Red cell distribution width and mortality in acute heart failure patients with preserved and reduced ejection fraction

Abstract

BackgroundElevated red blood cell distribution width (RDW) is a valid predictor of outcome in acute heart failure (AHF). It is unknown whether elevated RDW remains predictive in AHF patients with either preserved left ventricular ejection fraction (LVEF) ≥50% or reduced LVEF (<50%).Methods and resultsProspective local registry including 402 consecutive hospitalized AHF patients without acute coronary syndrome or need of intensive care. The primary outcome was all‐cause mortality (ACM) at 1 year after admission. Demographic and clinical data derive from admission, echocardiographic examinations (n = 269; 67%) from hospitalization.The Cox proportional hazard model including all patients (P < 0.001) was adjusted for age, gender, and RDW quartiles. Independent predictors of 1‐year ACM were cardiogenic shock (HR 2.86; CI: 1.3–6.4), male sex (HR 1.9; CI: 1.2–2.9), high RDW quartile (HR 1.66; CI: 1.02–2.8), chronic HF (HR 1.61; CI: 1.05–2.5), valvular heart disease (HR 1.61; CI: 1.09–2.4), increased diastolic blood pressure (HR 1.02 per mmHg; CI: 1.01–1.03), increasing age (HR 1.04 by year; CI: 1.02–1.07), platelet count (HR 1.002 per G/l; CI: 1.0–1.004), systolic blood pressure (HR 0.99 per mmHg; CI: 0.98–0.99), and weight (HR 0.98 per kg; CI: 0.97–0.99). A total of 114 patients (28.4%) died within the first year; ACM of all patients increased with quartiles of rising RDW (χ2 18; P < 0.001). ACM was not different between RDW quartiles of patients with reduced LVEF (n = 153; χ2 6.6; P = 0.084). In AHF with LVEF ≥50% the probability of ACM increased with rising RDW (n = 116; χ2 9.9; P = 0.0195).ConclusionsHigh RDW is associated with increased ACM in AHF patients with preserved but not with reduced LVEF in this study population.

Incidence and impact of cardiorenal anaemia syndrome on all‐cause mortality in acute heart failure patients stratified by left ventricular ejection fraction in the Middle East

“…CRAS in patients at discharge was an independent predictor of re-admission for HF and mortality. 19 Literature review shows that in the European Society of Cardiology-Heart Failure (ESC-HF) pilot registry, 26% (1300/5000) of AHF patients had CKD. 17 Left ventricular dysfunction and renal dysfunction are independent predictors of poor prognosis and higher mortality.…”

Prognostic value of red blood cell distribution width in patients with left ventricular systolic dysfunction: Insights from the COMMIT-HF registry

“…In contrast, Sotiropoulos et al reported that high RDW is associated with long-term mortality in patients with preserved, but not reduced ejection fraction. [19]. The results of prospective studies with long-term follow-up (Tromsø and National Health and Nutrition Examination Survey) demonstrate that high RDW values are associated with increased risk of myocardial infarction (MI) and mortality due to CAD in the general population [15,16], and in elderly patients without age-associated diseases [20].…”

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

“…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 . However, in the comparison of HFrEF with HFpEF, all‐cause mortality increased with elevating RDW in patients with HFpEF, but not in those with HFrEF, requiring further comparative investigations …”

“…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 .…”

“…A large‐scale cohort is standard to study the association of RDW with HF . Second, HF management protocol and antibiotic treatment strategy depend on the discretions of the treating physicians, although the discretions were strictly based on the guidelines of the domestic medical societies . Third, this observational study did not contain a healthy control group.…”