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Heshmat-Ghahdarijani K, Fakhrolmobasheri M. Is Red Cell Distribution Width a Reliable Marker for Cardiovascular Diseases? A Narrative Review. Cardiol Rev 2024; 32:362-370. [PMID: 36730493 DOI: 10.1097/crd.0000000000000500] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Red cell distribution width (RDW) is an easy-to-access marker which is routinely measured in complete blood count (CBC) test. Besides the classic use of RDW as a marker for discriminating different types of anemia, recent studies had indicated the relationship between high RDW and cardiovascular diseases. High RDW is not only useful in the diagnosis and prognostication of various cardiovascular conditions but also could be used as a valuable tool for predicting the incidence of cardiovascular diseases. population-based studies have indicated that higher RDW could effectively predict the incidence of heart failure (HF), atherosclerotic diseases, and atrial fibrillation (AF). It has been also demonstrated that higher RDW is associated with worse outcomes in these diseases. Recent studies have shown that high RDW is also associated with other cardiovascular conditions including cardiomyopathies, and pulmonary hypertension. The predictive role of RDW in endovascular interventions has also been demonstrated by many recent studies. Here in this review, we attempt to compile the most recent findings with older reports regarding the relation between high RDW and HF, cardiomyopathies, pulmonary hypertension, AF, atherosclerotic disorders, primary hypertension, and the outcomes of endovascular interventions. we also discussed the role of RDW in the prognostication of different cardiovascular conditions when combined with classic classification criteria.
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Affiliation(s)
- Kiyan Heshmat-Ghahdarijani
- From the Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Fakhrolmobasheri
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Zhang Q, Zhou B, Li X, Cong H. In-hospital changes in the red blood cell distribution width and mortality in critically ill patients with heart failure. ESC Heart Fail 2023; 10:3287-3298. [PMID: 37671738 PMCID: PMC10682898 DOI: 10.1002/ehf2.14513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 06/11/2023] [Accepted: 08/18/2023] [Indexed: 09/07/2023] Open
Abstract
AIMS A high red blood cell distribution width (RDW) at admission or discharge is associated with a worse prognosis in hospitalized patients with heart failure (HF), and the prognostic value of the in-hospital change in RDW (∆RDW) remains debatable. METHODS AND RESULTS We included 5514 patients with critical illness and HF from the MIMIC-IV database. The ΔRDW was calculated by the RDW at discharge minus that at admission. Clinical outcomes included all-cause mortality at 90 day, 180 day, and 1 year after discharge. The median age of the patients was 73.91 years, and 46.37% were women. Kaplan-Meier curve and Cox regression analyses were used to examine the association between the ΔRDW and all-cause mortality at different time points. A multivariable Cox proportional hazard model showed that the ΔRDW (per 1% increase) was independently associated with all-cause mortality at 90 day, 180 day, and 1 year after adjusting for confounding factors (hazard ratio [HR] = 1.17, 95% confidence interval [CI] = 1.13-1.21, P < 0.001; HR = 1.17, 95% CI = 1.14-1.20, P < 0.001; and HR = 1.18, 95% CI = 1.15-1.20, P < 0.001, respectively). Restricted cubic splines showed a non-linear relationship between the ΔRDW and the risk of clinical outcomes. High ΔRDW was associated with a high risk of mortality at different time points. A subgroup analysis showed that this positive association remained consistent in pre-specified subgroups. CONCLUSIONS Our study suggests that an increased RDW during hospitalization is independently associated with short- or long-term all-cause mortality in critical-ill patients with HF.
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Affiliation(s)
- Qi Zhang
- Department of CardiologyTianjin Chest HospitalTianjinChina
| | - Bingyang Zhou
- Department of CardiologyTianjin Chest HospitalTianjinChina
| | - Ximing Li
- Department of CardiologyTianjin Chest HospitalTianjinChina
- Tianjin Medical UniversityTianjinChina
- Tianjin UniversityTianjinChina
| | - Hongliang Cong
- Department of CardiologyTianjin Chest HospitalTianjinChina
- Tianjin Medical UniversityTianjinChina
- Tianjin UniversityTianjinChina
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Xiong X, Li T, Yu S, Cheng B. Association Between Red Blood Cell Indices and Preoperative Deep Vein Thrombosis in Patients Undergoing Total Joint Arthroplasty: A Retrospective Study. Clin Appl Thromb Hemost 2022; 28:10760296221149029. [PMID: 36572965 PMCID: PMC9806375 DOI: 10.1177/10760296221149029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To investigate the association of red blood cell (RBC), hemoglobin (Hb), red cell distribution width-coefficient of variation (RDW-CV), and red cell distribution width-standard deviation (RDW-SD) with preoperative deep vein thrombosis (DVT) in patients undergoing total joint arthroplasty (TJA). METHODS A total of 2059 TJA patients were enrolled. We used the ratios of RBC, Hb, RDW-CV, and RDW-SD to DVT before TJA to create the receiver operator characteristic (ROC) curve, thereby calculating the cut-off values and the area under the curve (AUC). The patients were categorized into groups based on cut-off value, and risk factors for DVT before TJA were subsequently analyzed. We included the variates that were statistically significant in the univariate analysis in the multivariate binary logistic regression analysis. RESULTS Preoperative DVT occurred in 107 cases (5.20%). Based on the ROC curve, we found that the AUC for RBC, Hb, RDW-CV, and RDW-SD were 0.658, 0.646, 0.568, and 0.586, respectively. Multivariate binary regression analysis revealed that the risk of preoperative DVT in TJA patients with RBC≤3.92*109 /L, Hb≤118g/L, RDW-CV≥13.2%, and RDW-SD≥44.6fL increased 3.02 (P < 0.001, 95% confidence interval (CI) [2.0-4.54]), 2.15 (P < 0.001, 95% CI [1.42-3.24]), 1.54 (P = 0.038, 95% CI [1.03-2.3]), and 1.98 times (P = 0.001, 95% CI [1.32-2.98]), respectively. The risk of preoperative DVT in patients with corticosteroid use increased approximately 2.6 times (P = 0.002, 95% CI [1.22-5.81]). CONCLUSION We found that decreased RBC and Hb, increased RDW-CV and RDW-SD, and corticosteroid use were independent risk factors for preoperative DVT in patients undergoing TJA.
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Affiliation(s)
- Xiaojuan Xiong
- Department of Anesthesiology, Army Medical Center of PLA, Daping Hospital, Army Medical University, Chongqing, China
| | - Ting Li
- Department of Anesthesiology, Army Medical Center of PLA, Daping Hospital, Army Medical University, Chongqing, China
| | - Shuang Yu
- Department of Anesthesiology, Army Medical Center of PLA, Daping Hospital, Army Medical University, Chongqing, China
| | - Bo Cheng
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China,Bo Cheng, Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University Yuzhong District, 1 Youyi Road, Chongqing 400000, China.
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Liang L, Huang L, Zhao X, Zhao L, Tian P, Huang B, Feng J, Zhang J, Zhang Y. Prognostic value of RDW alone and in combination with NT-proBNP in patients with heart failure. Clin Cardiol 2022; 45:802-813. [PMID: 35621296 PMCID: PMC9286336 DOI: 10.1002/clc.23850] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/06/2022] [Accepted: 05/16/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Red blood cell distribution width (RDW) and N-terminal pro brain natriuretic peptide (NT-proBNP) may predict the prognosis of heart failure (HF). However, the impact of combined RDW and NT-proBNP levels as a prognostic marker of HF remains unclear and the significance of this combination at various time-points has not been sufficiently studied. HYPOTHESIS RDW can predict prognosis in HF at various time-points and combination with NT-proBNP improves the prognostic value. METHODS Patients admitted to HF care unit of Fuwai Hospital CAMS&PUMC (Beijing, China) with a diagnosis of HF from November 2008 to November 2018 were analyzed retrospectively. RESULTS In total, 3231 patients with available RDW data at admission were evaluated (median age 58 years, 71.9% males, 39.7% coronary heart disease, 68.6% New York Heart Association [NYHA] III or IV). Median RDW and NT-proBNP at admission were 13.4% (interquartile range [IQR]: 12.7%-14.5%), and 1723.00 pg/ml (IQR: 754.00-4006.25 pg/ml), respectively. During 2.9-year median follow-up, all-cause death occurred in 1075 (33.27%) patients. Kaplan-Meier survival curve and Cox proportional-hazard models, showed patients in the top quarter RDW had a 32.0% increased mortality compared to the bottom quarter (hazard ratio: 4.39, 95% confidence interval: 3.59-5.38; p <.001). The top quarter RDW retained independent prognostic value across HF with reduced ejection fraction [HFrEF], HF with mid-range ejection fraction [HFmrEF], and HF with preserved ejection fraction [HFpEF] subgroups. Patients were subsequently divided into four groups by median RDW and NT-proBNP. Comparison of Kaplan-Meier survival curves for various groups showed good risk stratification (p < .001). CONCLUSIONS RDW is an independent predictor of mortality among patients with HF in the short-, medium-, and long-term. Combination of RDW and NT-proBNP improves the prognostic value. This is true across all clinical subtypes of heart failure (HFrEF, HFmrEF, HFpEF), and among most subgroups of patients with various comorbidities (infection, diabetes, hypertension).
