Association between red cell distribution width and short-term outcomes in patients with acute decompensated heart failure
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Abstract
This prospective cohort study combined with retrospective analysis was conducted on 233 patients with acute decompensated heart failure (ADHF) (median age 67 years old; 52.9% female) to determine the association between red cell distribution width (RDW) at admission and 3-month outcomes (all-cause mortality and heart failure readmission). Patients were divided into two groups: normal RDW (≤ 15%) and elevated RDW (> 15%). Elevated RDW was observed in 42.1% of patients and was associated with lower diastolic blood pressure, atrial fibrillation, chronic kidney disease, anemia, higher Charlson comorbidity index, lower hemoglobin and sodium levels, and higher creatinine and NT-proBNP levels. At 3 months of follow-up, 7 patients (3.2%) passed on and 42 (18.8%) were readmitted for heart failure, with a significantly higher event rate in the elevated RDW group compared to the normal RDW group (36.2% vs. 11.6%, p < 0.001). Multivariable Cox regression analysis showed that elevated RDW (hazard ratio [HR]: 2.67; 95% confidence interval [CI]: 1.34 – 5.35; p = 0.005), age (HR: 1.04; 95% CI: 1.01 – 1.07; p = 0.016), and log [NT-proBNP] (HR: 2.72; 95% CI: 1.11 – 6.65; p = 0.015) were independent factors associated with 3-month outcomes. The results suggest that increased RDW was a potential prognostic factor, but larger studies are needed to confirm its value as a marker for predicting short-term outcomes in ADHF patients.
Article Details
Keywords
Acute decompensated heart failure, prognosis, red cell distribution width, short-term outcomes
References
2. Adams KF, Fonarow GC, Emerman CL, et al. Characteristics and outcomes of patients hospitalized for heart failure in the United States: Rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J. 2005;149(2):209-216. doi:10.1016/j.ahj.2004.08.005
3. Wussler D, Michou E, Belkin M, et al. Mortality prediction in acute heart failure: Scores or biomarkers? Swiss Med Wkly. 2020;150(33-34):1-13. doi:10.4414/smw.2020.20320
4. Xanthopoulos A, Giamouzis G, Dimos A, et al. Red Blood Cell Distribution Width in Heart Failure: Pathophysiology, Prognostic Role, Controversies and Dilemmas. J Clin Med. 2022;11(7):1951. doi:10.3390/jcm11071951
5. Arkew M, Gemechu K, Haile K, et al. Red Blood Cell Distribution Width as Novel Biomarker in Cardiovascular Diseases: A Literature Review. J Blood Med. 2022;13:413-424. doi:10.2147/JBM.S367660
6. Dang HNN, Viet Luong T, Cao MTT, et al. Assessing red blood cell distribution width in Vietnamese heart failure patients: A cross-sectional study. PLoS One. 2024;19:e0301319. doi:10.1371/journal.pone.0301319
7. Joneja U, Gulati G, Florea AD, et al. The Results of Hemoglobin Variant Analysis in Patients Revealing Microcytic Erythrocytosis on Complete Blood Count. Lab Med. 2018;49(2):147-153. doi:10.1093/labmed/lmx071
8. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;5(40):373-383. doi:10.1016/0021-9681(87)90171-8
9. Nguyễn Quang Trung, Nguyễn Hoàng Anh, Đinh Tấn Quỳnh, và cs. Đặc điểm và kết cục ngắn hạn của người bệnh nhập viện vì suy tim mất bù cấp tại Bệnh viện Nhân dân Gia Định. Tạp chí Y học Việt Nam. 2024;542(3):227-231.
10. He W, Jia J, Chen J, et al. Comparison of prognostic value of red cell distribution width and NT-proBNP for short-term clinical outcomes in acute heart failure patients. Int Heart J. 2014;55(1):58-64. http://www.ncbi.nlm.nih.gov/pubmed/24463920.
11. Turcato G, Cervellin G, Bonora A, et al. Red blood cell distribution width improves reclassification of patients admitted to the emergency department with acute decompensated heart failure. J Med Biochem. 2018;37(3):299-306. doi:10.1515/jomb-2017-0054
12. Dvornik Š, Zaninović Jurjević T, Jurjević N, et al. Prognostic factors for in-hospital mortality of patients hospitalized for acutely decompensated heart failure. Acta Clin Belgica Int J Clin Lab Med. 2018;73(3):199-206. doi:10.1080/17843286.2017.1410599
13. Salvatori M, Formiga F, Moreno-Gónzalez R, et al. Red blood cell distribution width as a prognostic factor of mortality in elderly patients firstly hospitalized due to heart failure. Kardiol Pol. 2019;77(6):632-638. doi:10.33963/KP.14818
14. Ferreira JP, Girerd N, Arrigo M, et al. Enlarging Red Blood Cell Distribution Width during Hospitalization Identifies a Very High-Risk Subset of Acutely Decompensated Heart Failure Patients and Adds Valuable Prognostic Information on Top of Hemoconcentration. Med (United States). 2016;95(14):e3307. doi:10.1097/MD.0000000000003307
15. Melchio R, Rinaldi G, Testa E, et al. Red cell distribution width predicts mid-term prognosis in patients hospitalized with acute heart failure: the RDW in Acute Heart Failure (RE-AHF) study. Intern Emerg Med. 2019;14(2):239-247. doi:10.1007/s11739-018-1958-z
16. Imai R, Uemura Y, Okumura T, et al. Impact of red blood cell distribution width on non-cardiac mortality in patients with acute decompensated heart failure with preserved ejection fraction. J Cardiol. 2017;70(6):591-597. doi:10.1016/j.jjcc.2017.03.010
17. Sotiropoulos K, Yerly P, Monney P, et al. Red cell distribution width and mortality in acute heart failure patients with preserved and reduced ejection fraction. ESC Hear Fail. 2016;3(3):198-204. doi:10.1002/ehf2.12091
18. Adamsson Eryd S, Borné Y, Melander O, et al. Red blood cell distribution width is associated with incidence of atrial fibrillation. J Intern Med. 2014;275(1):84-92. doi:10.1111/joim.12143
19. Güngör B, Özcan KS, Erdinler I, et al. Elevated levels of RDW is associated with non-valvular atrial fibrillation. J Thromb Thrombolysis. 2014;37(4):404-410. doi:10.1007/s11239-013-0957-1
20. Giamouzis G, Kourek C, Magouliotis DE, et al. The Prognostic Role of RDW in Hospitalized Heart Failure Patients with and Without Chronic Kidney Disease. J Clin Med. 2024;13:7395.
21. Kanzaki Y, Minamisawa M, Motoki H, et al. Prognostic Impact of the Ratio of Hemoglobin to Red Blood Cell Distribution Width in Patients after Acute Decompensated Heart Failure. Intern Med. 2024:1-10. doi:10.2169/internalmedicine.3691-24
22. Okonko DO, Mandal AKJ, Missouris CG, et al. Disordered iron homeostasis in chronic heart failure: Prevalence, predictors, and relation to anemia, exercise capacity, and survival. J Am Coll Cardiol. 2011;58(12):1241-1251. doi:10.1016/j.jacc.2011.04.040