Combined Assessment of the Red Cell Distribution Width and B-type Natriuretic Peptide: A More Useful Prognostic Marker of Cardiovascular Mortality in Heart Failure Patients

Abstract

Objective An increased red cell distribution width (RDW) has been reported to be associated with adverse outcomes in patients with heart failure (HF). This study aimed to evaluate the prognostic power of the combined measurement of RDW and B-type natriuretic peptide (BNP) concentrations in patients with HF. Methods and Results We retrospectively studied 116 patients (mean age, 63.7±14.3 years) who were admitted for the treatment of HF. Data including demographic information, vital signs, and laboratory and echocardiographic measurements at admission were collected from medical records. The observational period was defined as the number of days from hospitalization, and the study endpoint was defined as cardiovascular death. The mean RDW and BNP concentration at admission were 14.5±2.0% and 626±593 pg/mL, respectively. During a median observation period of 1,046 days, 22 patients died of cardiovascular disease. A univariate Cox proportional hazard analysis revealed that both RDW [hazard ratio (HR) 1.252, p = 0.0391] and BNP (HR 1.001, p = 0.0445) were significant prognostic indices for cardiovascular death. A receiver operating characteristic curve analysis revealed that the optimal cut-off RDW and BNP values for cardiovascular death were 14.9% and 686 pg/mL, respectively. The Kaplan-Meier survival curve revealed that the survival rate of patients with both RDW ≥ 14.9% and BNP ≥ 686 pg/mL showed the poorest prognosis in comparison to the patients in the other groups. Conclusion The combined assessment of the RDW and BNP concentrations may be useful for predicting mortality in patients with HF.

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

“…BNP‐guided severity contributed roughly to the distinction of HFrEF and HFpEF, but not to RDW in the present study (Table ), indicating that RDW has no association with the severity or hemodynamics in HF. These findings are compatible with literature reporting that RDW is independent of BNP for predicting HF outcome . 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 .…”

“…When HF patients in group A were subdivided again by RDW, 35 patients showed RDW ≥15%, and 67 patients showed RDW 15%. The cut‐off level of RDW was the same as or very close to the level of 14.6–15.0 in the literature . As shown in Table , the mean hospital stay in the former subgroup was 19.2 ± 9.2 days, whereas that in the latter was 13.9 ± 8.2 days ( P < 0.01), showing that the HF patients with greater RDW required a longer hospital stay relative to those showing lesser RDW.…”

“…The severity of HF was graded by the baseline BNP concentration of 1000 pg/mL. The cut‐off level of plasma BNP ranges broadly from 686 to 2114 pg/mL . EF in the subgroup showing BNP ≥1000 pg/mL (severe HF) was reduced significantly ( P < 0.01) compared with that showing BNP <1000 pg/mL (less severe HF).…”

“…Approximately half of HF patients die within 5 years after the initial diagnosis . The etiology of HF was mainly hypertensive or ischemic heart diseases (Table ), as in the literature . These are the main underlying diseases causing HF with reduced (<50%) and preserved (≥50%) EF (HFrEF and HFpEF).…”

“…In this decade, this intriguing laboratory marker has been reported to have a prognostic value in cardiovascular and cerebrovascular diseases . Current evidence has suggested that RDW is useful to predict cardiac events and adverse outcomes in patients with HF . However, the results are conflicting in detail, which might reflect the complexity and heterogeneity of HF in the geriatric population.…”