The Intermountain Risk Score (including the red cell distribution width) predicts heart failure and other morbidity endpoints

Abstract

AimsThe complete blood count (CBC) and basic metabolic profile are common, low-cost blood tests, which have previously been used to create and validate the Intermountain Risk Score (IMRS) for mortality prediction. Mortality is the most definitive clinical endpoint, but medical care is more easily applied to modify morbidity and thereby prevent death. This study tested whether IMRS is associated with clinical morbidity endpoints. Methods and resultsPatients seen for coronary angiography (n ¼ 3927) were evaluated using a design similar to a genome-wide association study. The Bonferroni correction for 102 tests required a P-value of ≤ 4.9 × 10 24 for significance. A second set of angiography patients (n ¼ 10 413) was used to validate significant findings from the first patient sample. In the first patient sample, IMRS predicted heart failure (HF) (P trend ¼ 1.6 × 10 226), coronary disease (P trend ¼ 2.6 × 10 211), myocardial infarction (MI) (P trend ¼ 3.1 × 10 225 ), atrial fibrillation (P trend ¼ 2.5 × 10 220 ), and chronic obstructive pulmonary disease (P trend ¼ 4.7 × 10 24). Even more, IMRS predicted HF readmission [hazard ratio (HR) ¼ 2.29/category, P trend ¼ 1.2 × 10 26 ), incident HF (HR ¼ 1.88/category, P trend ¼ 0.02), and incident MI (HR ¼ 1.56/category, P trend ¼ 4.7 × 10 24 ). These findings were verified in the second patient sample. ConclusionIntermountain Risk Score, a predictor of mortality, was associated with morbidity endpoints that often lead to mortality. Further research is required to fully characterize its clinical utility, but its low-cost CBC and basic metabolic profile composition may make it ideal for initial risk estimation and prevention of morbidity and mortality. An IMRS web calculator is freely available at http://intermountainhealthcare.org/IMRS. Trial Registration: Database registry of the Intermountain Heart Collaborative Study: NCT00406185

Raised red cell distribution width as a prognostic marker in aortic valve replacement surgery

“…Nevertheless, the role of RDW as a predictor of mortality in different groups of patients has been widely described. RDW has also been included as a key element of the scales based on complete blood counts assessing the risks of mortality and morbidity [28,29]. Therefore, on the basis of this work, it appears that RDW may be helpful in selecting a group of patients with a higher risk for postoperative complications requiring additional attention in being qualified for surgery.…”

Pulmonary-Specific Intermountain Risk Score Predicts All-Cause Mortality via Spirometry, the Red Cell Distribution Width, and Other Laboratory Parameters

“…4 IMRS research led to the discovery that the red cell distribution width (RDW) predicts mortality. [4][5][6] IMRS also predicts common morbidity end points that lead to mortality, including COPD. 50 The finding that IMRS is associated with COPD raised the questions of whether IMRS, its components, or a rederivation of IMRS that integrated PFT variables could predict mortality in a pulmonary population.…”

Relationship between red cell distribution width and mean platelet volume with new onset atrial fibrillation afteroff-pump coronary artery bypass grafting

“…Many studies have shown that RDW is a strong predictor of adverse outcomes in patients with heart failure, stroke and myocardial infarction (4)(5)(6). In previous studies, in patients undergoing coronary angiography and CABG indicated a possible association between RDW and AF (7,8).…”