Prognostic value of RDW alone and in combination with NT‐proBNP in patients with heart failure

Liang, Lin; Huang, Liyan; Zhao, Xuemei; Zhao, Lang; Tian, Pengchao; Huang, Boping; Feng, Jiayu; Zhang, Jian; Zhang, Yuhui

doi:10.1002/clc.23850

Cited by 20 publications

(33 citation statements)

References 39 publications

(65 reference statements)

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“…It is linked to iron, folate or vitamin B12 deficiency, red cell early destruction, and an inflammatory status which leads to bone marrow dysfunction, hepatic congestion and hematological disorders ( 20 , 21 ). As regards chronic HF, RDW has been reported to be a strong tool for HF prognosis ( 21 – 24 ) alone or in combination with NT-proBNP ( 25 ). Of note RDW is usually part of the data provided when a complete red blood cell count is requested and therefore is frequently available without a specific request and further economic burden.…”

Section: Discussionmentioning

confidence: 99%

Is red distribution width a valid tool to predict impaired iron transport in heart failure?

Campodonico

Carulli

Doni

et al. 2023

Front. Cardiovasc. Med.

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BackgroundImpaired iron transport (IIT) is a form of iron deficiency (ID) defined as transferrin saturation (TSAT) < 20% irrespective of serum ferritin levels. It is frequently observed in heart failure (HF) where it negatively affects prognosis irrespective of anaemia.ObjectivesIn this retrospective study we searched for a surrogate biomarker of IIT.MethodsWe tested the predictive power of red distribution width (RDW), mean corpuscular volume (MCV) and mean corpuscular haemoglobin concentration (MCHC) to detect IIT in 797 non-anaemic HF patients.ResultsAt ROC analysis, RDW provided the best AUC (0.6928). An RDW cut-off value of 14.2% identified patients with IIT, with positive and negative predictive values of 48 and 80%, respectively. Comparison between the true and false negative groups showed that estimated glomerular filtration rate (eGFR) was significantly higher (p = 0.0092) in the true negative vs. false negative group. Therefore, we divided the study population according to eGFR value: 109 patients with eGFR ≥ 90 ml/min/1.73 m2, 318 patients with eGFR 60–89 ml/min/1.73 m2, 308 patients with eGFR 30–59 ml/min/1.73 m2 and 62 patients with eGFR < 30 ml/min/1.73 m2. In the first group, positive and negative predictive values were 48 and 81% respectively, 51 and 85% in the second group, 48 and 73% in the third group and 43 and 67% in the fourth group.ConclusionRDW may be seen as a reliable marker to exclude IIT in non-anaemic HF patients with eGFR ≥60 ml/min/1.73 m2.

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Section: Discussionmentioning

confidence: 99%

Is red distribution width a valid tool to predict impaired iron transport in heart failure?

Campodonico

Carulli

Doni

et al. 2023

Front. Cardiovasc. Med.

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“…As a traditional biomarker for the diagnosis and prognostic evaluation of HF, the clinical application of NT-proBNP is quite limited due to multiple factors[ 39 ], such as an advanced age and renal dysfunction[ 40 ]. Its effectiveness is further compromised in cases of HF with preserved ejection fraction (HFpEF), due to the impact from the clinical characteristics of HFpEF, including obesity, atrial fibrillation, and renal impairment[ 41 ]. Moreover, NT-proBNP levels may appear normal in the HFpEF patients, thereby impacting the accuracy of risk assessment[ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Value of red blood cell distribution width in prediction of diastolic dysfunction in cirrhotic cardiomyopathy

Chen¹,

Zhao²,

Li³

et al. 2023

World J Gastroenterol

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BACKGROUND Clinical diagnosis of cirrhotic cardiomyopathy (CCM) often encounters challenges of lack of timeliness and disease severity, with the commonly positive indicator usually associated with advanced heart failure. AIM To explore suitable biomarkers for early CCM prediction. METHODS A total of 505 eligible patients were enrolled in this study and divided into four groups according to Child-Pugh classification: Group I, Class A without CCM (105 cases); Group II, Class A with CCM (175 cases); Group III, Class B with CCM (139 cases); and Group IV, Class C with CCM (86 cases). Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to determine whether red blood cell distribution width (RDW) was an independent risk factor for CCM risk. The relationships between RDW and Child-Pugh scores, Model for End-Stage Liver Disease (MELD) scores, and N-terminal pro-brain natriuretic peptide (NT-proBNP) were analyzed by Pearson correlation analysis. RESULTS A constant RDW increase was evident from Group I to Group IV (12.54 ± 0.85, 13.29 ± 1.19, 14.30 ± 1.96, and 16.25 ± 2.13, respectively). Pearson correlation analysis showed that RDW was positively correlated with Child-Pugh scores ( r = 0.642, P < 0.001), MELD scores ( r = 0.592, P < 0.001), and NT-proBNP ( r = 0.715, P < 0.001). Furthermore, between Group I and Group II, RDW was the only significant index (odds ratio: 2.175, 95% confidence interval [CI]: 1.549-3.054, P < 0.001), and it reached statistical significance when examined by ROC curve analysis (area under the curve: 0.686, 95%CI: 0.624-0.748, P < 0.001). CONCLUSION RDW can serve as an effective and accessible clinical indicator for the prediction of diastolic dysfunction in CCM, in which a numerical value of more than 13.05% may indicate an increasing CCM risk.

