Background:
Platelets play a key role in the development and progression of cardiovascular diseases. Also red cell distribution width (RDW%) & platelet indices are a good predictor of clinical outcomes.
Purpose:
Study the relationship between RDW%, platelets count, mean platelet volume (MPVfl) and platelet distribution width (PDWfl) in children with congenital heart disease (CHD) or rheumatic heart diseases (RHD).
Subjects and Methods:
The
study was carried on 151 children diagnosed as CHD or RHD selected from pediatric department of Al-Zahraa University Hospital and National Heart Institute. They were aged from 6 months to 12 years. Another 80 apparently healthy children were taken as controls. Complete blood count and echocardiography examination were evaluated for all participants.
Results:
The mean value of RDW% was increased in CHD and RHD than controls, RDW% higher in cyanotic CHD (CCHD) (either decompensated or compensated) than acyanotic CHD, and in decompensated RHD than compensated RHD with more than one valve affection. The mean platelets count were decreased in cyanotic than acyanotic CHD, platelets count were increased in decompensated than compensated RHD either with one valve or more than one valve affection. The mean values of MPV and PDW were increased in decompensated CHD, but it decreased in decompensated RHD. Conclusion: The RDW%, MPV and PDW considered as simple markers in the follow up of patients with CHD or RHD for early detection of serious complication.
Congenital Disease Heart Platelet Indices Red Cell Distribution Width Rheumatic Heart Diseases1. Introduction
Congenital heart disease (CHD) defined as a structural abnormality of the heart and (or) great vessels that is present at birth [1]. Congenital heart disease is one of the most frequently diagnosed congenital disorders affecting approximately 0.8% to 1.2% of live births worldwide [2].
Rheumatic heart disease is a chronic disease affecting the heart valves mainly resulting from recurrent severe attacks of acute rheumatic fever (ARF) [3], and considered as one of the most common leading causes of cardiovascular diseases mortality in developing countries in children, adolescent and young adults [4].
The RDW% is a quantitative parameter representing red blood cells size and reflects heterogeneity in its volume [5]. RDW% is used as an indicator of inflammation and potential marker of prognosis in cardiovascular events of various diseases [6].
Platelets have emerged as an important marker for various types of diseases. They are multifunctional blood particles and regarded to be very important clinical targets for many diseases pathophysiology. In addition to playing a central role in normal hemostasis and thrombosis, platelets can make important contributions to host inflammatory and immune responses to infection or injury. Under uncontrolled pathological conditions, they have profound roles in pathogenic processes underlying atherosclerosis, cardiovascular diseases and uncontrolled inflammation [7]. The MPV and PDW are potential biomarkers of cardiovascular diseases (CVD) [8].
2. Aim of the Work
To investigate the relationship between RDW%, platelets count and its indices (MPV and PDW) in one side and chronic heart diseases either congenital or rheumatic on other side, also to investigate if there is a relationship between those parameters and severity of illness and decompensation in both RHD and CHD in order to promote early intervention and allow better out come in such patients.
3. Patients and Methods
This was a case controls study carried on 151 patients diagnosed as CHD or RHD aged from 6 months to 12 years old, selected from Al Zahraa University Hospital and National Heart Institute in the period from September 2018 to July 2019. Another 80 apparently healthy children age and sex matched with patients groups.
3.1. Inclusion Criteria
*Case groups:
· age: from 6 months to 12 years.
· sex: both sex were included.
The study population Included 151 cases subclassified into:
· Congenital heart disease group included 111case, 41case with CCHD and 70 case with acyanotic CHD, both cyanotic and acyanotic CHD could be compensated or decompensated.
· Rheumatic heart disease group included 40 case, 17 case with one valve affection and 23 case with more than one valve lesion, both of them either decompensated or compensated.
*Controls:
Eighty apparently healthy children age and sex matched with patients groups.
3.2. Exclusion Criteria
· Any chronic disease other than rheumatic heart disease.
· Blood diseases.
· Other Chronic inflammation or infection.
· Obese children and adolescents were also excluded from this study.
4. Methods
All cases were subjected to complete history taking, general and cardiac examination, laboratory investigation in the form of complete blood count to study (RDW%, MPV, PDW, platelets count), CRP, ESR and echocardiography examination using (Mindray M9 SC9101557, NYE 91102267, CC1-92000913) (GE Vivid S 5N, 0503788VS5N). MPV was measured within 30 minutes of sampling by Bechman Counter (USA) in a blood sample collected in citrate (1:4 v/v) in order to avoid platelets swelling induced by EDTA.
4.1. Statistical Analysis
Recorded data were analyzed by statistical package for social sciences, version 20.0 (SPSS Inc., Chicago, Illinois, USA). Quantitative data were expressed as mean ± standard deviation (SD) while qualitative data were expressed as frequency and percentage. Independent-samples t-test of significance was used for comparing between two means. A one-way analysis of variance (ANOVA) compared between more than two means. Hoc test used to detect differences in significant ANOVA test between multiple comparisons of different variables. While Chi-square (X2) test was used in comparison between qualitative parameters. Receiver operating characteristic (ROC curve) analysis was used to predict severity in CHD and RHD, best cut-off value, sensitivity and specificity at this cut-off value. The confidence interval was set to 95% and 5% was the margin error. So, the P-value <0.05 was considered significant, P-value <0.001 was highly significant and P-value >0.05 was insignificant.