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Affiliation(s)
- Lin Liang
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC)BeijingChina
| | - Liyan Huang
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC)BeijingChina
| | - Xuemei Zhao
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC)BeijingChina
| | - Lang Zhao
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC)BeijingChina
| | - Pengchao Tian
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC)BeijingChina
| | - Boping Huang
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC)BeijingChina
| | - Jiayu Feng
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC)BeijingChina
| | - Jian Zhang
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC)BeijingChina
- Key Laboratory of Clinical Research for Cardiovascular MedicationsNational Health CommitteeBeijingChina
| | - Yuhui Zhang
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC)BeijingChina
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Chen J, Li Y, Liu P, Wu H, Su G. A nomogram to predict the in-hospital mortality of patients with congestive heart failure and chronic kidney disease. ESC Heart Fail 2022; 9:3167-3176. [PMID: 35765720 DOI: 10.1002/ehf2.14042] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/11/2022] [Accepted: 06/03/2022] [Indexed: 11/06/2022] Open
Abstract
AIMS Patients with congestive heart failure (CHF) may also suffer from chronic kidney disease (CKD), and the two conditions may interact to increase the risk of death. The purpose of this study was to investigate the risk factors contributing to in-hospital mortality in patients with CHF and CKD and to develop a nomogram to predict the risk of in-hospital mortality. METHODS AND RESULTS This retrospective study used data from the Marketplace for Medical Information in Intensive Care (MIMIC-IV, version 1.0). Patients diagnosed with CHF and CKD in MIMIC-IV were included in this study. The least absolute shrinkage and selection operator (LASSO) logistic regression is used to select risk variables for the nomogram model, and bootstrap is used for internal validation. Simplified Acute Physiology Score II (SAPS II) and Logistic Organ Dysfunction Score (LODS) were compared with the nomogram model by the area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA). A total of 4638 adult patients with CHF and CKD were included in the final cohort; of them, 707 (15.2%) died and 3931 (84.8%) survived during hospitalization. Our final model included the following 13 variables: age, acute kidney injury, myocardial infarction, anaemia, heart rate ≥ 100 b.p.m., systolic blood pressure ≥ 130 mmHg, anion gap (AG) ≥ 20 mEq/L, sodium ≥ 145 mEq/L, red blood cell distribution width (RDW) ≥ 15.5%, white blood cell count ≥ 10 K/μL, continuous renal replacement therapy (CRRT), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and beta-blocker. The corrected C-statistic of the nomogram was 0.767, and the calibration curve indicating good concordance between the predicted and observed values. The nomogram demonstrated good accuracy for predicting the in-hospital mortality with an AUC of 0.771 (95% CI: 0.752-0.790), while the AUC for SAPS II and LODS was 0.747 (95% CI: 0.726-0.767) and 0.752 (95% CI: 0.730-0.773), respectively. DCA found that when the threshold probability was 0.05 to 0.41, the nomogram model could provide a greater net benefit than SAPS II. CONCLUSIONS In this retrospective cohort analysis of patients with CHF and CKD, we identified 13 independent variables associated with in-hospital mortality using LASSO logistic regression. RDW, AG, and CRRT were reported to play a significant role in in-hospital mortality among patients with CHF and CKD for the first time. Based on a simplified model including 13 variables, a nomogram was drawn to predict the risk of in-hospital mortality. In comparison with SAPS II and LODS, the nomogram model performed well.
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Affiliation(s)
- Jiamin Chen
- Research Center of Translational Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan, China.,Research Center of Translational Medicine, Jinan Central Hospital, Shandong University, Jinan, China
| | - Ying Li
- Research Center of Translational Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan, China.,Research Center of Translational Medicine, Jinan Central Hospital, Shandong University, Jinan, China
| | - Peng Liu
- Research Center of Translational Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Huihui Wu
- Research Center of Translational Medicine, Jinan Central Hospital, Shandong University, Jinan, China
| | - Guohai Su
- Research Center of Translational Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan, China.,Research Center of Translational Medicine, Jinan Central Hospital, Shandong University, Jinan, China
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Red Blood Cell Distribution Width in Heart Failure: Pathophysiology, Prognostic Role, Controversies and Dilemmas. J Clin Med 2022; 11:jcm11071951. [PMID: 35407558 PMCID: PMC8999162 DOI: 10.3390/jcm11071951] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/26/2022] [Accepted: 03/30/2022] [Indexed: 12/12/2022] Open
Abstract
Red blood cell distribution width (RDW), an integral parameter of the complete blood count (CBC), has been traditionally used for the classification of several types of anemia. However, over the last decade RDW has been associated with outcome in patients with several cardiovascular diseases including heart failure. The role of RDW in acute, chronic and advanced heart failure is the focus of the present work. Several pathophysiological mechanisms of RDW’s increase in heart failure have been proposed (i.e., inflammation, oxidative stress, adrenergic stimulation, undernutrition, ineffective erythropoiesis, reduced iron mobilization, etc.); however, the exact mechanism remains unknown. Although high RDW values at admission and discharge have been associated with adverse prognosis in hospitalized heart failure patients, the prognostic role of in-hospital RDW changes (ΔRDW) remains debatable. RDW has been incorporated in recent heart failure prognostic models. Utilizing RDW as a treatment target in heart failure may be a promising area of research.
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Garcia-Arce M, Gow AG, Handel I, Ngoi W, Thomas E. Retrospective evaluation of red blood cell distribution width as a prognostic factor in critically ill dogs (December 2016 to April 2017): 127 cas. J Vet Emerg Crit Care (San Antonio) 2021; 32:405-412. [PMID: 34962694 DOI: 10.1111/vec.13167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 07/25/2020] [Accepted: 08/06/2020] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the association between RBC distribution width (RDW) and in-hospital mortality, length of hospitalization, and leukocyte count in critically ill dogs. DESIGN Retrospective study. SETTING University teaching hospital. ANIMALS One hundred and twenty-seven dogs admitted to the ICU from December 2016 to April 2017. Patients were included if they had a CBC performed within the first 24 h of admission. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The overall in-hospital mortality rate was 29% (37/127), and median length of hospital stay was 3 days (interquartile range [IQR], 5). The median RDW value was 13.8% (IQR, 1.6%; reference interval, 11.9%-14.5 %). The canine Acute Patient Physiologic and Laboratory Evaluation (APPLE) fast score was calculated in 81 of 127 (64%) patients; the median score was 24/50 (IQR, 9). There was no significant correlation between RDW and APPLE fast score (P = 0.163). Subgroup analysis was performed according to the following diagnostic categories: abdominal (36%; 46/127), hematological (13%; 16/127), respiratory (13%; 16/127), neurological (12%; 15/127), cardiovascular (11%; 14/127), integument (3%; 4/127), trauma (3%; 4/127), musculoskeletal (2%; 3/127), and others (7%; 9/127). Increased RDW was not associated with in-hospital mortality overall (P = 0.381) or in any individual subgroup analysis. No association was found between length of hospitalization and RDW values in either survivors (P = 0.548) or nonsurvivors (P = 0.083). The correlation between RDW and leukocyte count was nonsignificant (P = 0.12). CONCLUSIONS In this study, admission RDW was not associated with in-hospital mortality or length of hospitalization in critically ill dogs. The correlation between RDW and leukocyte count was nonsignificant.
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Affiliation(s)
- Marta Garcia-Arce
- The Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Midlothian, UK
| | - Adam G Gow
- The Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Midlothian, UK
| | - Ian Handel
- The Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Midlothian, UK
| | - Waiyin Ngoi
- The Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Midlothian, UK
| | - Emily Thomas
- The Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Midlothian, UK
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Alem MM, Alshehri AM, Alshehri MA, AlElaiw MH, Almaa AA, Bustami RT. Red Blood Cell Distribution Width (RDW) in Chronic Heart Failure: Does it have a Prognostic Value in Every Population? ELECTRONIC JOURNAL OF GENERAL MEDICINE 2021. [DOI: 10.29333/ejgm/11400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Oz O, Gonel A. The Association Between Parameters of Erythrocytes Morphology and Thrombophilia-Related Mutations. Rev Recent Clin Trials 2021; 17:40-45. [PMID: 34814821 DOI: 10.2174/1574887116666211123092603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 09/21/2021] [Accepted: 10/04/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Alterations in erythrocyte morphology parameters have been identified and associated with hematological disorders and other chronic and cardiovascular diseases. Erythrocytes are abundant in thrombus content. Their hemoglobin density and differences in the ratio of macrocytic and microcytic cells may be associated with hypercoagulopathy in those with a history of thrombosis. OBJECTIVE This cross-sectional study aimed to investigate the relationship between hemogram parameters and thrombophilia genetic parameters. METHOD A total of 55 patients whose thrombophilia panel was reviewed due to the diagnosis of thrombosis were included in the study. %MIC, %MAC, %HPO, %HPR and all hemogram parameters were measured using Abbott Alinity HQ. Prothrombin G20210A, MTHFR C677T, MTHFR A1298C, Factor V Leiden G169A and PAI-1 4G/5G mutations were studied using Real Time-PCR. RESULTS The MTHFR C677T mutation was detected in 58.2% of the patients. The Factor V Leiden mutation was detected in 5.5% of the patients. The MTHFR A1298C mutation was detected in 58.2%, The PAI mutation was detected in 74.5%, and the Factor 13 mutation was detected in 29% of the patients. Prothrombin G20210A mutation was not detected in any of the patients. Red blood cell (RBC) and Hct values were higher in Factor 13 mutant group; the Hgb and Htc values were higher in the MTHFR C677T mutant group. CONCLUSION The MTHFR C677T and Factor 13 mutations may be associated with high Hct and RBC, Hgb, and Htc values, respectively and coagulation tendency in patients with a history of thrombosis.
