Online first
Current issue
Archive
Special Issues
About the Journal
Publication Ethics
Anti-Plagiarism system
Instructions for Authors
Instructions for Reviewers
Editorial Board
Editorial Office
Contact
Reviewers
All Reviewers
2024
2023
2022
2021
2020
2019
2018
2017
2016
General Data Protection Regulation (RODO)
RESEARCH PAPER
One condition, different environments? Haematologic parameter dynamics and pulmonary embolism in urban vs. rural orthopaedic patients
1
First Department of Anaesthesiology and Intensive Therapy, Medical University, Lublin, Poland
2
Department of Correct, Clinical and Imaging Anatomy, Medical University, Lublin, Poland
3
Department of Orthopaedics and Traumatology, Medical University of Lublin, Poland
4
Department of Internal Diseases with Subdepartments of Occupational Diseases and Rapid Diagnostics, Institute of Rural Health, Lublin, Poland
5
Department of Radiology and Nuclear Medicine, Medical University, Lublin, Poland
Corresponding author
Piotr Piech
Department of Correct, Clinical and Imaging Anatomy, Medical University of Lublin, Poland
Department of Correct, Clinical and Imaging Anatomy, Medical University of Lublin, Poland
Ann Agric Environ Med. 2025;32(2):295-301
KEYWORDS
RDWpulmonary embolismred cell distribution widthvenous thromboembolismrisk stratificationorthopaedic surgeryurban vs. rural healthhaematologic biomarkersenvironmental determinants of health
TOPICS
ABSTRACT
Introduction and objective:
Pulmonary embolism (PE) remains a major cause of morbidity and mortality among orthopaedic patients. Despite documented cardiovascular disparities between urban and rural populations, data linking these environments with PE incidence and haematologic changes are scarce. The study investigates the differences in acute pulmonary embolism (APE) incidence and dynamic haematologic changes between urban and rural orthopaedic patients.
Material and methods:
A retrospective analysis included 276 orthopaedic patients hospitalized over eight years in a tertiary centre in Eastern Poland. Patients were categorized by residence (urban vs. rural). Complete blood count parameters, notably red cell distribution width (RDW), platelet indices, and erythrocyte parameters, were analyzed on admission and at clinical suspicion of APE. APE was confirmed by computed tomography pulmonary angiography. Ethical approval was obtained (KE-0254/17/2019). Standard statistical tests were used (p<0.05).
Results:
APE incidence did not differ significantly between urban (39.1%) and rural (47.4%) patients (p=0.181). However, urban patients had significantly higher RDW values on admission (p=0.037). Additionally, females showed significantly elevated RDW, particularly in rural settings (p=0.038). Other haematologic parameters showed no significant differences between groups.
Conclusions:
Although residence did not significantly influence APE incidence, the elevated RDW in urban patients suggests environmental or lifestyle-related haematologic modulation. Considering the limited similar studies in the literature, RDW emerges as a potential, cost-effective biomarker for early APE risk stratification in orthopaedic patients.
Pulmonary embolism (PE) remains a major cause of morbidity and mortality among orthopaedic patients. Despite documented cardiovascular disparities between urban and rural populations, data linking these environments with PE incidence and haematologic changes are scarce. The study investigates the differences in acute pulmonary embolism (APE) incidence and dynamic haematologic changes between urban and rural orthopaedic patients.
Material and methods:
A retrospective analysis included 276 orthopaedic patients hospitalized over eight years in a tertiary centre in Eastern Poland. Patients were categorized by residence (urban vs. rural). Complete blood count parameters, notably red cell distribution width (RDW), platelet indices, and erythrocyte parameters, were analyzed on admission and at clinical suspicion of APE. APE was confirmed by computed tomography pulmonary angiography. Ethical approval was obtained (KE-0254/17/2019). Standard statistical tests were used (p<0.05).
Results:
APE incidence did not differ significantly between urban (39.1%) and rural (47.4%) patients (p=0.181). However, urban patients had significantly higher RDW values on admission (p=0.037). Additionally, females showed significantly elevated RDW, particularly in rural settings (p=0.038). Other haematologic parameters showed no significant differences between groups.
Conclusions:
Although residence did not significantly influence APE incidence, the elevated RDW in urban patients suggests environmental or lifestyle-related haematologic modulation. Considering the limited similar studies in the literature, RDW emerges as a potential, cost-effective biomarker for early APE risk stratification in orthopaedic patients.
REFERENCES (24)
1.
Martin KA, Molsberry R, Cuttica MJ, et al. Time Trends in Pulmonary Embolism Mortality Rates in the United States, 1999 to 2018. J Am Heart Assoc. 2020;9(17):e016784. doi:10.1161/JAHA.120.016784.
2.
Bikdeli B, Wang Y, Jimenez D, et al. Pulmonary embolism hospitalization, readmission, and mortality rates in US older adults, 1999–2015. JAMA. 2019;322(6):574–576. https://doi.org/10.1001/jama.2....
3.
Bagot CN, Arya R. Virchow and his triad: a question of attribution. Br J Haematol. 2008;143(2):180–90. https://doi.org/10.1111/j.1365....
4.
Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41(4):543–603. https://doi.org/10.1093/eurhea....
5.
American Society of Hematology. ASH Clinical Practice Guidelines on Venous Thromboembolism: Treatment of DVT and PE. https://www.hematology.org/edu... (access: 2024.05.20).
