title: Elevated red cell distribution width is associated with advanced fibrosis in NAFLD.
abstract: OBJECTIVE
  The red-blood-cell distribution width (RDW) is a newly recognized risk marker in patients with cardiovascular disease, but its role in nonalcoholic fatty liver disease (NAFLD) has not been well defined. The aim of the present study was to determine the association between RDW values and the level of fibrosis in NAFLD according to BARD and FIB-4 scores.
  
  
  METHODS
  This study included 24,547 subjects who had been diagnosed with NAFLD based on abdominal ultrasonography and questionnaires about alcohol consumption. The degree of liver fibrosis was determined according to BARD and FIB-4 scores. The association between RDW values and the degree of fibrosis in NAFLD was analyzed retrospectively.
  
  
  RESULTS
  After adjusting for age, hemoglobin level, mean corpuscular volume, history of hypertension, history of diabetes, and high-sensitivity C-reactive protein, the RDW values were 12.61±0.41% (mean±SD), 12.70±0.70%, 12.77±0.62%, 12.87±0.82%, and 13.25±0.90% for those with BARD scores of 0, 1, 2, 3, and 4, respectively, and 12.71±0.72%, 12.79±0.66%, and 13.23±1.52% for those with FIB-4 scores of <1.30, 1.31-2.66, and ≥2.67, respectively (P<0.05). The prevalence of advanced fibrosis (BARD score of 24 and FIB-4 score of ≥1.3) increased with the RDW [BARD score: 51.1% in quartile 1 (Q1) vs. 63.6% in Q4; FIB-4 score: 6.9% in Q1 vs. 10.5% in Q4; P<0.001]. After adjustments, the odds ratio of having advanced fibrosis for those in Q4 compared to Q1 were 1.76 (95%CI=1.55-2.00, P<0.001) relative to BARD score and 1.69 (95%CI=1.52-1.98, P<0.001) relative to FIB-4 score.
  
  
  CONCLUSIONS
  Elevated RDW is independently associated with advanced fibrosis in NAFLD.
authors.affiliation: Division of Gastroenterology and Hepatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Hwa Mok
authors.initials: HM
authors.lastname: Kim
authors.forename: Bum Soo
authors.initials: BS
authors.lastname: Kim
authors.forename: Yong Kyun
authors.initials: YK
authors.lastname: Cho
authors.forename: Byung Ik
authors.initials: BI
authors.lastname: Kim
authors.forename: Chong Il
authors.initials: CI
authors.lastname: Sohn
authors.forename: Woo Kyu
authors.initials: WK
authors.lastname: Jeon
authors.forename: Hong Joo
authors.initials: HJ
authors.lastname: Kim
authors.forename: Dong Il
authors.initials: DI
authors.lastname: Park
authors.forename: Jung Ho
authors.initials: JH
authors.lastname: Park
authors.forename: Kwan Joong
authors.initials: KJ
authors.lastname: Joo
authors.forename: Chang Joon
authors.initials: CJ
authors.lastname: Kim
authors.forename: Yong Sung
authors.initials: YS
authors.lastname: Kim
authors.forename: Woon Je
authors.initials: WJ
authors.lastname: Heo
authors.forename: Won Seok
authors.initials: WS
authors.lastname: Choi
mesh_terms: D000328:Adult; D000428:Alcohol Drinking; D002097:C-Reactive Protein / Q000032:analysis; D003920:Diabetes Mellitus / Q000473:pathology; D004909:Erythrocyte Indices; D005234:Fatty Liver / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D006973:Hypertension / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D016017:Odds Ratio; D015995:Prevalence; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014463:Ultrasonography
chemical_list: D002097:C-Reactive Protein
keywords: BARD score; FIB-4 score; Nonalcoholic fatty liver disease; Red-blood-cell distribution width