Correlations Between Red Blood Cell Distribution Width And The Course Of Liver Cirrhosis And Child-Pugh Classification

Objectives:Due to the decline of synthesis and metabolism function of liver and the occurrence of gastrointestinal bleeding,different types of anemia and hemodynamic abnormalities usually appeared in patients with liver cirrhosis.The occurrence of these conditions is closely related to the morphological changes of red blood cells.Red blood cell distribution width(RDW)is a parameter representing the heterogeneity of blood cell volume that determines whether the red blood cells are homogeneous and stalble in blood routine tests.In this item,128 patients with liver cirrhosis admitted by Kunming General Hospital were selected,and RDW and several main indexes of blood biochemistry and blood coagulation function tests were analyzed.Data of RDW in groups of different etiologies were compared to explore the characteristics and clinical significance of RDW in different course and complications of liver cirrhosis,and to determine if RDW follows the severity of the disease according to Child-Pugh score,in order to offer new ideas for the condition evaluation and new thinking of the related blood flow dynamic problems in liver cirrhosis.Methods:128 hospitalized patients with liver cirrhosis in Kunming General Hospital from November 2015 to February 2017 were selected as study group.According to the progresses of the disease,the related complications,different etiologies and liver function classification standard,all of cases were divide into several groups.And there were 68 cases of posthepatitic liver cirrhosis,21 cases of alcoholic liver cirrhosis and 39 cases of cirrhosis due to other causes.There were 21 cases of compensatory cirrhosis and 107 cases of decompensation.According to the Child-Pugh classification,there were 42 cases of grade A,46 case of grade B,and 40 cases of grade C.Meanwhile,another 120 cases selected randomly from the health check-up crowd in the hospital in February 2017 were served as normal control group.The results of the blood routine examination,blood biochemistry indexes and coagulation function indexes were collected.And the changes of RDW among different groups and the relationships between RDW and the course of cirrhosis and Child-Pugh score were analyzed.Results:1.According to the related parameters of blood routine examination and blood biochemistry indexes,RDW in liver cirrhosis group was(15.52+2.47)%,which was significantly higher than normal control group(13.24+1.10)%,and its platelet distribution width(PDW)was(14.62+2.77)%,which was also significantly higher than that in normal control group(12.90+2.38)%,(P<0.01,respectively).However,hemoglobin(Hb),red blood cell count(RBC),hematocrit(HCT)and platelet count(PLT)were significantly lower than those in normal control group(P<0.01,respectively).2.Basing on the progression of liver cirrhosis,RDW in decompensated group((15.94 ±-2.48)%)was significantly higher than that in compensatory group((13.41 + 0.68)%),and RDW in decompensated group was significantly higher than normal control group((13.24 + 1.10)%)(P<0.05).3.RDW in gastrointestinal bleeding group((16.81±2.80)%)was significantly higher than that((15.02±2.14)%)in no gastrointestinal bleeding group(P<0.01).RBC and Hb in hemorrhage group were significantly lower than those in the group without bleeding(P<0.01).RDW differed among different degrees of severity of anemia,and the more severe degree of anemia,the higher RDW was(P<0.01).RDW differed among the groups of different anemia types,and it was the largest in small cell anemia group((19.38±2.23)%)(P<0.01).There were significant difference among different groups of splenomegaly degrees of RDW,the severer the splenomegaly,the larger RDW was(P<0.05).4.The RDW value of cirrhotic patients was positively related to total bilirubin(TBil)and prothrombin time(PT),while negatively correlated with serum albumin(Alb)and fibrinogen(FIB)(P<0.05).5.There was no statistically significant difference of RDW values among posthepatitic cirrhosis group((15.09±2.20)%),alcoholic liver cirrhosis group((15.7112.53)%)and the group caused by other factors((16.16±2.77)%),(P>0.05).6.According to the severity assessment of cirrhotic Child-Pugh classification,there was no statistically difference of RDW among group A((15.000±2.73)%),group B((15.64±2.41)%)and group C((15.922±2.20)%)(P>0.05).Conclusions:1.In liver cirrhosis,a number of biochemical indicators which can reflect the condition of liver function become abnormal,anemia usually appears according to routine blood tests,all of these can reflect the decline of liver function and the morphological changes of red blood cells and platelets.2.With the course of liver cirrhosis progressed into the decompensated period,RDW significantly increases,and it indicates that RDW can be used as a reference for the progression of liver cirrhosis.3.RDW increases significantly along with gastrointestinal bleeding,anemia,or the complications such as splenomegaly occurres and aggravates.Therefore,RDW can reflect the severity degree of several certain complications of liver cirrhosis,and provide reference for condition evaluation of the disease.4.RDW is correlated with several parameters of biochemical and coagulation function tests which reflects the function of liver synthesis and metabolism,therefore RDW can reflect the liver function status of cirrhosis to some extent.5.There is no difference among cirrhosis of different etiologies of RDW,so RDW can't be used to identify different etiologies of liver cirrhosis.6.There is no correlation between Child-Pugh grading of liver function in cirrhosis and RDW,therefore RDW may not be used as a reference for Child-Pugh classification in the course of liver cirrhosis.