Red cell distribution width as a prognosticator in patients with heart failure

Abstract

Aims Increased red cell distribution width (RDW) is a poor prognostic factor in patients with heart failure (HF). However, only a few large‐scale studies have identified the clinical utility of RDW after adjusting for covariates affecting RDW. Methods and results From January 2010 to April 2021, we retrospectively enrolled patients diagnosed with HF from three referral hospitals with available RDW data (taken within 3 months of HF diagnosis) using an integrated clinical data system. Patients with an ejection fraction (EF) < 50% or HFA‐PEFF (Heart Failure Association Pre‐test assessment, Echocardiography and natriuretic peptide, Functional testing, Final aetiology) score ≥ 2 without severe valvular heart disease or coronary revascularization were enrolled. The primary endpoint was all‐cause mortality, and cardiovascular mortality was also collected. Multivariable Cox regression analysis and stabilized inverse probability of treatment weighting (IPTW) were used to identify any association between RDW and all‐cause death by balancing covariates or compounding factors. The global χ 2 score was calculated and discrimination analysis was performed to evaluate the incremental value of RDW in predicting prognosis. Among the 6599 participants enrolled in this study, 1256 (19.0%) cases of all‐cause death occurred, and the median duration of follow‐up was 887 (interquartile range 351–1589) days. Elevated RDW at the initial diagnosis was associated with poor prognosis [cumulative incidence: 819 (30.2%) vs. 437 (11.2%), relative risk 1.58, 95% confidence interval (CI) 1.51–1.67, log‐rank P < 0.001]. Multivariable Cox analysis showed that elevated RDW was a poor prognostic factor for the primary endpoint [hazard ratio (HR) 1.11, 95% CI 1.06–1.16, P < 0.001], independent of clinical risk factors, N‐terminal pro‐brain natriuretic peptide (NT‐proBNP), and EF, which was concordant with the stabilized IPTW (HR 1.29, 95% CI 1.10–1.49, P < 0.001). Adding RDW to model composed of traditional risk factors, NT‐proBNP, and echocardiographic parameters showed incremental prognostic value for predicting poor prognosis (area under the receiver operating characteristic curve, 0.799–0.826; P < 0.001). Conclusions Increased RDW at the time of diagnosis is associated with poor prognosis in patients with HF, independent of clinical risk factors, such as NT‐proBNP, and echocardiographic parameters. Therefore, RDW may aid in the management of these patients beyond traditional risk factors.

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

“…Several studies showed that the RDW in combination with NT‐proBNP improved the prognostic value in a traditional model in patients with acute or chronic HF 12,15,45 . In addition, many studies have shown that the baseline RDW is an independent predictive marker for all‐cause mortality in patients with acute or chronic HF 8,13,14,46 . Moreover, a high RDW was also associated with increased all‐cause mortality, even in patients with advanced HF who underwent cardiac resynchronization therapy, 47,48 implantation of a left ventricular assist device, 49,50 or heart transplantation 51 .…”

“… 12 , 15 , 45 In addition, many studies have shown that the baseline RDW is an independent predictive marker for all‐cause mortality in patients with acute or chronic HF. 8 , 13 , 14 , 46 Moreover, a high RDW was also associated with increased all‐cause mortality, even in patients with advanced HF who underwent cardiac resynchronization therapy, 47 , 48 implantation of a left ventricular assist device, 49 , 50 or heart transplantation. 51 In our study, the ΔRDW improved the risk stratification for short‐ and long‐term mortality in the established model including baseline RDW and NT‐proBNP.…”

“…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.…”

“…Previous studies have shown that an increased RDW is associated with poor short‐ and long‐term outcomes in acute or chronic HF. 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 An increased RDW indicates the deregulation of erythrocyte homeostasis and abnormal survival of red blood cells. This situation may lead to a variety of underlying pathophysiological disorders, such as oxidative stress, inflammation, and a poor nutritional status.…”

Association between red cell distribution width and all-cause mortality in patients with breast cancer: A retrospective analysis using MIMIC-IV 2.0

“…The higher the RDW value, the greater the change in red blood cell size. Fluctuations in RDW have been reported in many pathophysiological conditions; for example, elevated RDW is associated with acute and chronic heart failure [ 9 ], coronary artery disease, cerebral infarction, and acute myocardial infarction [ 10 ]. Previous studies have reported an association between elevated RDW levels in elderly patients and unfavorable outcomes in terms of overall survival (OS) and disease-free survival (DFS) [ 11 ].…”