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Affiliation(s)
- Ozlem Oz
- Department of Medical Genetics, Harran University. Turkey
| | - Ataman Gonel
- Department of Medicinal Biochemistry, Harran University. Turkey
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Aali-Rezaie A, Kuo FC, Kozaily E, Vahedi H, Parvizi J, Sharkey PF. Red Cell Distribution Width: Commonly Performed Test Predicts Mortality in Primary Total Joint Arthroplasty. J Arthroplasty 2021; 36:3646-3649. [PMID: 34344549 DOI: 10.1016/j.arth.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Mortality after total joint arthroplasty (TJA) has been thoroughly explored. Short and long-term mortality appear to be correlated with patient comorbidities. Red Cell Distribution Width (RDW) is a commonly performed test that reflects the variation in red blood cell size. This study investigated the utility of RDW, when combined with comorbidity indices, in predicting mortality after TJA. METHODS Using a single institutional database, 30,437 primary TJA were identified. Patient demographics (age, gender, body mass index (BMI), pre-operative hemoglobin, RDW, and Charlson Comorbidity Index(CCI)) were queried. The primary outcome was 1-year mortality after TJA. Anemia was defined as hemoglobin <12g/dL for women and <13 g/dL for men. The normal range for RDW is 11.5-14.5%. A preliminary analysis assessed the bivariate association between demographics, preoperative anemia, RDW, CCI, and all-cause mortality within 1-year after TJA. A multivariate regression model was conducted to determine independent predictors of 1-year mortality. Finally, ROC curves were used to compare AUC of RDW, CCI and the combination of both in predicting 1-year mortality. RESULTS The mean RDW was 13.6% ± 1.2. Eighteen percent of patients had pre-operative anemia. The mean CCI was 0.4 ± 0.9. RDW, anemia, CCI, and age were significantly associated with a higher incidence of 1-year mortality. RDW, CCI, age, and male sex were found to be independent risk factors for 1-year mortality. RDW (AUC = 0.68) was a better predictor of mortality compared to CCI (AUC = 0.66). The combination of RDW and CCI (AUC = 0.76) predicted 1-year mortality more accurately than CCI or RDW alone. CONCLUSION RDW appears to be a useful parameter that, when combined with CCI, can predict the risk for 1-year mortality after TJA.
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Affiliation(s)
- Arash Aali-Rezaie
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Feng-Chih Kuo
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA; Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Elie Kozaily
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Hamed Vahedi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA; Department of Orthopaedic Surgery, West Virginia University Medicine, Morgantown, WV
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Peter F Sharkey
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
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Prognostic value of natriuretic peptides in heart failure: systematic review and meta-analysis. Heart Fail Rev 2021; 27:645-654. [PMID: 34227029 DOI: 10.1007/s10741-021-10136-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 12/11/2022]
Abstract
Risk models, informing optimal long-term medical management, seldom use natriuretic peptides (NP) in ascertaining the absolute risk of outcomes for HF patients. Individual studies evaluating the prognostic value of NPs in HF patients have reported varying effects, arriving at best estimates requires a systematic review. We systematically summarized the best evidence regarding the prognostic value of brain natriuretic peptide (BNP) and NT-proBNP in predicting mortality and hospitalizations in ambulatory heart failure (HF) patients. We searched bibliographic databases from 2005 to 2018 and included studies evaluating the association of BNP or NT-proBNP with mortality or hospitalization using multivariable Cox proportional hazard models. We pooled hazard ratios using random-effect models, explored heterogeneity using pre-specified subgroup analyses, and evaluated the certainty of evidence using the Grading of Recommendations and Development Evaluation framework. We identified 67 eligible studies reporting on 76,178 ambulatory HF patients with a median BNP of 407 pg/mL (261-574 pg/mL). Moderate to high-quality evidence showed that a 100-pg/mL increase in BNP was associated with a 14% increased hazard of mortality (HR 1.14, 95% CI 1.06-1.22); a 1-log-unit increase was associated with a 51% increased hazard of mortality (HR 1.51, 95% CI 1.41-1.61) and 48% increased hazard of mortality or hospitalization (HR 1.48, 95% CI 1.29-1.69). With moderate to high certainty, we observed a 14% independent relative increase in mortality, translating to a clinically meaningful increase in absolute risk even for low-risk patients. The observed associations may help in developing more accurate risk models that incorporate NPs and accurately prognosticate HF patients.
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Zhu M, Dai L, Wan L, Zhang S, Peng H. Dynamic Increase of Red Cell Distribution Width Predicts Increased Risk of 30-Day Readmission in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2021; 16:393-400. [PMID: 33658772 PMCID: PMC7917314 DOI: 10.2147/copd.s291833] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/08/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Studies have demonstrated that red blood cell distribution width (RDW) is closely associated with the prognosis of patients with chronic obstructive pulmonary disease (COPD). In addition, the dynamic changes in RDW appear to play an important role. Thus, we aimed to investigate the relationship between dynamic changes in RDW and 30-day all-cause readmission of patients with acute exacerbation of COPD (AECOPD). Methods In this retrospective cohort study, we enrolled patients with AECOPD hospitalized in the Department of Respiratory Medicine in Liyuan Hospital (Wuhan China), a tertiary, university-affiliated, public hospital. Patients with AECOPD were divided into three groups based on their RDW values after the first and fourth days of admission. The normal range for RDW is 10-15%. Patients with normal RDW values were included in the normal group. Patients with an RDW value >15% on the first day, which subsequently decreased by >2% on the fourth day was included in the decreased group. The increased group was comprised of patients with an RDW value >15% on the first day which continued to increase, or those with a normal RDW value on the first day which increased >15% on the fourth day. Results A total of 239 patients (age: 72 years [range: 64-81 years]; male: n=199 [83.3%]) were included. There were 108, 72, and 59 patients in the RDW normal, decreased, and increased groups, respectively; the 30-day all-cause readmission rate was 9.3%, 9.7%, 27.1%, respectively; (p=0.003), being noticeably higher in the RDW increased group. Dynamic increase of RDW (OR:3.45, 95% CI: 1.39-8.58, p= 0.008) was independently correlated with 30-day all-cause readmission of patients with AECOPD. Conclusion The dynamic increase of RDW is an independent prognostic factor of 30-day all-cause readmission of patients with AECOPD.
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Affiliation(s)
- Mengpei Zhu
- Department of Respiratory Medicine, Liyuan Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Lisong Dai
- Radiology Department, Liyuan Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Lei Wan
- Department of Cardiovascular Medicine, Liyuan Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Shuling Zhang
- Department of Respiratory Medicine, Liyuan Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Hongxing Peng
- Department of Respiratory Medicine, Liyuan Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
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Yi JE, Lee HJ, Kim YJ, Kim Y, Joung B, Park J. Additive prognostic value of red cell distribution width over late gadolinium enhancement on CMR in patients with non-ischemic dilated cardiomyopathy. Sci Rep 2020; 10:9212. [PMID: 32513998 PMCID: PMC7280504 DOI: 10.1038/s41598-020-66198-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 05/13/2020] [Indexed: 11/09/2022] Open
Abstract
Elevated red cell distribution width (RDW) and late gadolinium enhancement on cardiac magnetic resonance (LGE-CMR) are both poor prognostic factors. This study examined the relationship between RDW and LGE-CMR characteristics in patients with non-ischemic dilated cardiomyopathy (NICM), and investigated whether the additive prognostic value of RDW as an integrative systemic factor over LGE-CMR exists or not. A total of consecutive 378 patients who underwent CMR at two general hospitals in South Korea were retrospectively analyzed. The primary endpoint was a composite of all-cause death, hospitalizations due to worsening heart failure and major arrhythmic events. During a mean follow-up period of 40.8 months, 151 (39.9%) patients experienced primary endpoints. The RDW value was significantly higher in patients with LGE than in those without LGE (13.7 ± 1.5% vs. 13.3 ± 1.4%, p = 0.034), but it was not associated with the extent or distribution patterns of the LGE. Addition of RDW into the model with clinical risk factors and LGE-CMR characteristics led to a significant improvement in the prediction of worse outcomes (χ2 increased from 73 to 82; p = 0.023). RDW could provide incremental predictive value for adverse clinical events beyond LGE-CMR data in NICM patients.
