Prognostic significance of red cell distribution width and other red cell parameters in patients with chronic heart failure during two years of follow-up

Abstract

A b s t r a c tBackground: Studies published during the last decade seem to indicate red blood cell parameters as inexpensive, rapidly available, and simple tools for the assessment of prognosis in patients with chronic heart failure (CHF). Aim:To evaluate the prognostic value of red cell parameters determined in a routine blood count in patients with CHF. Methods:The study group included 165 patients with the New York Heart Association (NYHA) class II-IV CHF hospitalised in the 2 nd Department of Cardiology in Bydgoszcz. On the first day of hospitalisation, all patients in the study group underwent a complete blood count with an assessment of haemoglobin (Hb) level, mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC) and red blood cell distribution width (RDW). Follow-up was carried over 24 months by phone calls every 3 months.Results: MCV, MCH and MCHC were not shown to be significant predictors of mortality in CHF patients at 1 and 2 years of follow-up. In univariate analysis at 1-year follow-up, the following variables were significantly associated with the occurrence of the study endpoint: Hb level (p = 0.022; HR = 0.80), RDW (p = 0.004; HR = 1.257), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) level (p = 0.0001; HR = 1). At 2 years of follow-up, the following variables were significantly associated with the occurrence of the study endpoint: left ventricular ejection fraction (p = 0.018; HR = 0.956), NYHA class (p = 0.007; HR = 0.378), RDW (p = 0.044; HR = 1.175), and NT-proBNP level (p < 0.001; HR = 1). Multivariate analysis for 1-year follow-up showed that RDW and NT-proBNP level were independent significant predictors of mortality, while NT-proBNP level (p = 0.006; HR = 1) and NYHA class (p = 0.024; HR = 0.439) were significant predictors of mortality at 2 years of follow-up. Based on receiver operating characteristic curve analysis, the cut-off RDW was 15.00% (AUC = 0.63; 0.523-0.737), at 12 months of follow-up and 14.00% (AUC = 0.6; 0.504-0.697), at 24 months of follow-up. The cut-off for Hb level was 13.9 g/dL (AUC = 0.662; 0.553-0.77), at 12 months of follow-up and 12.2 g/dL (AUC = 0.581; 0.482-0.681), at 24 months of follow-up. Conclusions:Baseline RDW and Hb level in patients hospitalised with the diagnosis of NYHA class II-IV CHF seem to be important predictors of mortality in this population. Among the red blood cell parameters, only RDW was shown to be an independent prognostic factor at 1 year of follow-up but it appeared to lose its significance during longer-term follow-up.

Red Blood Cell Distribution Width in Heart Failure: Pathophysiology, Prognostic Role, Controversies and Dilemmas

“…The authors found that RDW exhibited the strongest association with cardiovascular death or HF hospitalization (adjusted HR 1.17 per 1-SD increase, 95% CI: 1.10–1.25, p < 0.001) among 36 laboratory parameters in a cohort of 2679 symptomatic chronic HF patients from the North American CHARM (Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity) program. Similar were the findings in the Study of Anemia in a Heart Failure Population (STAMINA-HFP) [ 18 , 34 ], as well as in patients post myocardial infarction (MI) [ 35 ]. In this regard, it has been proposed that RDW may be a better predictor of outcomes in HF patients than several echocardiographic parameters [ 36 ].…”

Comparison of the red blood cell indices based on accuracy, sensitivity, and specificity to predict one-year mortality in heart failure patients

“…Recently, MCV has been associated with mortality in many clinical settings [ 13 ]. Wolowiec et al [ 5 ] found that there was no statistically significant relationship between MCV and the prognosis of patients with heart failure with 1-year follow-up. In our study, no mortality-predicting role can be assumed for MCV in heart failure patients.…”

“…Mean corpuscular hemoglobin represents the average amount of Hb in RBCs, and Hb is essential for the distribution and delivery of oxygen to the tissues [ 24 ]. Following a study by Wolowiec et al [ 5 ] that showed MCH was not a prognostic factor in heart failure patients, the current project failed to determine the MCH as a 1-year mortality predictor. Although it possesses an acceptable significant sensitivity in ROC analysis, in the multivariate model, with the effect of other co-factors, the prognostic utility was alleviated, and it cannot be supposed as a predictor.…”

Red cell distribution width and its relationship with global longitudinal strain in patients with heart failure with reduced ejection fraction: a study using two-dimensional speckle tracking echocardiography

“…Regarding to the prognostic value of RDW in patients with HF, it has been concluded that RDW independently predicts one-year mortality in acute HF patients, as well as in patients with chronic HF [14,15]. High RDW values also predict poor long-term outcome regardless of anaemia status in HF patients [16].…”