Can red cell distribution width (RDW) and immature granulocyte parameters predict mortality in patients with pleural effusion?

Abstract

Aims: Pleural effusion is a frequent clinical manifestation with variable etiologies and prognoses. Identifying reliable, accessible prognostic biomarkers is critical for early risk stratification. This study aimed to assess the prognostic significance of red cell distribution width (RDW) and immature granulocyte (IG) parameters in predicting in-hospital mortality in patients with pleural effusion. Methods: A retrospective analysis was conducted on 107 adult patients who underwent diagnostic thoracentesis. Hematologic data including RDW-CV, RDW-SD, IG percentage (IG%), and IG absolute count (IG#) were obtained within 24 hours of thoracentesis. Patients were categorized based on in-hospital survival status. Receiver operating characteristic (ROC) analysis was used to evaluate the predictive performance of these parameters. Results: In-hospital mortality occurred in 21.5% of patients. Non-survivors exhibited significantly higher RDW-CV, RDWSD, IG%, and IG# values (p<0.001 for all). RDW-CV demonstrated the highest prognostic accuracy (AUC=0.793), with an optimal cut-off value of 16.1% (sensitivity: 70.2%, specificity: 82.6%). RDW-SD showed an AUC of 0.782, with a cut-off of 55.8 fL (sensitivity: 88.1%, specificity: 60.9%). Among IG parameters, IG% (AUC=0.770) had a cut-off of 1.1% (sensitivity: 81.0%, specificity: 65.2%) and IG# (AUC=0.752) had a cut-off of 0.055×10³/μL (sensitivity: 61.9%, specificity: 87.0%). Conclusion: Elevated RDW and IG parameters independently predict in-hospital mortality in patients with pleural effusion. These readily available and cost-effective markers may serve as valuable tools for early prognostic assessment, particularly in settings where advanced diagnostic resources are limited.

Keywords

• Pleural effusion
• red cell distribution width
• immature granulocytes
• prognostic biomarkers
• in-hospital mortality
• hematologic indices

RDW ve olgunlaşmamış granülosit parametreleri plevral efüzyonlu hastalarda mortaliteyi öngörebilir mi?

Abstract

Arka Plan: Plevral efüzyon, çeşitli etiyolojilere ve prognozlara sahip sık görülen bir klinik tablodur. Erken risk sınıflandırması için güvenilir ve kolay erişilebilir prognostik biyobelirteçlerin belirlenmesi büyük önem taşır. Bu çalışmada, kırmızı hücre dağılım genişliği (RDW) ve olgunlaşmamış granülosit (IG) parametrelerinin plevral efüzyonlu hastalarda hastane içi mortaliteyi öngörmedeki prognostik değeri değerlendirildi. Yöntem: Tanısal torasentez yapılan 107 yetişkin hastanın verileri retrospektif olarak analiz edildi. RDW-CV, RDW-SD, IG yüzdesi (IG%) ve IG mutlak sayısı (IG#) dahil olmak üzere hematolojik veriler torasentezden sonraki 24 saat içinde elde edildi. Hastalar hastane içi sağkalım durumuna göre gruplandırıldı. Bu parametrelerin prediktif performansı ROC eğrisi analizi ile değerlendirildi. Bulgular: Hastaların %21,5’i hastane süresince hayatını kaybetti. Kaybedilen hastalarda RDW-CV, RDW-SD, IG% ve IG# değerleri anlamlı olarak daha yüksekti (tümünde p < 0.001). En yüksek prognostik doğruluğu RDW-CV gösterdi (AUC = 0.793); optimal eşik değeri %16.1 (duyarlılık: %70.2, özgüllük: %82.6) olarak saptandı. RDW-SD için AUC 0.782, eşik değeri 55.8 fL (duyarlılık: %88.1, özgüllük: %60.9) idi. IG% için AUC 0.770 (eşik: %1.1; duyarlılık: %81.0, özgüllük: %65.2) ve IG# için AUC 0.752 (eşik: 0.055 ×10³/μL; duyarlılık: %61.9, özgüllük: %87.0) olarak bulundu. Sonuç: RDW ve IG parametrelerindeki yükseklik, plevral efüzyonlu hastalarda hastane içi mortaliteyi bağımsız olarak öngörebilmektedir. Bu kolay ulaşılabilir ve düşük maliyetli belirteçler, özellikle ileri tanısal araçlara erişimin kısıtlı olduğu ortamlarda, erken prognostik değerlendirmede değerli birer araç olabilir.

Keywords

• Plevral efüzyon
• Kırmızı hücre dağılım genişliği
• Olgunlaşmamış granülositler
• Prognostik biyobelirteçler
• Hastane içi mortalite
• Hematolojik indeksler
• Risk sınıflandırması.