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Affiliation(s)
- Jeong-Eun Yi
- Department of Cardiology, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hye-Jeong Lee
- Department of Radiology, Research Institute of Radiological Science, The Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Jin Kim
- Department of Radiology, Research Institute of Radiological Science, The Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yookyung Kim
- Department of Radiology, Ewha Womans Mokdong's Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Boyoung Joung
- Yonsei University Health System, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Junbeom Park
- Department of Cardiology, Ewha Womans Mokdong's Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea.
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Fava C, Cattazzo F, Hu ZD, Lippi G, Montagnana M. The role of red blood cell distribution width (RDW) in cardiovascular risk assessment: useful or hype? ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:581. [PMID: 31807562 DOI: 10.21037/atm.2019.09.58] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Red blood cell distribution width (RDW) reflects erythrocyte size distribution, thus representing a reliable index of anisocytosis, widely used for the differential diagnosis of micro- and normocytic anaemias. Along with the large use in diagnostic hematology, RDW has been associated with presence and complications of a vast array of human pathologies during the last decades, including cardiovascular (CV) diseases. This article is hence aimed to provide an overview of important studies and systematic reviews with meta-analysis, in which RDW has been associated with CV events and mortality, in the attempt of establishing whether enough evidence exists for supporting its routine use in clinical practice. According to available data it seems reasonable to conclude that although the diagnostic specificity is low, and this measure is still plagued by important lack of standardization, RDW can be regarded as an index of enhanced patient fragility and higher vulnerability to adverse outcomes. Abnormal RDW values shall hence persuade physicians to broaden the diagnostic reasoning over anaemias, especially those due to malnutrition or malabsorption, encompassing a comprehensive assessment of traditional and non-traditional CV risk factors.
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Affiliation(s)
- Cristiano Fava
- Department of Medicine, University of Verona, Verona, Italy
| | | | - Zhi-De Hu
- Department of Laboratory Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China
| | - Giuseppe Lippi
- Department of Neurosciences, Biomedicine and Movement Sciences, Clinical Biochemistry Section, University of Verona, Verona, Italy
| | - Martina Montagnana
- Department of Neurosciences, Biomedicine and Movement Sciences, Clinical Biochemistry Section, University of Verona, Verona, Italy
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Abstract
Objective: To determine whether complete blood count parameters could be used as the biomarkers of inflammation in patients with in peripheral arterial disease. Methods: Seventy-five patients with peripheral arterial disease (study group) and 75 healthy subjects (control group) were included in this retrospective study. Their baseline clinical characteristics and laboratory data were recorded and compared. Data were compared using univariate tests including independent samples t-test, Mann-Whitney U-test and chi-square test. Moreover, multivariate logistic regression analysis was also conducted to determine independent predictors of peripheral arterial disease. Results: The groups were statistically similar with regards to baseline clinical and demographic features. The values of C-reactive protein, white blood cell and neutrophil-to-lymphocyte ratio values were found to be statistically significantly higher in study group versus control group, but none of them were considered as an independent predictor of peripheral arterial disease according to multivariate logistic regression analysis. Only mean platelet volume was demonstrated to be a statistically significant predictor of peripheral arterial disease. Conclusion: Our study deduced that mean platelet volume was an independent predictor of peripheral arterial disease, and could be used as a marker of inflammation in patients with peripheral arterial disease.
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Affiliation(s)
- Yusuf Velioglu
- a Faculty of Medicine, Department of Cardiovascular Surgery , Abant Izzet Baysal University , Bolu , Turkey
| | - Ahmet Yuksel
- a Faculty of Medicine, Department of Cardiovascular Surgery , Abant Izzet Baysal University , Bolu , Turkey
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16
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Hui M, Zhao J, Tian Z, Wang J, Qian J, Yang X, Wang Q, Li M, Zhao Y, Zeng X. Red blood cell distribution width as a potential predictor of survival of pulmonary arterial hypertension associated with primary Sjogren's syndrome: a retrospective cohort study. Clin Rheumatol 2018; 38:477-485. [PMID: 30218288 DOI: 10.1007/s10067-018-4281-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/26/2018] [Accepted: 08/27/2018] [Indexed: 12/19/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a severe complication and leading cause of mortality in patients with primary Sjogren's syndrome (pSS). This study was to investigate the overall survival rates and the utility of red blood cell distribution width (RDW) as a potential prognostic factor of pSS-PAH. This cohort study retrospectively enrolled 55 patients with pSS-PAH who were followed up at the Department of Rheumatology of Peking Union Medical College Hospital (PUMCH) between August 2007 and May 2017. The patients were stratified according to the level of RDW (≤ 15.0 and > 15.0%). Baseline demographics, laboratory results, pulmonary function conditions, hemodynamic assessments, and treatment regimens were analyzed. Cox proportional hazards regression analysis was used to identify whether RDW level is a factor related to adverse outcome. A total of 55 patients were recruited, with an average age of 38.9 ± 9.3 years. Fifty-four were female (98.2%), and the average duration at the time of PAH diagnosis was 25.5 ± 33.2 months. Higher RDW levels were found in patients who deceased in follow-up (13.8 ± 2.6 vs 16.5 ± 1.6%, p = 0.003) and with higher NYHA classes (13.8 ± 1.8 vs 16.5 ± 2.9%, p < 0.001). Patients with RDW > 15% had a significantly worse overall survival than patients with RDW ≤ 15% (3-year survival rate 59.5 vs. 88.7% log-rank p = 0.015). Cox regression analysis identified RDW > 15% as a prognostic factor for adverse outcome (HR 1.786, 95% CI 1.137-2.803, p = 0.012). RDW can serve as a potential negative prognostic factor of pSS-PAH.
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Affiliation(s)
- Min Hui
- Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Jiuliang Zhao
- Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Zhuang Tian
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Beijing, 100730, China
| | - Jieying Wang
- Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Junyan Qian
- Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Xiaoxi Yang
- Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Qian Wang
- Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Mengtao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Yan Zhao
- Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
| | - Xiaofeng Zeng
- Department of Rheumatology, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
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Yin P, Lv H, Li Y, Meng Y, Zhang L, Zhang L, Tang P. Hip fracture patients who experience a greater fluctuation in RDW during hospital course are at heightened risk for all-cause mortality: a prospective study with 2-year follow-up. Osteoporos Int 2018; 29:1559-1567. [PMID: 29656346 DOI: 10.1007/s00198-018-4516-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 03/28/2018] [Indexed: 12/24/2022]
Abstract
UNLABELLED This study aims to detect whether there remains valuable prognostic information in fluctuation of red cell distribution width (RDW) in hip fracture patients. Results show that this readily available parameter may provide a more effective strategy for assessment of mortality risk, therefore providing a reference for clinical planning and decision-making. INTRODUCTION Prognostic values have been found in the fluctuation of some hematologic parameters. The red cell distribution width (RDW) routinely reported with all complete blood cell counts (CBC) has proven to be associated with poor outcomes in various diseases. However, whether the fluctuation in RDW is predictive of long-term mortality in hip fracture patients treated with surgery remains unknown. METHODS One thousand three hundred thirty hip fracture patients who underwent surgery from January 1, 2000 to November 18, 2012 were recruited in this prospective cohort study. Fluctuation in the RDW between admission and discharge was measured, and a Kaplan-Meier (KM) analysis and multivariable Cox regression model were applied to evaluate the relationship between this fluctuation and mortality. Risk factors for a larger fluctuation were detected by using Logistic regression analyses. RESULTS In addition to the admission RDW, a high RDW level at the time of discharge was also associated with an increased risk of death, while no significant difference was found in the postoperative RDW. Fluctuation in the RDW between admission and discharge was an independent risk predictor for 2-year mortality (HR 1.45 95%CI 1.06-2.00, p = 0.022). Factors affecting the change in the RDW between admission and discharge included both the demographic characteristics of the patients and clinical interventions. CONCLUSION Hip fracture patients who experience a greater fluctuation in RDW during the hospital course are at a heightened risk for 2-year all-cause mortality.
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Affiliation(s)
- P Yin
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - H Lv
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Y Li
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Y Meng
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - L Zhang
- Department of Clinical Laboratory, Chinese PLA General Hospital, Beijing, 100853, China
| | - L Zhang
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China.
| | - P Tang
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China.
