Red Blood Cell Distribution Width Improves Reclassification of Patients Admitted to the Emergency Department with Acute Decompensated Heart Failure

Abstract

SummaryBackgroundThe usual history of chronic heart failure (HF) is characterized by frequent episodes of acute decompensation (ADHF), needing urgent management in the emergency department (ED). Since the diagnostic accuracy of routine laboratory tests remains quite limited for predicting short-term mortality in ADHF, this retrospective study investigated the potential significance of combining red blood cell distribution width (RDW) with other conventional tests for prognosticating ADHF upon ED admission.MethodsWe conducted a retrospective study including visits for episodes of ADHF recorded in the ED of the Uni versity Hospital of Verona throughout a 4-year period. Demo - graphic and clinical features were recorded upon patient presentation. All patients were subjected to standard Chest X-ray, electrocardiogram (ECG) and laboratory testing in - cluding creatinine, blood urea nitrogen, B-type natriuretic peptide (BNP), complete blood cell count (CBC), sodium, chloride, potassium and RDW. The 30-day overall mortality after ED presentation was defined as primary endpoint.ResultsThe values of sodium, creatinine, BNP and RDW were higher in patients who died than in those who survived, whilst hypochloremia was more frequent in patients who died than in those who survived. The multivariate model, incorporating these parameters, displayed a modest efficiency for predicting 30-day mortality after ED admission (AUC, 0.701; 95% CI, 0.662-0.738; p=0.001). Notably, the inclusion of RDW in the model significantly enhanced prediction efficiency, with an AUC of 0.723 (95% CI, 0.693-0.763; p<0.001). These results were confirmed with net reclassification improvement (NRI) analysis, showing that combination of RDW with conventional laboratory tests resulted in a much better prediction performance (net reclassification index, 0.222; p=0.001).ConclusionsThe results of our study show that prognostic assessment of ADHF patients in the ED can be significantly improved by combining RDW with other conventional laboratory tests.

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

“…Increased RDW may be associated with a slower diuretic response [ 39 ], and elevated LV filling pressure (E/E’) [ 40 ], and has been shown to predict early mortality in patients presenting with acute dyspnea at the emergency department (ED), irrespective of its etiology [ 41 ]. Notably, the addition of RDW to conventional laboratory tests (B-type natriuretic peptide, creatinine, sodium and chloride) may significantly improve the 30-day prognostic assessment (for all-cause mortality) of acute HF patients presenting in the ED [ 42 ].…”

Superoxide dismutase isoenzymes gene expression in peripheral blood mononuclear cells in patients with coronary artery disease

“…Atherosclerosis, as chronic inflammatory, fibro-proliferative disease of the large and middle-sized arteries is the essential for onset and development of CAD (2). Dyslipidemia, chronic low-grade inflammation and the imbalance between the production of reactive oxygen species (ROS) and enzymatic and non-enzymatic antioxidant protection could cause endothelial dysfunction of coronary arteries (3, 4, 5). Increased total cholesterol (TC) concentrations, especially low-density lipoprotein cholesterol (LDL-c), high triglyceride (TG) and low high-density lipoprotein cholesterol (HDL-c) levels in plasma, are unique factors that are sufficient to lead to atherosclerosis development (4).…”

“…Hyperlipidemia stimulates the proinflammatory monocytes to migrate to atherosclerotic lesions where they synthesize large amounts of cytokines and other proinflammatory mediators. Modified lipoproteins interact with scavenger receptors and induce proinflammatory signals within macrophages and foam cells formation (2, 5).…”

Leukocytosis interference in clinical chemistry: shall we still interpret test results without hematological data?

“…The term »artifactual hypoglycemia« was proposed when results of laboratory measurement do not reflect the actual blood glucose concentration, regardless of the presence of symptoms of both hypoor hyperglycemia (3). Artifactual hypoglycemia has also been related to in vitro glucose consumption by blood cells after blood sample has been drawn (4,5).…”