Red blood cell distribution width predicts long‐term outcome regardless of anaemia status in acute heart failure patients

Abstract

AimsTo study the long-term prognostic value of red blood cell distribution width (RDW) in patients hospitalized with acute heart failure (AHF) and to compare the value of this measurement with haemoglobin levels and anaemia status. Methods and resultsDuring a 2-year period, we studied 628 consecutive patients (aged 71 years [interquartile range, IQR: 61 -77], 68% male) hospitalized with AHF. Demographic, clinical, echocardiographic, and laboratory characteristics were registered at discharge and patients were closely followed-up for 38.1 months [16.5-49.1]. Median RDW was 14.4% [13.5 -15.5] and was higher among decedents (15.0% [13.8-16.1] vs. 14.2 [13.3 -15.3], P , 0.001). After adjustment for other prognostic factors in a multivariable Cox proportional-hazards model, RDW remained a significant predictor (P ¼ 0.004, HR 1.072, 95% CI 1.023 -1.124); whereas, haemoglobin or anaemia status did not add prognostic information. RDW levels above the median were associated with a significantly lower survival rate on long-term follow-up (log rank ,0.001). These levels were predictive of death in anaemic patients (n ¼ 263, P ¼ 0.029) and especially in non-anaemic patients (n ¼ 365) (P , 0.001, HR 1.287, 95% CI 1.147-1.445), even after adjustment in the multivariable model. ConclusionHigher RDW levels at discharge were associated with a worse long-term outcome, regardless of haemoglobin levels and anaemia status.--

Comparison of Prognostic Value of Red Cell Distribution Width and NT-proBNP for Short-Term Clinical Outcomes in Acute Heart Failure Patients

“…15,20,21) However, it has already been concluded that RDW predicts poor long-term outcome regardless of anemia status in AHF patients. 14,22,23) We observed that RDW was associated with low hemoglobin and depressed MCV, which are consistent with a state of impaired iron mobilization. RDW was an independent predictive factor after adjustment for hemoglobin in short-term outcome, though it had limitations in predicting 30-day clinical outcome.…”

“…Ample evidence has demonstrated the value of RDW for predicting long-term adverse outcome in patients with AHF 5,14) and CHF.…”

Red Blood Cell Distribution Width (RDW) and its Association with Coronary Atherosclerotic Burden in Patients with Stable Angina Pectoris

“…At the present time, it is well know that atherosclerosis is chronic inflammatory disease and varied causative cytokines such as TNF-α, IL-1b, and IL-6 are released in its process (11,12). These increased inflammatory cytokines in blood stream may have a suppressing effect on erythropoietin (Epo) and hemoglobin synthesis that this situation causes chronic inflammatory anemia.…”

Could Red Cell Distribution Width Serve as a New Inflammatory Marker in Coronary Artery Bypass Grafting?

“…Originally it is used to distinguish types of anemia. However, it has been recently demonstrated that an increase in the RDW values may be associated with heart failure, coronary ar tery disease or peripheral artery disease [1][2][3][4]. Moreover, RDW is believed to be an indicator of inflammation as well, since an increase in this value might be a result of oxidative stress on the erythrocytes.…”