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Lippi G, Turcato G, Cervellin G, Sanchis-Gomar F. Red blood cell distribution width in heart failure: A narrative review. World J Cardiol 2018; 10:6-14. [PMID: 29487727 PMCID: PMC5827617 DOI: 10.4330/wjc.v10.i2.6] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 01/23/2018] [Accepted: 02/05/2018] [Indexed: 02/07/2023] Open
Abstract
The red blood cell distribution width (RDW) is a simple, rapid, inexpensive and straightforward hematological parameter, reflecting the degree of anisocytosis in vivo. The currently available scientific evidence suggests that RDW assessment not only predicts the risk of adverse outcomes (cardiovascular and all-cause mortality, hospitalization for acute decompensation or worsened left ventricular function) in patients with acute and chronic heart failure (HF), but is also a significant and independent predictor of developing HF in patients free of this condition. Regarding the biological interplay between impaired hematopoiesis and cardiac dysfunction, many of the different conditions associated with increased heterogeneity of erythrocyte volume (i.e., ageing, inflammation, oxidative stress, nutritional deficiencies and impaired renal function), may be concomitantly present in patients with HF, whilst anisocytosis may also directly contribute to the development and worsening of HF. In conclusion, the longitudinal assessment of RDW changes over time may be considered an efficient measure to help predicting the risk of both development and progression of HF.
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19
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Contreras Gutiérrez V. Red cell distribution width: A marker of in-hospital mortality in ST-segment elevation myocardial infarction patients? REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2017. [DOI: 10.1016/j.hgmx.2016.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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20
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Roderick KV, Abelson AL, Nielsen L, Price LL, Quinn R. Evaluation of red blood cell distribution width as a prognostic indicator in cats with acquired heart disease, with and without congestive heart failure. J Feline Med Surg 2017; 19:648-656. [PMID: 27225272 PMCID: PMC11128818 DOI: 10.1177/1098612x16649988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives Congestive heart failure secondary to cardiomyopathy is a common manifestation of cardiac disease in cats, carrying a variable prognosis. The objective of this retrospective study was to evaluate the relationship between red blood cell distribution width (RDW) and survival time in feline patients with acquired heart disease with and without congestive heart failure (CHF). Methods Three hundred and forty-nine client-owned cats with echocardiograms and complete blood count, including RDW measurement, performed between March 2006 and December 2011, were included in the study. Patient characteristics, including signalment, hematocrit, RDW, echocardiographic parameters and survival, were recorded. Comparisons between RDW in cats with asymptomatic acquired heart disease and those with CHF were made. Survival was documented and compared at 30 days and 6 months. Results CHF was present in 80 cats and absent in 269 cats. Cats with CHF had an increase in mortality compared with cats without CHF at 30 days and 6 months ( P = 0.007 and P = 0.04, respectively). RDW was not significantly associated with survival in cats with or without CHF at 30 days or 6 months. A significant difference was found between median RDW values in cats with CHF vs cats without CHF (16.3% vs 15.8%; P = 0.02). The median RDW value was significantly higher in cats with unclassified cardiomyopathy compared with cats with other types of cardiomyopathy (16.3% vs 15.8%; P = 0.03). Conclusions and relevance Single RDW values did not predict mortality in cats with acquired heart disease but may be useful in determining if cats have decompensated heart disease and CHF. Human studies indicate that incremental increases in serial RDW measurements are associated with decreased survival; serial RDW measurements in cats may be an area of future study.
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Affiliation(s)
- Kursten V Roderick
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, USA
- Angell Animal Medical Center, MA, USA
| | - Amanda L Abelson
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, USA
| | | | - Lori Lyn Price
- The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, MA, USA
- Tufts Clinical and Translational Science Institute, Tufts University, MA, USA
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Muhlestein JB, Lappe DL, Anderson JL, Muhlestein JB, Budge D, May HT, Bennett ST, Bair TL, Horne BD. Both initial red cell distribution width (RDW) and change in RDW during heart failure hospitalization are associated with length of hospital stay and 30-day outcomes. Int J Lab Hematol 2017; 38:328-37. [PMID: 27121354 DOI: 10.1111/ijlh.12490] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 02/12/2016] [Indexed: 01/12/2023]
Abstract
INTRODUCTION We examined the predictive ability of red cell distribution width (RDW) and the change in RDW during hospitalization (ΔRDW) for length of stay (LOS) and 30-day outcomes after heart failure (HF) inpatient stay. METHODS Electronic query of Intermountain Healthcare medical records identified patients (N = 6414) with a primary diagnosis of HF who were discharged between 2004 and 2013, had RDW measured within 24 h after admission, and had RDW tested at least once more during the same hospitalization. ΔRDW was defined as the last RDW within 24 h prior to discharge minus the first RDW. RESULTS Median LOS by initial RDW quartiles was Q1: 3.0, Q2: 3.1, Q3: 3.7, and Q4: 4.0 days (P-trend<0.001), and by ΔRDW quartiles was Q1: 4.1, Q2: 3.4, Q3: 3.6, and Q4: 4.7 days (P-trend<0.001). Both initial RDW (16.8 ± 2.8% vs. 16.3 ± 2.7%, P < 0.001) and ΔRDW (0.21 ± 1.09% vs. 0.14 ± 1.04%, P = 0.039) predicted 30-day readmission vs. no readmit. For 30-day decedents vs. survivors, initial RDW was 17.3 ± 3.0% vs. 16.3 ± 2.6% (P < 0.001), while ΔRDW was +0.20 ± 1.14% vs. +0.14 ± 1.04% (P = 0.15). CONCLUSIONS Greater initial RDW and ΔRDW during HF hospitalization were associated with 30-day mortality, longer LOS, and 30-day all-cause readmission, suggesting both ΔRDW and initial RDW may aid in personalizing prognosis and treatment.
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Affiliation(s)
- J B Muhlestein
- Intermountain Heart Institute, Salt Lake City, UT, USA.,University of Utah, Department of Internal Medicine, Salt Lake City, UT, USA
| | - D L Lappe
- Intermountain Heart Institute, Salt Lake City, UT, USA
| | - J L Anderson
- Intermountain Heart Institute, Salt Lake City, UT, USA.,University of Utah, Department of Internal Medicine, Salt Lake City, UT, USA
| | - J B Muhlestein
- Intermountain Heart Institute, Salt Lake City, UT, USA.,University of Utah, Department of Internal Medicine, Salt Lake City, UT, USA
| | - D Budge
- Intermountain Heart Institute, Salt Lake City, UT, USA
| | - H T May
- Intermountain Heart Institute, Salt Lake City, UT, USA
| | - S T Bennett
- Intermountain Central Laboratory, Intermountain Medical Center, Salt Lake City, UT, USA.,Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - T L Bair
- Intermountain Heart Institute, Salt Lake City, UT, USA
| | - B D Horne
- Intermountain Heart Institute, Salt Lake City, UT, USA.,Genetic Epidemiology Division, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
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An overall and dose-response meta-analysis of red blood cell distribution width and CVD outcomes. Sci Rep 2017; 7:43420. [PMID: 28233844 PMCID: PMC5324076 DOI: 10.1038/srep43420] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/24/2017] [Indexed: 01/04/2023] Open
Abstract
Red blood cell distribution width (RDW) is the coefficient of variation of red blood cell size, considered to be associated with cardiovascular disease (CVD). This study aimed to comprehensively synthesize previous studies on RDW and CVD outcomes through an overall and dose-response meta-analysis. PubMed, Embase and Web of Science were searched systematically for English and Chinese language publications up to November 30, 2015. We extracted data from publications matching our inclusion criteria for calculating pooled hazard ratio (HR), which was used to assess prognostic impact of RDW on CVD. Twenty-seven articles, consisting of 28 studies and 102,689 participants (mean age 63.9 years, 63,703 males/36,846 females, 2,140 gender-unmentioned subjects) were included in the present meta-analysis. The pooled HRs are 1.12 (95% CI = 1.09-1.15) for the association of all-cause mortality (ACM) per 1% increase of RDW, 1.12(95% CI = 1.08-1.17) for major adverse cardiac events (MACEs) per 1% increase of RDW. A dose-response curve relating RDW increase to its effect on CVD outcomes was established (pcurve < 0.001). For every 1-unit increase of RDW, there is an increased risk of occurrence of ACM (pooled HR = 1.03, 95% CI = 1.02-1.04) and MACEs (pooled HR = 1.04, 95% CI = 1.01-1.06). This study indicates RDW may be a prognostic indicator for CVD outcomes.
