The Ratio of Hemoglobin to Red Cell Distribution Width: A Strong Predictor of Clinical Outcome in Patients with Heart Failure

Abstract

Background: Hemoglobin (Hb) is a standard and widely available clinical parameter that predicts clinical outcomes in heart failure (HF) patients. Red cell distribution width (RDW) is also a routinely measured clinical parameter that is predictive of clinical outcomes in HF. The ratio between Hb and RDW has yet to be evaluated in HF. Methods: We evaluated the predictive value of the Hb/RDW ratio on clinical outcomes in patients with HF. All patients diagnosed with chronic HF at a health maintenance organization were evaluated for Hb/RDW ratio and followed for cardiac-related hospitalizations and death. Results: The study cohort included 6888 HF patients. The mean Hb/RDW ratio was 0.85 ± 0.18; median was 0.85 (interquartile range 0.72–0.98). Patients with a lower Hb/RDW ratio were more likely to be women and had more comorbidities. The overall two year-mortality rate was 23.2%. Decreasing quantiles of the Hb/RDW ratio were associated with reduced survival rates and reduced event-free survival from death or cardiovascular-hospitalizations. Multivariable Cox regression analysis after adjustment for significant predictors demonstrated that low Hb/RDW ratio was a significant predictor of mortality, with a graded increased risk as Hb/RDW ratio decreased. Lower Hb/RDW ratio was also a significant independent predictor of the combined endpoint of death or cardiovascular hospitalizations. A sensitivity analysis evaluating Hb/RDW ratio as a continuous parameter using restricted cubic splines demonstrated a continuous increase in the mortality risk with decreasing Hb/RDW ratio, p < 0.0001 for the linear model. Conclusions: Hb/RDW ratio is a significant prognostic tool for predicting HF mortality and cardiovascular hospitalizations.

Red Blood Cell Distribution Width in Heart Failure: Pathophysiology, Prognostic Role, Controversies and Dilemmas

“…A recent study reported an independent association between a low hemoglobin/RDW ratio and the risk of death as well as the combined endpoint of death or cardiovascular hospitalization in a cohort of 6888 HF patients. Interestingly, this association was observed over the whole spectrum of HF types, including HFrEF and HFpEF [ 38 ].…”

The Hemoglobin-to-Red Cell Distribution Width Ratio to Predict All-Cause Mortality in Patients with Sepsis-Associated Encephalopathy in the MIMIC-IV Database

“…There is increasing evidence that HRR is a new prognostic indicator in critically ill patients with malignant diseases. For example, Qin et al explored the nonlinear relationship between all-cause mortality and HRR value in patients with ischemic stroke [ 27 ], and Rahamim et al found that HRR was an important prognostic tool for predicting mortality in heart failure and the hospitalization of patients with cardiovascular disease [ 9 ]. Chi et al found that low HRR were associated with a dual risk of disease progression or cancer recurrence in patients and used them to predict poor prognosis in patients with cancer [ 28 ].…”

“…Thus, the first measurement of vital signs and laboratory data within the first 24 hours of ICU admission was included in this study. The initially selected laboratory measurements included ethnicity, age, sex, pregnancy, abrosia, dialysis, heart rate (beats/minute), mean blood pressure (MBP, mmHg), respiratory rate (breaths/minute), temperature (°C), peripheral oxygen saturation (SpO 2 , %), Oxford Acute Severity of Illness Score (OASIS), Simplified Acute Physiology Score II (SAPSII), Logistic Organ Dysfunction System (LODS) score, SOFA score, GCS score, myocardial infarction, congestive heart failure, peripheral vascular disease, chronic pulmonary disease, diabetes, paraplegia, RDW (×10 9 /L), calcium (mg/dL), potassium (mmol/L), Hb (g/L), sodium (mmol/L), glucose (mg/dL), hematocrit (%), platelets (×10 9 /L), the Hb/RDW ratio (HRR) [ 9 , 18 , 19 ], chloride (mmol/L), prothrombin time (PT, seconds), white blood cell (WBC) count (×10 9 /L), anion gap (×10 9 /L), bicarbonate (mmol/L), creatinine (mEq/L), international normalized ratio (INR), norepinephrine, and vasopressin. ICU all-cause mortality referred to in-hospital survival and was used as the outcome of this study.…”

“…The Hb/RDW ratio (HRR) can especially reflect the early abnormal manifestations of SAE. Meanwhile, no specific SAE biomarker has been found for use in clinical practice [ 9 , 10 ].…”

Age and sex trend differences in hemoglobin levels in China: a cross-sectional study

“…Side effects were also found in a higher level of hemoglobin, such as polycythemia, plateau residents and newborns [ 4 – 6 ]. Moreover, mortality and incidence of complications of cardiovascular disease in diabetic patients could be affected by hemoglobin concentration [ 7 ]. Collectively, hemoglobin concentration has become an important monitoring indicator of health status.…”