Red blood cell distribution width and mortality in traumatic brain injury
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LETTER TO THE EDITOR
Red blood cell distribution width and mortality in traumatic brain injury Cihan Bedel1 · Mustafa Korkut1 · Hamit Hakan Armağan2 Received: 16 October 2020 / Accepted: 21 October 2020 © Belgian Neurological Society 2020
We read with great interest the article “Red blood cell distribution width as mortality biomarker in patients with traumatic brain injury” reported by Lorente et al. [1]. They emphasized that red blood cell distribution width (RDW) was a prognostic factor for during the first week of traumatic brain injury (TBI). We appreciate the authors for their valuable contribution to the literature; nevertheless, we wanted to mention some important points that merit more attention. RDW is a quantitative measure of the variability in the size of circulating red blood cells, and today it maintains its importance by physicians as it can be obtained easily and routinely from blood counts. Previous studies have reported high RDW levels as a predictor of mortality and morbidity in various gastrointestinal and cardiovascular disease states [2, 3]. The relationship between high RDW levels and proinflammatory diseases has been reported previously [4]. It is well known that the neuroinflammatory response following TBI is an important secondary damage factor that can trigger ongoing neuronal damage and worsen outcome [5]. The observed association between RDW and TBI may be that elevated RDW reflects an underlying inflammatory state. It would have been helpful if the authors had evaluated the value of RDW along with other inflammatory biomarkers in the TBI setting. Additionally, RDW can be affected by many situations. Among them ethnicity, thyroid disease, nutritional conditions such as folate, vitamin B12 and iron deficiency, bone marrow dysfunction, malignancy, inflammatory diseases, medications, renal dysfunction and hepatic dysfunction [6]. It would have been helpful if the authors had reported the * Cihan Bedel [email protected] 1
Department of Emergency Medicine, Health Science University Antalya Training and Research Hospital, Kazım Karabekir Street, 07100, Muratpaşa, Antalya, Turkey
Department of Emergency Medicine, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
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effect of these factors. Moreover, it is a confusing potential source of bias. In the light of findings from this study and other previous data. Studies show that RDW is easily applicable and can be used as a prognostic marker. Studies to be conducted by considering all risk factors that may affect RDW value by prospective, multi-center studies are needed.
Funding The authors declare that this article has received no financial support.
Compliance with ethical standrads Conflict of ınterest The authors have no conflicts of interest relevant nor financial support for this article.
References 1. Lorente L, Martín MM, Ruiz C et al (2020) Red blood cell distribution width as mortality biomarker in patients with traumatic brain injury. Acta Neurol Belg. https://doi.org/10.1007/s1376 0-020-0140
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