癌症（非黑色素瘤皮肤癌除外）。生存模型（具有竞争危险）测试了与住院记录和死亡证明结果的关联。高RDW（≥15%变异，n = 6，050）与低RDW（<12.5% n = 20，844）相比与死亡率密切相关（HR 3.10：95% CI 2.57 - 3.74），校正了年龄、性别、吸烟状况、教育水平、平均细胞体积和血红蛋白浓度。较高的RDW也与CAD（亚HR 1.67：1.40 - 1.99）、心力衰竭、外周血管疾病、房颤、卒中和癌症（sHR 1.37：1.21 - 1.55;结直肠癌sHR 1.92：1.36 - 2.72）相关，尤其是白血病（sHR 2.85：1.63 - 4.97）。相关性显示了剂量-反应关系，RDW对大多数结局具有长期预测价值（评估后≥4.5年），这在年轻人和老年人中相似。总之，在一个大型健康志愿者队列中，较高的RDW预测了广泛的常见疾病的发作以及死亡率。RDW不仅仅是一个短期预测因子，因为在健康志愿者中，高水平的RDW在基线后4.5至9年具有预测性。广泛的结果反映了已知的RDW遗传影响，包括不同的疾病风险。RDW可能是一个有用的临床标志物纳入健康评估。
Higher Red Blood Cell Distribution Width (RDW or anisocytosis) predicts incident coronary artery disease (CAD) plus all-cause and cardiovascular mortality, but its predictive value for other common diseases in healthy volunteers is less clear. We aimed to determine the shorter and longer term associations between RDW and incident common conditions in participants free of baseline disease, followed for 9 years. We undertook a prospective analysis of RDW% using 240,477 healthy UK Biobank study volunteers aged 40–70 years at baseline, with outcomes ascertained during follow-up (≤9 years). Participants were free of anemia, CAD, type-2 diabetes, stroke, hypertension, COPD, and any cancer (except non-melanoma skin cancer) at baseline. Survival models (with competing Hazards) tested associations with outcomes from hospital admission records and death certificates. High RDW (≥15% variation, n = 6,050) compared to low (<12.5% n = 20,844) was strongly associated with mortality (HR 3.10: 95% CI 2.57 to 3.74), adjusted for age, sex, smoking status, education level, mean cell volume and hemoglobin concentration. Higher RDW was also associated with incident CAD (sub-HR 1.67: 1.40 to 1.99), heart failure, peripheral vascular disease, atrial fibrillation, stroke, and cancer (sHR 1.37: 1.21 to 1.55; colorectal cancer sHR 1.92: 1.36 to 2.72), especially leukemia (sHR 2.85: 1.63 to 4.97). Associations showed dose-response relationships, and RDW had long-term predictive value (≥4.5 years after assessment) for the majority of outcomes, which were similar in younger and older persons. In conclusion, higher RDW predicted onsets of a wide range of common conditions as well as mortality in a large healthy volunteer cohort. RDW is not just a short term predictor, as high levels were predictive 4.5 to 9 years after baseline in healthy volunteers. The wide range of outcomes reflects known RDW genetic influences, including diverse disease risks. RDW may be a useful clinical marker for inclusion in wellness assessments.
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