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“…Studies have shown that oxidative stress shortens the lifespan of red blood cells and changes the distribution of red blood cell volume. RDW may reflect the inflammatory response, which is a powerful biomarker for long-term prognosis in patients with AHF ( 17 , 43 ). In a cohort study including 3231 patients with HF with a median follow-up of 2.9 years, those with RDW in the upper quartile had an increased risk of all-cause mortality, 120% and 114% increased risk of all-cause mortality (HR=2.20 [1.68–2.89]) and cardiovascular mortality (HR=2.14 [1.53–2.98]) respectively, compared to patients with RDW in the lower quartile ( 43 ).…”

Section: Discussionmentioning

confidence: 99%

“…RDW may reflect the inflammatory response, which is a powerful biomarker for long-term prognosis in patients with AHF ( 17 , 43 ). In a cohort study including 3231 patients with HF with a median follow-up of 2.9 years, those with RDW in the upper quartile had an increased risk of all-cause mortality, 120% and 114% increased risk of all-cause mortality (HR=2.20 [1.68–2.89]) and cardiovascular mortality (HR=2.14 [1.53–2.98]) respectively, compared to patients with RDW in the lower quartile ( 43 ).…”

Section: Discussionmentioning

confidence: 99%

“…LASSO regression analysis performed feature selection on 12 inflammatory markers using a 5-fold cross-validation method. respectively, compared to patients with RDW in the lower quartile (43). Altogether, inflammatory biomarkers play diverse roles in the progression of myocardial fibrosis, persistent systemic inflammation, endothelial injuries or the impairment of left ventricular systolic function, leading to a worsening HF.…”

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confidence: 99%

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Long-term prognostic value of inflammatory biomarkers for patients with acute heart failure: Construction of an inflammatory prognostic scoring system

Zhu

Cheang

et al. 2022

Front. Immunol.

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Objective: Systemic inflammation is associated with a poor prognosis in acute heart failure (AHF). This study was to assess the long-term prognostic value of combining the accessible inflammatory markers in relation to all-cause mortality in patients with AHF.Methods: Consecutive patients with AHF who were hospitalized between March 2012 and April 2016 at the Department of Cardiology of the First Affiliated Hospital of Nanjing Medical University were enrolled in this prospective study. The LASSO regression model was used to select the most valuable inflammatory biomarkers to develop an inflammatory prognostic scoring (IPS) system. Kaplan-Meier method, multivariate COX regression and time-dependent ROC analysis were used to assess the relationship between inflammatory markers and AHF prognosis. A randomized survival forest model was used to estimate the relative importance of each inflammatory marker in the prognostic risks of AHF.Results: A total of 538 patients with AHF were included in the analysis (mean age, 61.1 ± 16.0 years; 357 [66.4%] men). During a median follow-up of 34 months, there were 227 all-cause deaths (42.2%). C-reactive protein (CRP), red blood cell distribution width (RDW) and neutrophil-to-lymphocyte ratio (NLR) were incorporated into the IPS system (IPS = 0.301×CRP + 0.263×RDW + 0.091×NLR). A higher IPS meant a significantly worse long-term prognosis in Kaplan-Meier analysis, with 0.301 points as the optimal cut-off value (P logrank <0.001). IPS remained an independent prognostic factor associated with an increased risk of all-cause mortality among patients with AHF in multivariate Cox regression models with a full adjustment of the other significant covariables. Random forest variable importance and minimal depth analysis Frontiers in Immunology frontiersin.org 01

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Prognostic value of RDW alone and in combination with NT‐proBNP in patients with heart failure

Cited by 20 publications

References 39 publications

Is red distribution width a valid tool to predict impaired iron transport in heart failure?

Is red distribution width a valid tool to predict impaired iron transport in heart failure?

Value of red blood cell distribution width in prediction of diastolic dysfunction in cirrhotic cardiomyopathy

Long-term prognostic value of inflammatory biomarkers for patients with acute heart failure: Construction of an inflammatory prognostic scoring system

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