Validation and Potential Mechanisms of Red Cell Distribution Width as a Prognostic Marker in Heart Failure

Abstract

Background: Adverse outcomes have recently been linked to elevated red cell distribution width (RDW) in heart failure. Our study sought to validate the prognostic value of RDW in heart failure and to explore the potential mechanisms underlying this association. Methods and Results: Data from the Study of Anemia in a Heart Failure Population (STAMINA-HFP) registry, a prospective, multicenter cohort of ambulatory patients with heart failure supported multivariable modeling to assess relationships between RDW and outcomes. The association between RDW and iron metabolism, inflammation, and neurohormonal activation was studied in a separate cohort of heart failure patients from the United Investigators to Evaluate Heart Failure (UNITE-HF) Biomarker registry. RDW was independently predictive of outcome (for each 1% increase in RDW, hazard ratio for mortality 1.06, 95% CI 1.01-1.12; hazard ratio for hospitalization or mortality 1.06; 95% CI 1.02-1.10) after adjustment for other covariates. Increasing RDW correlated with decreasing hemoglobin, increasing interleukin-6, and impaired iron mobilization. Conclusions: Our results confirm previous observations that RDW is a strong, independent predictor of adverse outcome in chronic heart failure and suggest elevated RDW may indicate inflammatory stress and impaired iron mobilization. These findings encourage further research into the relationship between heart failure and the hematologic system.

The impact of admission red cell distribution width on long-term cardiovascular events after primary percutaneous intervention: A four-year prospective study

“…was suggested as another mechanism of prognostic value of RDW [22,23]. Red blood cells have a powerful antioxidant capacity and function as a primary oxidative sink; they are prone to oxidative damage which decreases cell survival and they increase the release of juvenile erythrocytes into circulation.…”

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

“…the risk assessment and determination of prognosis in patients with coronary artery disease, hypertension, HF, acute coronary syndrome, stroke, and peripheral arterial disease, and in patients undergoing coronary artery bypass surgery [1][2][3][6][7][8][9][10][11].…”

“…Until now RDW has been used mainly as an auxiliary marker in haematology indicating the increased destruction or impaired production of red blood cells. Several studies have reported that elevated RDW levels are associated with poor outcomes in patients with such cardiovascular diseases as coronary artery disease, idiopathic pulmonary hypertension, chronic heart failure (HF), and severe aortic stenosis after transcatheter aortic valve implantation [1][2][3][4][5]. Its prognostic utility in patients undergoing aortic valve replacement surgery is unknown.…”

Diagnostic values of red cell distribution width, platelet distribution width and neutrophil-lymphocyte count ratio for sepsis

“…A number of previous investigations have shown that RDW and PDW are significantly associated diseases including chronic spontaneous urticaria and gram-negative bacteremia (3)(4)(5). Furthermore, RDW has also been regarded as a prognostic marker for certain diseases, such as stable angina pectoris (6,7).…”