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Yazıcı S, Kırış T, Sadık Ceylan U, Terzi S, Uzun AO, Emre A, Yeşilçimen K. Relation between dynamic change of red cell distribution width and 30-day mortality in patients with acute pulmonary embolism. CLINICAL RESPIRATORY JOURNAL 2017; 12:953-960. [PMID: 28063201 DOI: 10.1111/crj.12611] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 12/19/2016] [Accepted: 12/29/2016] [Indexed: 12/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES Recent studies suggest that an increase in red cell distribution width (RDW) levels have a better prognostic value than a single measurement. In the current study, we investigated the predictive value of increasing RDW levels for mortality in acute pulmonary emboli (APE) patients. MATERIALS AND METHODS For the study, 199 APE patients who were hospitalized were enrolled. Patients were divided into three groups according to their admission and 24th hour RDW values. Patients for whom both RDW values normal were put in group 1 (normal); patients with admission RDW > 14.5% and decreased 24th hour RDW values were in group 2 (decreased); patients whose 24th hour RDW levels were >14.5% and increased compared to their baseline RDW measurement were in group 3 (increased). Clinical and laboratory findings and 30-day mortality of these groups were compared. RESULTS Mean patient age was 68 ± 16, and 48% of the patients were male. There were 98 patients (49%) in group 1, 59 patients (30%) in group 2, and 42 patients (21%) in group 3. Patients in group 3 were older, had lower eGFR and hemoglobin values, and had higher brain type natriuretic peptide values. Mortality rate was higher in group 3 (0%, 3.4%, 19%, respectively, P < .0001). Increase in RDW was independently related to mortality [HR: 4.9, (95%CI: 1.2-18, P = .02)]. CONCLUSION APE patients with increasing RDW levels have higher mortality rates. Serial measurements of RDW may help us determine patients with high risk for mortality.
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Affiliation(s)
- Selçuk Yazıcı
- Dr.Siyami Ersek Thoracic and Cardiovascular Surgery Center, Department of Cardiology, İstanbul, Turkey
| | - Tuncay Kırış
- Katip Celebi University, Atatürk Training and Research Hospital, Department of Cardiology, İzmir, Turkey
| | - Ufuk Sadık Ceylan
- Dr.Siyami Ersek Thoracic and Cardiovascular Surgery Center, Department of Cardiology, İstanbul, Turkey
| | - Sait Terzi
- Dr.Siyami Ersek Thoracic and Cardiovascular Surgery Center, Department of Cardiology, İstanbul, Turkey
| | - Ahmet Okan Uzun
- Dr.Siyami Ersek Thoracic and Cardiovascular Surgery Center, Department of Cardiology, İstanbul, Turkey
| | - Ayşe Emre
- Dr.Siyami Ersek Thoracic and Cardiovascular Surgery Center, Department of Cardiology, İstanbul, Turkey
| | - Kemal Yeşilçimen
- Dr.Siyami Ersek Thoracic and Cardiovascular Surgery Center, Department of Cardiology, İstanbul, Turkey
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Toward a Blood-Borne Biomarker of Chronic Hypoxemia: Red Cell Distribution Width and Respiratory Disease. Adv Clin Chem 2017; 82:105-197. [PMID: 28939210 DOI: 10.1016/bs.acc.2017.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Hypoxemia (systemic oxygen desaturation) marks the presence, risk, and progression of many diseases. Episodic or nocturnal hypoxemia can be challenging to detect and quantify. A sensitive, specific, and convenient marker of recent oxygen desaturation represents an unmet medical need. Observations of acclimatization to high altitude in humans and animals reveals several proteosomic, ventilatory, and hematological responses to low oxygen tension. Of these, increased red cell distribution width (RDW) appears to have the longest persistence. Literature review and analyses of a 2M patient database across the full disease pathome revealed that increased RDW is predictive of poor outcome for certain diseases including many if not all hypoxigenic conditions. Comprehensive review of diseases impacting the respiratory axis show many are associated with increased RDW and no apparent counterexamples. The mechanism linking RDW to outcome is unknown. Conjectural roles for iron deficiency, inflammation, and oxidative stress have not been born out experimentally. Sports-doping studies show that erythropoietin (EPO) injection can induce formation of unusually large red blood cells (RBC) in sufficient numbers to increase RDW. Because endogenous EPO responds strongly to hypoxemia, this molecule could potentially mediate a long-lived RDW response to low oxygenation. RDW may be a guidepost signaling that unexploited information is embedded in subtle RBC variation. Applying modern techniques of measurement and analysis to certain RBC characteristics may yield a more specific and sensitive marker of chronic pulmonary and circulatory diseases, sleep apnea, and opioid inhibition of breathing.
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Atogami S, de Kerckhove C, Yanagihara K, Kamihira S. Red blood cell size differential method for time-series detailed monitoring of anemic disorders with RBC size abnormalities in mean corpuscular volume (MCV) and/or red blood cell distribution width (RDW). COGENT MEDICINE 2016. [DOI: 10.1080/2331205x.2016.1251833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Sunao Atogami
- Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki-shi, Nagasaki 852-8501, Japan
- Department of Laboratory Medicine, Sasebo City General Hospital, 9-3, Hirase-cho, Sasebo-shi, Nagasaki 857-8511, Japan
| | - Charles de Kerckhove
- Translational Unit, Innovation and Translational Research Center (ITREC), Nagasaki Harbor Medical Center City Hospital, 6-39, Shinchimachi, Nagasaki-shi, Nagasaki 850-8555, Japan
| | - Katsunori Yanagihara
- Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki-shi, Nagasaki 852-8501, Japan
| | - Shimeru Kamihira
- Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki-shi, Nagasaki 852-8501, Japan
- Translational Unit, Innovation and Translational Research Center (ITREC), Nagasaki Harbor Medical Center City Hospital, 6-39, Shinchimachi, Nagasaki-shi, Nagasaki 850-8555, Japan
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León Subías E, Gómara de la Cal S, Marin Trigo JM. Red Cell Distribution Width in Obstructive Sleep Apnea. Arch Bronconeumol 2016; 53:114-119. [PMID: 27381970 DOI: 10.1016/j.arbres.2016.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 05/12/2016] [Accepted: 05/15/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Red cell distribution width (RDW) describes heterogeneity in the size of red blood cells. An increase in RDW has been associated with excess mortality in heart failure and other chronic diseases. Since there is an increased risk of cardiovascular morbidity and mortality in obstructive sleep apnea (OSA), it is possible that these patients have a high RDW. METHOD We recruited subjects aged 18 to 60 years referred to the sleep-disordered breathing unit for suspected OSA. Subjects with any comorbidity were excluded. Apnea-hypopnea index (AHI) was calculated from the respiratory polygraphy. The RDW was obtained from the complete blood count. Changes in RDW after one year of treatment with continuous positive airway pressure (CPAP) were determined. RESULTS We included 34 healthy subjects and 138 with OSA, aged 40.5±9.8 and 45.6±9.2 (P=.004) years, respectively. The RDW was higher in subjects with OSA compared to healthy subjects: 13.40 (12.40 to 14.40) vs. 13.15 (12.07 to 14.23) (P=.036). AHI showed a positive independent relationship with RDW in both the whole population (r=0.223; P=.002) and the OSA group (r=0.231; P=.005). No significant changes were found in RDW after one year of CPAP therapy. CONCLUSIONS RDW increase in patients with OSA is directly associated with severity, although levels are not modified by the effective treatment of OSA with CPAP.
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Affiliation(s)
- Erica León Subías
- Servicio de Neumología, Hospital Universitario Miguel Servet, Zaragoza, España.
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Red cell distribution width is a predictor of mortality in patients with chronic heart failure. Int J Cardiol 2016; 212:79-81. [PMID: 27035607 DOI: 10.1016/j.ijcard.2016.03.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 03/14/2016] [Accepted: 03/16/2016] [Indexed: 01/11/2023]
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Uemura Y, Shibata R, Takemoto K, Uchikawa T, Koyasu M, Watanabe H, Mitsuda T, Miura A, Imai R, Watarai M, Murohara T. Elevation of red blood cell distribution width during hospitalization predicts mortality in patients with acute decompensated heart failure. J Cardiol 2015; 67:268-73. [PMID: 26140955 DOI: 10.1016/j.jjcc.2015.05.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 04/27/2015] [Accepted: 05/05/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Increased red blood cell distribution width (RDW) is associated with adverse outcomes in heart failure. In the present study, we assessed the association between changes in RDW values during hospitalization and long-term prognosis in patients with acute decompensated heart failure (ADHF). METHODS We measured the RDW value in 229 consecutive patients with ADHF. Blood samples were obtained at the time of hospital admission and at discharge. Changes in RDW were calculated as the mean difference between RDW values on admission and those at the time of hospital discharge. RESULTS Patients were followed up for a median of 692 days. A Kaplan-Meier survival analysis demonstrated that patients whose RDW levels increased during hospitalization had significantly higher all-cause and cardiac-based mortality following heart failure than did patients whose RDW levels decreased during hospitalization. A multivariate Cox regression analysis revealed that change in RDW values during hospitalization, but not the values of RDW and hemoglobin on admission, was independently correlated with all-cause and cardiac-based mortality after adjusting for other risk factors in patients with ADHF. CONCLUSIONS These data document that the change in RDW values during hospitalization independently predicts poor outcomes in patients with ADHF. Continuous follow-up of RDW values could provide useful information for long-term prognosis after heart failure.
