title: Red blood cell distribution width: can it be a predictive marker for long-term valvular involvement in children with acute rheumatic carditis?
abstract: BACKGROUND
  In this study, we aimed to evaluate Red blood cell distribution width (RDW) in patients with acute rheumatic carditis during the acute phase and after anti-inflammatory therapy.
  
  
  METHODS
  Pediatric patients diagnosed with acute rheumatic carditis (ARC) between 2006 and 2014 and age- and sex-matched controls were retrospectively analyzed. At the time of diagnosis and after 2 months of medical therapy, we reviewed the obtained demographic features; echocardiographic data; complete blood count reports, including RDW; acute phase reactants, including C-reactive protein; and erythrocyte sedimentation rate values.
  
  
  RESULTS
  The number of the cases with ARC and age- and sex-matched controls were 100 and 110, respectively. The mean age of patients was 11.6 ± 2.5 years. WBC and platelet counts, RDW were found to be significantly higher in patient group compared with controls at the time of diagnosis, prior to the onset of treatment. RDW, platelet count, CRP, and ESR levels significantly decreased after an 8 weeks of medical treatment. RDW values after the medical treatment were still significantly higher compared with controls. RDW values were significantly higher in patients with multiple valvular involvement both prior to and after the treatment. Moreover, we found a significant and positive correlation between the RDW and the severity of mitral regurgitation in our patients (r: 0.46, P < 0.001).
  
  
  CONCLUSIONS
  High levels of RDW after initial medical treatment may indicate an ongoing subtle inflammatory process that leads to future stenotic valvular lesions. However, long-term follow-up studies are needed involving adulthood period to support this hypothesis.
authors.affiliation: Division of Pediatric Cardiology, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Kucuk
authors.affiliation: Division of Pediatric Cardiology, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey. rahmiozdemir35@gmail.com.
authors.forename: R
authors.initials: R
authors.lastname: Ozdemir
authors.affiliation: Division of Pediatric Cardiology, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey.
authors.forename: C
authors.initials: C
authors.lastname: Karadeniz
authors.affiliation: Department of Pediatrics, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey.
authors.forename: K
authors.initials: K
authors.lastname: Celegen
authors.affiliation: Division of Pediatric Cardiology, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Demirol
authors.affiliation: Division of Pediatric Cardiology, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey.
authors.forename: M M
authors.initials: MM
authors.lastname: Yilmazer
authors.affiliation: Division of Pediatric Cardiology, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey.
authors.forename: T
authors.initials: T
authors.lastname: Mese
authors.affiliation: Division of Pediatric Cardiology, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey.
authors.forename: N
authors.initials: N
authors.lastname: Unal
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D002648:Child; D004909:Erythrocyte Indices; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008944:Mitral Valve Insufficiency / Q000097:blood* / Q000209:etiology; D010976:Platelet Count; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000097:blood* / Q000150:complications
chemical_list: D015415:Biomarkers
keywords: Children; carditis; red cell distribution width; rheumatic fever; rheumatic heart disease