4.2. Ethical Consideration
The protocol of this study was approved by ethical committee of faculty of Medicine for Girls-Al-Azhar University.
An informed oral consent was obtained from all parents of patients before getting them involved in this study.
5. Results
Regarding demographic data of cases and controls, there was no significant difference between them, and clinical data of patient showed that there was 91% of CHD patients on antifailure medication, 73.9% of them has pan systolic murmur (PSM) and 45.9% presented by shortness of breath, while 100% of RHD patients had history of repeated tonsillitis, 95% of them had history of long acting penicillin, 75% has PSM and 47.5% presented by shortness of breath (Table 1(a), Table 1(b)).
In CHD subgroups, our study showed that RDW%, MPV, PDW and CRP were higher, while the mean values of platelets count and ESR were lower in cases with cyanotic compared to acyanotic CHD (Table 2(a), Table 2(b)).
In RHD subgroups, also the mean values of RDW%, platelets count, CRP and ESR were higher, while the mean values of MPV and PDW were lower in decompensated compared to compensated RHD either with one valve or more than one valve lesion (Table 3(a), Table 3(b)).
(a) Demographic data of studied groups; (b) Clinical characteristics of studied cases
(b)
Demographic Data
Patients (n = 151)
Controls (n = 80)
t/x2#
p-value
Age (years)
Mean ± SD
5.66 ± 4.34
6.58 ± 4.30
1.356
0.126
Range
0.5 - 12
0.5 - 12
Sex
Female
86 (57.0%)
54 (67.5%)
2.436#
0.119
Male
65 (43.0%)
26 (32.5%)
Congenital
Rheumatic
Frequency of the clinical findings
Shortness of breath
51 (45.9%)
19 (47.5%)
Cyanosis
36 (32.4%)
0 (0.0%)
History of recurrent cyanotic spells
23 (20.7%)
0 (0.0%)
Antifailure medication
101 (91.0%)
23 (57.5%)
Recurrent heart failure
29 (26.1%)
2 (5%)
History of repeated tonsillitis
3 (2.7%)
40 (100.0%)
History of long acting penicilline
0 (0.0%)
38 (95.0%)
Enlarged tender liver
32 (28.8%)
8 (20.0%)
Pan systolic murmur (PSM)
82 (73.9%)
30 (75.0%)
(a) Comparison between congenital heart disease subgroups either decompensated or compensated as regard laboratory data readings; (b) Comparison between congenital heart disease subgroups either decompensated or compensated as regard laboratory data results using Post Hoc analysis: Tukey test
Laboratory data
Decompensated CHD (n = 45)
Compensated CHD (n = 66)
Controls (n = 80)
F
p-value
Cyanotic CHD (n = 10)
Acyanotic CHD (n = 35)
Cyanotic CHD (n = 31)
Acyanotic CHD (n = 35)
RDW%
Mean ± SD
17.01 ± 4.57
16.27 ± 3.24
14.45 ± 2.72
13.02 ± 1.69
11.31 ± 1.12
37.959
<0.001*
Range
13 - 25
11.2 - 22.3
11.1 - 21.4
10.4 - 16.5
8.5 - 13
Platelets count ×103/µl
Mean ± SD
187.10 ± 80.26
310.77 ± 145.98
203.45 ± 85.80
351.86 ± 104.72
242.08 ± 83.80
13.424
<0.001*
Range
75 - 344
146 - 635
68 - 342
210 - 547
4 - 362
MPV fl
Mean ± SD
9.52 ± 0.46
8.97 ± 0.99
9.10 ± 0.81
7.72 ± 0.85
8.52 ± 0.61
20.634
<0.001*
Range
8.9 - 10
6.9 - 10.9
7.8 - 10.3
5.1 - 9.1
7.79 - 9.9
PDW fl
Mean ± SD
13.81 ± 2.33
12.80 ± 2.19
14.26 ± 2.25
11.50 ± 2.08
12.06 ± 1.13
12.665
<0.001*
Range
11 - 17
10.3 - 20.5
10.2 - 17
8.3 - 16
8.46 - 14.7
CRP mg/l
Mean ± SD
43.21 ± 16.79
9.58 ± 16.20
5.51 ± 6.56
1.67 ± 2.66
Standard variation
38.781
<0.001**
Range
19 - 78
0 - 58
0 - 28
0 - 10.19
ESR mm/h
Mean ± SD
14.67 ± 8.91
26.46 ± 22.76
6.44 ± 7.37
16.82 ± 16.30
Standard variation
8.169
<0.001**
Range
1 - 24
4 - 88
0 - 37.7
0 - 75
Post Hoc analysis: Tukey test
Decompensated CHD
Compensate CHD
Cyanotic CHD
Acyanotic CHD
Cyanotic/Acyanotic
Cyanotic/Acyanotic
Decompensated/ Compensated
Decompensated/ Compensated
RDW%
0.602
0.012*
0.007*
<0.001**
Platelets ×103/µl
0.001*
<0.001**
0.660
0.093
MPV fl
0.046*
<0.001**
0.130
<0.001**
PDW fl
0.121
<0.001**
0.495
0.003*
CRP mg/l
<0.001**
0.159
<0.001**
0.003*
ESR mm/h
0.048*
0.012*
0.172
0.016*
>
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