Red blood cell distribution width as a prognostic marker in patients with heart failure and diabetes mellitus

Abstract

BackgroundRed blood cell distribution width (RDW) is an established prognostic marker in acute and chronic heart failure (HF). Recent studies have pointed out a link among RDW, diabetes mellitus (DM) and inflammation. We sought to investigate the prognostic value and longitudinal pattern of RDW in patients with concomitant HF and DM, which remains unknown.MethodsA total of 218 patients (71 diabetics) who presented with acute HF had RDW measured at admission, discharge and 4, 8 and 12 months post-discharge. The study endpoint was all-cause mortality or rehospitalization for HF during 1-year follow-up.ResultsThe study endpoint was met in 33 patients (46.5%) with DM and in 54 patients (36.7%) without DM. RDW at admission was associated with higher event rate both in HF patients with and without DM (adjusted HR: 1.349, p = 0.002, 95% CI 1.120–1.624 and adjusted HR: 1.142, p = 0.033, 95% CI 1.011–1.291 respectively). In addition, a significant interaction was found between diabetes and RDW longitudinal changes (βinteraction = −0.002; SE = 0.001; p = 0.042).ConclusionsDespite the similar prognostic significance of RDW in diabetic and non-diabetic HF patients regarding the study endpoint, longitudinal changes were found to be significantly different between these two groups of HF patients. This might be due to the higher inflammatory burden that diabetic HF patients carry and may provide new insights to the pathophysiological mechanism of RDW increase in HF, which remains unknown.

Neutrophil to lymphocyte ratio and clinical outcomes in COPD: recent evidence and future perspectives

“…Systemic inflammation reduces the survival of erythrocytes and platelets and deforms their membranes. High RDW and MPV have been associated with increased inflammatory activity in several diseases [57][58][59][60]. This might explain the correlations with NLR found by GÜNAY et al [36] in patients with stable COPD, and supports the potential applicability of simple blood count indexes in the clinical evaluation of the disease.…”

Psoriasis and Psoriatic Arthritis Cardiovascular Disease Endotypes Identified by Red Blood Cell Distribution Width and Mean Platelet Volume

“…Patients aged 18-65 years with SNOMED-CT codes for psoriasis and available RDW measurements and/or available MPV measurements were selected from Explorys (Run date 07/09/2018) (Supplementary Figure S1). Patients with associated SNOMED-CT codes related to psoriasis types different from plaque psoriasis, namely "Impetigo herpetiformis", "Pustular psoriasis", and "Guttate psoriasis", and related to diseases known to increase MACE, namely "Diabetes mellitus" [33], "Crohn's disease" [34], "Rheumatoid arthritis" [35], "Generalized atherosclerosis" [36] were excluded from the cohort. Hematological disorders were not used as exclusion criteria in this study because in the CHARM program and in the Duke Databank RDW was not related to hemoglobin levels [37].…”

The diagnostic and prognostic value of red cell distribution width in cardiovascular disease; current status and prospective

“…There was an association between RDW on admission and higher incidence of clinical events in diabetic or non‐diabetic HF. However, it was shown that RDW 1 year after discharge was significantly higher in HF patients with DM compared to non‐diabetic HF patients . It has been demonstrated that increased RDW after 4 days of hospitalization, increased risk of 30‐day mortality up to fourfold in patients with acute decompensated HF, suggesting that these patients with elevated RDW require more care in the first days of hospitalization …”