Impact of red blood cell distribution width on non-cardiac mortality in patients with acute decompensated heart failure with preserved ejection fraction

Imai, Ryo; Uemura, Yoshiko; Okumura, Takahiro; Takemoto, Kenji; Uchikawa, Tomohiro; Koyasu, Masayoshi; Ishikawa, Shinya; Iwamiya, Satoshi; Ozaki, Yuta; Shibata, Rei; Watarai, Masato; Murohara, Toyoaki

doi:10.1016/j.jjcc.2017.03.010

Cited by 22 publications

(37 citation statements)

References 37 publications

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“…BNP‐guided severity contributed roughly to the distinction of HFrEF and HFpEF, but not to RDW in the present study (Table ), indicating that RDW has no association with the severity or hemodynamics in HF. These findings are compatible with literature reporting that RDW is independent of BNP for predicting HF outcome . Baseline RDW is reported to independently predict the prognosis of patients with acutely decompensated HFpEF, and the same is true in patients hospitalized for the treatment of HF with highly reduced (≤35%) EF .…”

Section: Discussionsupporting

confidence: 91%

“…When HF patients in group A were subdivided again by RDW, 35 patients showed RDW ≥15%, and 67 patients showed RDW 15%. The cut‐off level of RDW was the same as or very close to the level of 14.6–15.0 in the literature . As shown in Table , the mean hospital stay in the former subgroup was 19.2 ± 9.2 days, whereas that in the latter was 13.9 ± 8.2 days ( P < 0.01), showing that the HF patients with greater RDW required a longer hospital stay relative to those showing lesser RDW.…”

Section: Resultssupporting

confidence: 64%

“…Approximately half of HF patients die within 5 years after the initial diagnosis . The etiology of HF was mainly hypertensive or ischemic heart diseases (Table ), as in the literature . These are the main underlying diseases causing HF with reduced (<50%) and preserved (≥50%) EF (HFrEF and HFpEF).…”

Section: Discussionmentioning

confidence: 96%

“…Although many factors affect RDW, higher levels of RDW in patients with infection is a consequence of elevated inflammatory cytokines causing stress erythropoiesis and impaired maturation of red cells. Many investigations have used RDW on admission as a parameter predicting mortality and morbidity of HF, and some studies investigated serial changes of RDW during hospitalization . In‐hospital elevation of RDW is associated with increased mortality in HF patients .…”

Section: Discussionmentioning

confidence: 99%

“…In this decade, this intriguing laboratory marker has been reported to have a prognostic value in cardiovascular and cerebrovascular diseases . Current evidence has suggested that RDW is useful to predict cardiac events and adverse outcomes in patients with HF . However, the results are conflicting in detail, which might reflect the complexity and heterogeneity of HF in the geriatric population.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic significance of red cell distribution width in hospitalized older patients with heart failure or infection

Nakashima

Ohgami

Kato

et al. 2019

Geriatrics Gerontology Int

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Aim Red cell distribution width (RDW) is a simple, sensitive and cost‐effective parameter, and is associated with pathophysiology of many common diseases. The aim of the present study was to investigate the prognostic role of RDW in older adults hospitalized for the treatment of heart failure (HF) or infection, because both diseases are fatal, especially in the geriatric population. Methods This observational study consecutively enrolled 196 Japanese older (aged ≥75 years) patients hospitalized for the treatment of HF (group A, n = 102) or non‐cardiovascular bacterial infection (group B, n = 94). Baseline and clinical data were extracted from medical records. The observational period was that of hospitalization. The primary end‐point was classified in the order of discharge to the patients’ home, discharge to other facilities and in‐hospital death. Results Longer hospital stay (P < 0.01) and worse prognosis (P < 0.01), including higher in‐hospital mortality, were found in patients showing RDW ≥15% relative to those with RDW <15% in both groups. RDW showed no in‐hospital variation despite successful treatment of acutely decompensated HF in selected patients of group A (n = 64). Conclusions The present study showed the role of RDW in predicting the prognostic outcome of older adults hospitalized for the treatment of HF or infection, indicating that RDW is a stable and reliable parameter in these common diseases. Geriatr Gerontol Int 2019; 19: 988–992.

