Red cell distribution width is associated with short‐term mortality in critically ill patients with heart failure

Abstract

Aims There is limited evidence for the correlation between short-term mortality and red cell distribution width (RDW) in critical patients with heart failure. Herein, a retrospective cohort study was conducted to investigate whether RDW was independently associated with short-term mortality in critically ill patients with heart failure. Methods and resultsAs a retrospective cohort study, it involved a total of 9465 patients with heart failure from the MIMIC-IV database. The target-dependent and independent variables were in-hospital mortality, 90 day mortality and RDW measured at baseline, respectively. The relationship between all-cause death and baseline RDW in hospital and after 90 days of admission to ICU was evaluated by using the Kaplan-Meier plot and Cox proportional hazard analysis. The average age of participants was 74.4 (64.2, 83.5) years old, among whom about 54.6% were male. Results of the adjusted Cox proportional hazard model revealed that RDW had a positive association with both in-hospital and 90 day mortality risk after the adjustment of confounders (HR = 1.09, 95% CI: 1.04-1.15, P < 0.001; HR = 1.11, 95% CI: 1.08-1.14, P < 0.001, respectively). A non-linear relationship was found between RDW and 90 day mortality, which had a threshold of 14.96%. The effect sizes and confidence intervals below and above the threshold were 1.36 (1.14 to 1.62) and 1.09 (1.04 to 1.15), respectively. It was also found by subgroup analysis that there were stronger correlations in male and patients with normal renal function. Conclusions Our data suggest that the short-term mortality of critically ill patients with HF is independently predicted by RDW. At the same time, large prospective research and longer follow-up time are required to further validate the findings of this study.Keywords Red cell distribution width; Critically ill patients with heart failure; Prognosis

In‐hospital changes in the red blood cell distribution width and mortality in critically ill patients with heart failure

“…Recently, Zhang et al showed that a higher RDW at baseline was an independent predictor for in‐hospital and short‐term all‐cause mortality in critically ill patients with HF 9 . However, the dynamic ΔRDW in critically ill patients with HF is unknown.…”

“…However, because HF is a complex syndrome caused by various heart diseases, the predictive value of the RDW for the prognosis could be different. Zhang et al reported that the RDW was a prognostic indicator for patients with HF caused by coronary heart disease and dilated cardiomyopathy, but not valvular heart disease 42 . Moreover, several studies have shown that a high RDW is associated with an increased risk of mortality in patients with HF and a preserved ejection fraction, but not with a reduced ejection fraction 43,44 .…”

“…In patients with HF, accurate risk stratification for a poor prognosis is crucial. Previous studies have shown that an increased RDW is associated with poor short‐ and long‐term outcomes in acute or chronic HF 8–20 . An increased RDW indicates the deregulation of erythrocyte homeostasis and abnormal survival of red blood cells.…”

“…Several studies have shown that a persistent increase in the RDW during hospitalization is associated with adverse short‐or long‐term outcomes in patients with acute or chronic HF 23–28 . However, the RDW value may be different from that of general inpatients or outpatients with HF who are critically ill. A recent study showed that the baseline RDW was associated with in‐hospital and short‐term mortality in critically ill patients with HF 9 . However, the in‐hospital ∆RDW and the mortality rate in the short or long term in critically ill patients with HF is unclear.…”

Red cell distribution width and mortality in older patients with frailty in the emergency department

“…RDW is calculated by dividing the standard deviation of red blood cell volumes by the mean corpuscular volume (MCV), usually expressed as a percentage value. RDW has traditionally been used for differential diagnosis of anaemia, but, subsequently, RDW elevation has been found to associate with higher short-and long-term increased mortality, both in the general population and in patients with many specific conditions [1-5], such as infections and sepsis [6-8], liver cirrhosis [9, 10], diabetic ketoacidosis [11], trauma [12,13], acute pancreatitis [14], cardiac diseases [8, [15][16][17][18][19], pulmonary embolism [20], COVID-19, and acute respiratory failure [21][22][23]. In hospitals, high RDW has been shown to predict poor prognosis among general patients [24], among surgical patients [25], and among patients with critical illness [26,27].…”