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Affiliation(s)
- Yusuke Uemura
- Division of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan.
| | - Rei Shibata
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Takemoto
- Division of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan
| | - Tomohiro Uchikawa
- Division of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan
| | - Masayoshi Koyasu
- Division of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan
| | - Hiroki Watanabe
- Division of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan
| | - Takayuki Mitsuda
- Division of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan
| | - Ayako Miura
- Division of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan
| | - Ryo Imai
- Division of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan
| | - Masato Watarai
- Division of Cardiology, Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Yoon HE, Kim SJ, Hwang HS, Chung S, Yang CW, Shin SJ. Progressive rise in red blood cell distribution width predicts mortality and cardiovascular events in end-stage renal disease patients. PLoS One 2015; 10:e0126272. [PMID: 25961836 PMCID: PMC4427112 DOI: 10.1371/journal.pone.0126272] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 03/31/2015] [Indexed: 12/15/2022] Open
Abstract
Red blood cell distribution width (RDW) is a robust marker of adverse clinical outcomes in various populations. However, the clinical significance of a progressive rise in RDW is undetermined in end-stage renal disease (ESRD) patients. The purpose of this study was to determine the prognostic importance of a change in RDW in ESRD patients. Three hundred twenty-six incident dialysis patients were retrospectively analyzed. Temporal changes in RDW during 12 months after dialysis initiation were assessed by calculating the coefficients by linear regression. Patients were divided into two groups: an RDW-decreased group who had negative coefficient values (n = 177) and an RDW-increased group who had positive values (n = 149). The associations between rising RDW and mortality and cardiovascular (CV) events were investigated. During a median follow-up of 2.7 years (range, 1.0–7.7 years), 75 deaths (24.0%) and 60 non-fatal CV events (18.4%) occurred. The event-free survival rate for the composite of end-points was lower in the RDW-increased group (P = 0.004). After categorizing patients according to baseline RDW, the event-free survival rate was lowest in patients with a baseline RDW >14.9% and increased RDW, and highest in patients with a baseline RDW ≤14.9% and decreased RDW (P = 0.02). In multivariate analysis, rising RDW was independently associated with the composite of end-points (hazard ratio = 1.75, P = 0.007), whereas the baseline RDW was not. This study shows that a progressive rise in RDW independently predicted mortality and CV events in ESRD patients. Rising RDW could be an additive predictor for adverse CV outcomes ESRD patients.
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Affiliation(s)
- Hye Eun Yoon
- Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Internal Medicine, Incheon St. Mary’s Hospital, Incheon, Korea
| | - Sung Jun Kim
- Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Internal Medicine, Incheon St. Mary’s Hospital, Incheon, Korea
| | - Hyeon Seok Hwang
- Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sungjin Chung
- Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chul Woo Yang
- Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seok Joon Shin
- Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Internal Medicine, Incheon St. Mary’s Hospital, Incheon, Korea
- * E-mail:
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Martínez-Velilla N, Cambra-Contin K, García-Baztán A, Alonso-Renedo J, Herce PA, Ibáñez-Beroiz B. Change in Red Blood Cell Distribution width During the Last Years of Life in Geriatric Patients. J Nutr Health Aging 2015; 19:590-4. [PMID: 25923491 DOI: 10.1007/s12603-015-0470-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Most of the studies that evaluate the association between red blood cell distribution width (RDW) and mortality assess it on a single occasion instead of doing so through serial measurements. Very few studies have investigated repeated measurements of RDW and its prognostic value, and most of them are focused on patients with cardiovascular diseases. RDW is a dynamic value so we aimed at determining the prognostic value of sequential RDW assessment in the last years of life in patients enrolled in a Department of Geriatrics. DESIGN This work is part of a prospective study derived from a cohort of 122 patients over 75 years hospitalized in 2005 for the purpose of assessing the prognostic significance of several comorbidity and prognostic indices. SETTING Patients were consecutively recruited for the study at admission in a tertiary hospital and then followed up for at least 5 years. PARTICIPANTS A total of 55 patients with repeated RDW assessments during all the five years before their death were selected from the total cohort of 122 patients. RESULTS We found a strong correlation between progressive rise in RDW and mortality risk, especially during the last year of life. There was a gradual significant increase in the RDW values along the last five years of life, with means growing up from 14,8 (95% CI: 13,98-15.62) to 16,37 (15,80-16,94). CONCLUSION In our cohort of geriatric patients, RDW is a dynamic variable that is modified during the last five years of life, irrespective of their age, and especially during the last year.
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Affiliation(s)
- N Martínez-Velilla
- Nicolás Martínez-Velilla, Servicio de Geriatría del Complejo Hospitalario de Navarra, Irunlarrea 4, 31008 Pamplona, Spain, E-mail: , Telephone: 00 34 848422222, Fax: 00 34 848428830
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Salvagno GL, Sanchis-Gomar F, Picanza A, Lippi G. Red blood cell distribution width: A simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci 2014; 52:86-105. [PMID: 25535770 DOI: 10.3109/10408363.2014.992064] [Citation(s) in RCA: 612] [Impact Index Per Article: 61.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The red blood cell distribution width (RDW) is a simple and inexpensive parameter, which reflects the degree of heterogeneity of erythrocyte volume (conventionally known as anisocytosis), and is traditionally used in laboratory hematology for differential diagnosis of anemias. Nonetheless, recent evidence attests that anisocytosis is commonplace in human disorders such as cardiovascular disease, venous thromboembolism, cancer, diabetes, community-acquired pneumonia, chronic obstructive pulmonary disease, liver and kidney failure, as well as in other acute or chronic conditions. Despite some demographic and analytical issues related to the routine assessment that may impair its clinical usefulness, an increased RDW has a high negative predictive value for diagnosing a variety of disorders, but also conveys important information for short- and long-term prognosis. Even more importantly, the value of RDW is now being regarded as a strong and independent risk factor for death in the general population. Although it has not been definitely established whether an increased value of RDW is a risk factor or should only be considered an epiphenomenon of an underlying biological and metabolic imbalance, it seems reasonable to suggest that the assessment of this parameter should be broadened far beyond the differential diagnosis of anemias. An increased RDW mirrors a profound deregulation of erythrocyte homeostasis involving both impaired erythropoiesis and abnormal red blood cell survival, which may be attributed to a variety of underlying metabolic abnormalities such as shortening of telomere length, oxidative stress, inflammation, poor nutritional status, dyslipidemia, hypertension, erythrocyte fragmentation and alteration of erythropoietin function. As such, the aim of this article is to provide general information about RDW and its routine assessment, to review the most relevant implications in health and disease and give some insights about its potential clinical applications.
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Affiliation(s)
- Gian Luca Salvagno
- Clinical Chemistry Section, Department of Life and Reproductive Sciences, Academic Hospital of Verona , Verona , Italy
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Prognostic value of red blood cell distribution width in heart failure patients: a meta-analysis. Int J Cardiol 2014; 179:495-9. [PMID: 25465815 DOI: 10.1016/j.ijcard.2014.11.042] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 11/04/2014] [Indexed: 02/08/2023]
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Huang YL, Hu ZD, Liu SJ, Sun Y, Qin Q, Qin BD, Zhang WW, Zhang JR, Zhong RQ, Deng AM. Prognostic value of red blood cell distribution width for patients with heart failure: a systematic review and meta-analysis of cohort studies. PLoS One 2014; 9:e104861. [PMID: 25133510 PMCID: PMC4136732 DOI: 10.1371/journal.pone.0104861] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 07/13/2014] [Indexed: 12/30/2022] Open
Abstract
Aims Multiple studies have investigated the prognostic role of red blood cell distribution width (RDW) for patients with heart failure (HF), but the results have been inconsistent. The aim of the present study was to estimate the impact of RDW on the prognosis of HF by performing a systematic review and meta-analysis. Methods and Results The Embase, PubMed, and Web of Science databases were searched up to November 16, 2013 to identify eligible cohort studies. The quality of each study was assessed using the Newcastle-Ottawa Scale (NOS). The association between RDW, either on admission or at discharge, and HF outcomes (all-cause mortality [ACM], heart transplantation, cardiovascular mortality, and rehospitalization, etc.) were reviewed. The overall hazard ratio (HR) for the effect of RDW on ACM was pooled using a random-effects model, and the publication bias was evaluated using funnel plots and Eggers' tests. Seventeen studies, with a total of 18288 HF patients, were included for systematic review. All eligible studies indicated that RDW on admission and RDW at discharge, as well as its change during treatment, were of prognostic significance for HF patients. The HR for the effect of a 1% increase in baseline RDW on ACM was 1.10 (95% confidence interval: 1.07–1.13), based on pooling of nine studies that provided related data. However, publication bias was observed among these studies. Conclusions HF patients with higher RDW may have poorer prognosis than those with lower RDW. Further studies are needed to explore the potential mechanisms underlying this association.