References

1. Jany B, Welte T. Pleural effusion in adults-etiology, diagnosis, and treatment. Dtsch Arztebl Int. 2019;116(21):377-386. doi:10.3238/arztebl. 2019.0377
2. Arnold DT, De Fonseka D, Perry S, et al. Investigating unilateral pleural effusions: the role of cytology. Eur Respir J. 2018;52(5):1801254. doi:10. 1183/13993003.01254-2018
3. Kassirian S, Hinton SN, Cuninghame S, et al. Diagnostic sensitivity of pleural fluid cytology in malignant pleural effusions: systematic review and meta-analysis. Thorax. 2023;78(1):32-40. doi:10.1136/thoraxjnl- 2021-217959
4. Gioia M, Arancibia RL. A review of medical thoracoscopy and its role in management of malignant pleural effusion. J Respir. 2024;4(1):35 49. doi:10.3390/jor4010004
5. Chen N, Liu S, Huang L, et al. Prognostic significance of neutrophil-to-lymphocyte ratio in patients with malignant pleural mesothelioma: a meta-analysis. Oncotarget. 2017;8(34):57460-57469. doi:10.18632/oncotarget.15404
6. Shbeer AM, Robadi IA. Liquid biopsy holds a promising approach for the early detection of cancer: current information and future perspectives. Pathol Res Pract. 2024;254:155082. doi:10.1016/j.prp.2023.155082
7. Islam MM, Satici MO, Eroglu SE. Unraveling the clinical significance and prognostic value of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, systemic inflammation response index, and delta neutrophil index: an extensive literature review. Turk J Emerg Med. 2024;24(1):8-19. doi:10.4103/tjem.tjem_198_23
8. Han R, Tian Z, Jiang Y, et al. Prognostic significance of the systemic immune inflammation index in patients with metastatic and unresectable pancreatic cancer. Front Surg. 2022;9:915599. doi:10.3389/fsurg.2022.915599

9. Zhang P, Chen Y, Zhou J, et al. The prognostic value of red blood cell distribution width for mortality in intracranial hemorrhage: a systematic review and meta-analysis. Medicine (Baltimore). 2025;104(11):e41487. doi:10.1097/MD.0000000000041487
10. Parizadeh SM, Jafarzadeh-Esfehani R, Bahreyni A, et al. The diagnostic and prognostic value of red cell distribution width in cardiovascular disease; current status and prospective. Biofactors. 2019;45(4):507-516. doi:10.1002/biof.1518
11. Wang PF, Song SY, Guo H, Wang TJ, Liu N, Yan CX. Prognostic role of pretreatment red blood cell distribution width in patients with cancer: a meta-analysis of 49 studies. J Cancer. 2019;10(18):4305-4317. doi:10. 7150/jca.31598
12. Deniz M, Sahin Yildirim Z, Erdin Z, Alisik M, Erdin R, Yildirim M. Role of immature granulocytes in monitoring sepsis treatment. BMC Anesthesiol. 2025;25(1):198. doi:10.1186/s12871-025-03072-4
13. Dal İ, Gülten S. The role of immature granulocytes in the early diagnosis of pneumonia developing secondary to rib fractures. Kastamonu Med J. 2024;4(3):84-87. doi:10.51271/KMJ-0149
14. Kozanlı F, Akkök B. Contribution of immature granulocyte level to diagnosis in pleural effusion. Turk Gogus Kalp Damar Cerrahisi Derg. 2022;30(2):257-263. doi:10.5606/tgkdc.dergisi.2022.21523
15. Sundaralingam A, Grabczak EM, Burra P, et al. ERS statement on benign pleural effusions in adults. Eur Respir J. 2024;64(6):2302307. doi: 10.1183/13993003.02307-2023
16. Porcel JM, Light RW. Diagnostic approach to pleural effusion in adults. Am Fam Physician. 2006;73(7):1211-1220.
17. Shaw JA, Louw EH, Koegelenberg CFN. A practical approach to the diagnosis and management of malignant pleural effusions in resource-constrained settings. Breathe (Sheff). 2023;19(4):230140. doi:10.1183/ 20734735.0140-2023
18. García-Escobar A, Lázaro-García R, Goicolea-Ruigómez J, et al. Red blood cell distribution width as a biomarker of red cell dysfunction associated with inflammation and macrophage iron retention: a prognostic marker in heart failure and a potential predictor for iron replacement responsiveness. Card Fail Rev. 2024;10:e17. doi:10.15420/cfr.2024.17
19. Yang Y, Wang Q, Gao L, et al. Promising applications of red cell distribution width in diagnosis and prognosis of diseases with or without disordered iron metabolism. Cell Biol Int. 2023;47(7):1161-1169. doi:10.1002/cbin.12029
20. 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(4):628-632. doi:10.5858/133.4.628
21. Nierhaus A, Klatte S, Linssen J, et al. Revisiting the white blood cell count: immature granulocytes count as a diagnostic marker to discriminate between SIRS and sepsis--a prospective, observational study. BMC Immunol. 2013;14(1):8. doi:10.1186/1471-2172-14-8
22. Monteiro WO, Bó SD, Farias MG, Castro SM. Definition of reference range for the immature granulocytes parameter provided by a hematology analyzer. Clin Lab. 2021;67(1):10.7754/Clin.Lab.2020. 200439. doi:10.7754/Clin.Lab.2020.200439
23. Ge S, Zhao Y, Liang J, et al. Immune modulation in malignant pleural effusion: from microenvironment to therapeutic implications. Cancer Cell Int. 2024;24(1):105. doi:10.1186/s12935-024-03211-w
24. De Cicco P, Ercolano G, Ianaro A. The new era of cancer immunotherapy: targeting myeloid-derived suppressor cells to overcome immune evasion. Front Immunol. 2020;11:1680. doi:10.3389/fimmu.2020.01680
25. Templeton AJ, McNamara MG, Šeruga B, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014;106(6):dju124. doi:10.1093/jnci/dju124
26. Myojo M, Iwata H, Kohro T, et al. Prognostic implication of macrocytosis on adverse outcomes after coronary intervention. Atherosclerosis. 2012; 221(1):148-53. doi:10.1016/j.atherosclerosis.2011.11.044