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Section: Discussionsupporting

confidence: 91%

Section: Resultssupporting

confidence: 64%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prognostic significance of red cell distribution width in hospitalized older patients with heart failure or infection

Nakashima

Ohgami

Kato

et al. 2019

Geriatrics Gerontology Int

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In‐hospital changes in the red blood cell distribution width and mortality in critically ill patients with heart failure

Zhang,

Zhou,

et al. 2023

ESC Heart Failure

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AimsA high red blood cell distribution width (RDW) at admission or discharge is associated with a worse prognosis in hospitalized patients with heart failure (HF), and the prognostic value of the in‐hospital change in RDW (∆RDW) remains debatable.Methods and resultsWe included 5514 patients with critical illness and HF from the MIMIC‐IV database. The ΔRDW was calculated by the RDW at discharge minus that at admission. Clinical outcomes included all‐cause mortality at 90 day, 180 day, and 1 year after discharge. The median age of the patients was 73.91 years, and 46.37% were women. Kaplan–Meier curve and Cox regression analyses were used to examine the association between the ΔRDW and all‐cause mortality at different time points. A multivariable Cox proportional hazard model showed that the ΔRDW (per 1% increase) was independently associated with all‐cause mortality at 90 day, 180 day, and 1 year after adjusting for confounding factors (hazard ratio [HR] = 1.17, 95% confidence interval [CI] = 1.13–1.21, P < 0.001; HR = 1.17, 95% CI = 1.14–1.20, P < 0.001; and HR = 1.18, 95% CI = 1.15–1.20, P < 0.001, respectively). Restricted cubic splines showed a non‐linear relationship between the ΔRDW and the risk of clinical outcomes. High ΔRDW was associated with a high risk of mortality at different time points. A subgroup analysis showed that this positive association remained consistent in pre‐specified subgroups.ConclusionsOur study suggests that an increased RDW during hospitalization is independently associated with short‐ or long‐term all‐cause mortality in critical‐ill patients with HF.

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Heart failure with preserved ejection fraction, red cell distribution width, and sacubitril/valsartan

Butt,

McDowell,

Kondo

et al. 2023

ESC Heart Failure

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AimsRed cell distribution width (RDW) is a strong prognostic marker in patients with heart failure (HF) and reduced ejection fraction and other conditions. However, very little is known about its prognostic significance in HF with preserved ejection fraction. We examined the relationship between RDW and outcomes and the effect of sacubitril/valsartan, compared with valsartan, on RDW and clinical outcomes in PARAGON‐HF.Methods and resultsPARAGON‐HF enrolled patients with a left ventricular ejection fraction of ≥45%, structural heart disease, and elevated N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP). The primary endpoint was a composite of total HF hospitalizations and cardiovascular deaths. Median RDW at randomization was 14.1% (interquartile range 13.5–15.0%). Patients with higher RDW levels were more often men and had more comorbidity, a higher heart rate and NT‐proBNP concentration, more advanced New York Heart Association class, and worse Kansas City Cardiomyopathy Questionnaire scores. There was a graded relationship between quartiles of RDW at randomization and the primary endpoint, with a significantly higher risk associated with increasing RDW, even after adjustment for NT‐proBNP and other prognostic variables {Quartile 1, reference; Quartile 2, rate ratio 1.03 [95% confidence interval (CI) 0.83 to 1.28]; Quartile 3, 1.25 [1.01 to 1.54]; Quartile 4, 1.70 [1.39 to 2.08]}. This association was seen for each of the secondary outcomes, including cardiovascular and all‐cause death. Compared with valsartan, sacubitril/valsartan reduced RDW at 48 weeks [mean change −0.09 (95% CI −0.15 to −0.02)]. The effect of sacubitril/valsartan vs. valsartan was not significantly modified by RDW levels at randomization.ConclusionsRDW, a routinely available and inexpensive biomarker, provides incremental prognostic information when added to established predictors. Compared with valsartan, sacubitril/valsartan led to a small reduction in RDW.

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Impact of red blood cell distribution width on non-cardiac mortality in patients with acute decompensated heart failure with preserved ejection fraction

Abstract: The current study demonstrated that RDW levels at admission independently predict poor outcomes because of non-cardiac events in patients with acute decompensated HFpEF. Evaluation of RDW could provide useful information for the long-term prognosis of HFpEF.

Cited by 22 publications

References 37 publications

Prognostic significance of red cell distribution width in hospitalized older patients with heart failure or infection

Prognostic significance of red cell distribution width in hospitalized older patients with heart failure or infection

In‐hospital changes in the red blood cell distribution width and mortality in critically ill patients with heart failure

Heart failure with preserved ejection fraction, red cell distribution width, and sacubitril/valsartan

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