6.
Stevens SM, Woller SC, Baumann Kreuziger L, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest. 2021;160(6):e545–e608. https://doi.org/10.1016/j.ches....
7.
Kim HJ, Walcott-Sapp S, Leggett K, et al. Detection of Pulmonary Embolism in the Postoperative Orthopaedic Patient Using Spiral CT Scans. HSS J. 2010;6(1):95-98. doi:10.1007/s11420-009-9128-5.
8.
Zuin M, Bikdeli B, Ballard-Hernandez J, et al. International Clinical Practice Guideline Recommendations for Acute Pulmonary Embolism: Harmony, Dissonance, and Silence. J Am Coll Cardiol. 2024;84(16):1561-1577. doi:10.1016/j.jacc.2024.07.044.
9.
Borowski B, Haratym M, Piech P, et al. D-dimers or more? Assessing the role of laboratory factors in predicting and confirming pulmonary embolism in high-risk orthopaedic patients. Pract Lab Med. 2025;44:e00452. doi:10.1016/j.plabm.2025.e00452.
10.
Yang G, Nie S. Risk factors for pulmonary embolism: a case-control study. J Thorac Dis. 2025;17(3):1552-1560. doi:10.21037/jtd-24-1293.
11.
Liang S, Zhang J, Ning R, et al. The critical role of endothelial function in fine particulate matter-induced atherosclerosis. Part Fibre Toxicol. 2020;17(1):61. https://doi.org/10.1186/s12989....
12.
Ji X, Ke W. Red blood cell distribution width and all-cause mortality in congestive heart failure patients: a retrospective cohort study based on the MIMIC-III database. Front Cardiovasc Med. 2023;10:1126718. doi:10.3389/fcvm.2023.1126718.
13.
Takahashi EA, Sista AK, Addison D, et al. Disparities in Current Pulmonary Embolism Management and Outcomes: A Scientific Statement From the American Heart Association. Circulation. 2025;151(15):e944-e955. doi:10.1161/CIR.0000000000001306.
14.
Nowicki GJ, Ślusarska B, Piasecka H, et al. The status of cardiovascular health in rural and urban areas of Janów Lubelski district in eastern Poland: A population-based study. Int J Environ Res Public Health. 2018;15(11):2388. https://doi.org/10.3390/ijerph....
15.
Doryńska A, Polak M, Kozela M, et al. Cardiovascular disease (CVD) risk factors in Kraków and in the whole Poland adult population. Przegl Epidemiol. 2015;69(1):79–86.
16.
Jurin I, Trkulja V, Lucijanić M, et al. Red Cell Distribution Width in Acute Pulmonary Embolism Patients Improves 30-Day Mortality Risk Stratification Based on the Pulmonary Embolism Severity Index. Heart Lung Circ. 2022;31(6):859–866. doi:10.1016/j.hlc.2021.12.006.
17.
Kassem AM, Abdel-Baset A, Abo Elwafa H,et al. Value of platelet indices in prediction of pulmonary embolism. Menoufia Med J. 2023;35(4):Article 26. https://doi.org/10.4103/mmj.mm....
18.
Piech P, Haratym M, Borowski B, et al. Beyond the fractures: A comprehensive Comparative analysis of Affordable and Accessible laboratory parameters and their coefficients for prediction and Swift confirmation of pulmonary embolism in high-risk orthopaedic patients. Pract Lab Med. 2024;40:e00397. https://doi.org/10.1016/j.plab....
19.
Ding C, Zhang Z, Qiu J, et al. Association of red blood cell distribution width to albumin ratio with the prognosis of acute severe pulmonary embolism: A cohort study. Medicine. 2023;102(47):e36141. https://doi.org/10.1097/MD.000....
20.
Costello HM, Sharma RK, McKee AR, et al. Circadian Disruption and the Molecular Clock in Atherosclerosis and Hypertension. Can J Cardiol. 2023;39(12):1757-1771. doi:10.1016/j.cjca.2023.06.416.
21.
Głąbska D, Rahelić V, Guzek D, et al. Dietary Health-Related Risk Factors for Women in the Polish and Croatian Population Based on the Nutritional Behaviors of Junior Health Professionals. Sustainability. 2019;11(18):5073. https://doi.org/10.3390/su1118....
22.
Işık B, Sarcan E, Özkan S, et al. Effects of RDW and MPV on Mortality in Patients with Pulmonary Thromboembolism. J Tepecik Educ Res Hosp. 2023;33(2):169-74. doi:10.4274/terh.galenos.2023.74429.
23.
Piech P, Komisarczuk M, Tuszyńska W, et al. Unreliability of d-dimers in diagnosis of venous thromboembolism – comprehensive literature review. J Pre Clin Clin Res. 2023;17(2):85-90. doi:10.26444/jpccr/165920.
24.
Liu Y, Sun S, Liu L. Association between the red blood cell distribution width-albumin ratio and cardiovascular diseases. Front. Cardiovasc Med. 2025;12:1529533. doi:10.3389/fcvm.2025.1529533.
Share
RELATED ARTICLE
| eISSN: | 1898-2263 |
| ISSN: | 1232-1966 |
Generation of the DOI (Digital Object Identifier) - task financed under the agreement No NrRCN/SP/0532/2021/1 by the Minister of Science and Higher
© 2006-2025 Journal hosting platform by Bentus
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
