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Association between elevated red blood cell distribution width and Clonorchis sinensis infection: a retrospective cohort study

parasitology
gastroenterology-and-hepatology
infectious-diseases

Abstract

Background: C.sinensis infection represents a significant public health concern in East Asia. The presence of a chronic infection has been demonstrated to result in the inflammation of the bile ducts, the subsequent development of fibrosis, and an elevated risk of developing cholangiocarcinoma. RDW, a potential marker of systemic inflammation and nutritional status, has not been thoroughly investigated in the context of C.sinensis infection.

Objective: The present study aims to investigate the association between C.sinensis infection and RDW levels, and to analyze its correlation with noninvasive serum markers that reflect biliary injury and liver fibrosis.

Methods: A single-centre retrospective cohort study design was employed, with adults who underwent health examinations at Liuzhou Municipal Liutie Central Hospital between July 2023 and June 2025 being enrolled. Participants were divided into two groups, positive and negative, based on the results of a stool examination for C.sinensis eggs. PSM was employed to control for confounding factors, comparing differences in RDW-SD and other laboratory indicators between groups. The present study utilized logistic regression models to investigate the association between RDW-SD and C.sinensis infection. Additionally, Spearman correlation analysis was used to evaluate the relationships between RDW-SD and liver function and fibrosis markers.

Results: The present study comprised a total of 2,410 participants. Following PSM, the positive group demonstrated significantly elevated RDW-SD, RDW-CV, MCHC, GGT, GPR, and EO compared to the negative group (all P < 0.05). At the same time, HCT, MCV, and ALB exhibited significantly reduced levels. Multivariate logistic regression analysis revealed that, in comparison with the reference group (RDW-SD ≤39.8 fL), the risk of C.sinensis infection was significantly elevated in the >42.7 fL group across all three models: Model 2: OR = 2.628, P < 0.001; Model 3: OR = 2.285, P = 0.008. Further correlation analysis demonstrated a positive correlation between RDW-SD and GGT (r = 0.265), FIB-4 (r = 0.286), and GPR (r = 0.211) (all P < 0.05). However, no significant association was observed between RDW-SD and EO or ALB.

Conclusion: Elevated RDW-SD correlates with C.sinensis infection and shows positive correlations with serological markers reflecting biliary tract injury and liver fibrosis. RDW-SD may serve as a potential noninvasive biomarker for assessing liver injury associated with C.sinensis infection in endemic areas.

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