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Affiliation(s)
- Yuan-Lan Huang
- Department of Laboratory Medicine, NO. 455 Hospital of People's Liberation Army, Shanghai, P. R. China
- Department of Laboratory Diagnosis, Changhai Hospital, Second Military Medical University, Shanghai, P. R. China
- Department of Laboratory Diagnosis, Changzheng Hospital, Second Military Medical University, Shanghai, P. R. China
| | - Zhi-De Hu
- Department of Laboratory Diagnosis, Changzheng Hospital, Second Military Medical University, Shanghai, P. R. China
- Department of Laboratory Medicine, General Hospital of Ji'nan Military Region of People's Liberation Army, Ji'nan, Shandong Province, P. R. China
| | - Shi-Jian Liu
- Department of Biobank and Biostatistics, Pediatric Translational Institute, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiaotong University, Shanghai, P. R. China,
| | - Yi Sun
- Department of Laboratory Diagnosis, Changhai Hospital, Second Military Medical University, Shanghai, P. R. China
| | - Qin Qin
- Department of Laboratory Diagnosis, Changhai Hospital, Second Military Medical University, Shanghai, P. R. China
| | - Bao-Dong Qin
- Department of Laboratory Diagnosis, Changzheng Hospital, Second Military Medical University, Shanghai, P. R. China
| | - Wei-Wei Zhang
- Department of Laboratory Diagnosis, Changhai Hospital, Second Military Medical University, Shanghai, P. R. China
| | - Jian-Rong Zhang
- Department of Laboratory Diagnosis, Changhai Hospital, Second Military Medical University, Shanghai, P. R. China
| | - Ren-Qian Zhong
- Department of Laboratory Diagnosis, Changzheng Hospital, Second Military Medical University, Shanghai, P. R. China
- * E-mail: (AMD); (RQZ)
| | - An-Mei Deng
- Department of Laboratory Diagnosis, Changhai Hospital, Second Military Medical University, Shanghai, P. R. China
- * E-mail: (AMD); (RQZ)
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Elevated red blood cell distribution width as a simple prognostic factor in patients with symptomatic multiple myeloma. BIOMED RESEARCH INTERNATIONAL 2014; 2014:145619. [PMID: 24963470 PMCID: PMC4055253 DOI: 10.1155/2014/145619] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 04/25/2014] [Accepted: 05/08/2014] [Indexed: 12/13/2022]
Abstract
Red blood cell distribution width (RDW) is a parameter reported in complete blood cell count tests, and has been reported as an inflammatory biomarker. Multiple myeloma (MM) is known to be associated with inflammatory microenvironments. However, the importance of RDW has been seldom studied in MM. For this study, 146 symptomatic myeloma patients with available RDW at diagnosis were retrospectively reviewed, and their characteristics were compared between two groups, those with high (>14.5%) and normal (≤14.5%) RDW. RDW was correlated to hemoglobin, MM stage, β2-microglobulin, M-protein, bone marrow plasma cells, and cellularity (P < 0.001). During induction, overall response rates of the two groups were similar (P = 0.195); however, complete response rate was higher in the normal-RDW group than it was in the high-RDW group (P = 0.005). With a median follow-up of 47 months, the normal-RDW group showed better progression-free survival (PFS) (24.2 versus 17.0 months, P = 0.029) compared to the high-RDW group. Overall survival was not different according to the RDW level (P = 0.236). In multivariate analysis, elevated RDW at diagnosis was a poor prognostic factor for PFS (HR 3.21, 95% CI 1.24–8.32) after adjustment with other myeloma-related prognostic factors. RDW would be a simple and immediately available biomarker of symptomatic MM, reflecting the systemic inflammation.
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Kilicaslan B, Dursun H, Aydin M, Ekmekci C, Ozdogan O. The relationship between red-cell distribution width and abnormal left ventricle geometric patterns in patients with untreated essential hypertension. Hypertens Res 2014; 37:560-4. [PMID: 24599016 DOI: 10.1038/hr.2014.39] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 09/16/2013] [Accepted: 11/12/2013] [Indexed: 01/19/2023]
Abstract
Abnormal left ventricle (LV) geometric patterns are associated with an increased risk of vascular complications of hypertension (HT). The association between red-cell distribution width (RDW) and HT has been recently investigated; however, the relationship between abnormal LV geometric patterns and RDW has not been studied before. The aim of this study was to investigate the relationship between RDW and abnormal LV geometric patterns in patients with untreated essential HT. Measurements were obtained from 139 patients with untreated essential HT (mean age=51.3±16.3 years). Four different geometric patterns (NG, normal geometry; CR, concentric remodeling; EH, eccentric hypertrophy; CH, concentric hypertrophy) were determined according to the LV mass index (LVMI) and relative wall thickness (RWT). RDW, lipid parameters and other biochemical markers were measured in all patients. While the highest RDW values were detected in the CH group (P<0.05, for all), it was similar among the NG, CR and EH groups (P>0.05, for all). RDW was associated with age, LVMI and LV geometry in bivariate analysis (P<0.05, for all). In a receiver operating characteristic (ROC) curve analysis, a level of RDW>14.5 predicted CH with 81% sensitivity and 59% specificity. Age (beta=0.309, P=0.001), LV geometry type (beta=0.228, P=0.01) and RWT (beta=-0.278; P=0.25) were independent predictors of high RDW in multiple linear regression analysis. In conclusion, the highest RDW values were observed in the CH group in the untreated essential HT patients. RDW seems to be a useful tool for the prediction of end-organ damage in patients with untreated essential HT.
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Affiliation(s)
- Baris Kilicaslan
- Department of Cardiology, İzmir Tepecik Research and Training Hospital, Izmir, Turkey
| | - Huseyin Dursun
- Department of Cardiology, İzmir Tepecik Research and Training Hospital, Izmir, Turkey
| | - Mehmet Aydin
- Department of Cardiology, İzmir Tepecik Research and Training Hospital, Izmir, Turkey
| | - Cenk Ekmekci
- Department of Cardiology, İzmir Tepecik Research and Training Hospital, Izmir, Turkey
| | - Oner Ozdogan
- Department of Cardiology, İzmir Tepecik Research and Training Hospital, Izmir, Turkey
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Relation between Red Cell Distribution Width and Left Ventricular Function in Children with Heart Failure. ISRN PEDIATRICS 2014; 2014:234835. [PMID: 24660068 PMCID: PMC3934566 DOI: 10.1155/2014/234835] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 01/06/2014] [Indexed: 11/29/2022]
Abstract
Background. Most of the studies done on adults showed that red cell distribution width (RDW) can be used as a prognostic marker in patients with chronic heart failure. However, RDW has not been tested in children with heart failure. Methods and Results. 31 children with heart failure admitted to Cardiology Unit, Tanta University Hospital, during the period of January 2012 to December 2012 were included in this study, RDW as a component of routine blood count was evaluated and correlated to the echocardiographic parameters of left ventricle. The mean age of our cohort was 16.16 ± 14.97 months, congenital heart disease with left-to-right shunt represented 58.1% of the underlying causes of heart failure while dilated cardiomyopathy made 41.9%. The mean hemoglobin level was 9.14 ± 1.18 gm/dL; RDW level ranged from 10.7% to 27.7% with a mean of 16.01 ± 3.34. Hemoglobin was significantly correlated with RDW at any level. For the echo parameters, at cutoff point of 16.4%, RDW was significantly correlated with fraction shortening (FS), and A, E/A ratio, but it was not correlated with LVEDD, LVESD, and E/É at the same cutoff level. Conclusion. RDW, a simple, available test, can be used as a marker for the left ventricular function in children with heart failure until an echocardiography assessment for the patients is done.
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Núñez J, Núñez E, Rizopoulos D, Miñana G, Bodí V, Bondanza L, Husser O, Merlos P, Santas E, Pascual-Figal D, Chorro FJ, Sanchis J. Red blood cell distribution width is longitudinally associated with mortality and anemia in heart failure patients. Circ J 2013; 78:410-8. [PMID: 24292127 DOI: 10.1253/circj.cj-13-0630] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Red blood cell distribution width (RDW) has been found to be an independent predictor for adverse outcome in patients with heart failure (HF), but there are no data on the association of longitudinal RDW with all-cause mortality and occurrence of anemia. METHODS AND RESULTS 1,702 patients discharged from a previous admission for acute HF (AHF) were included. RDW was measured during the available longitudinal history of the patient. Joint modeling and Multistate Markov were used for the analysis. The median RDW at baseline was 15.0% (IQR: 14.0-16.5), and 45.6% of patients had anemia. At a median follow-up of 1.5 years (IQR: 0.45-3.25), 713 patients died. The last RDW-trajectory value and cumulative RDW-trajectory mean were predictive of mortality (HR, 1.18; 95% CI: 1.12-1.24; and HR, 1.12; 95% CI: 1.08-1.16, respectively; P<0.001 for both). This effect, however, varied according the anemia status (P for interaction<0.001), being more pronounced in absence of anemia [HR=1.31 (95% CI: 1.22-1.42) and HR=1.48 (95% CI: 1.33-1.64)] compared to those with anemia [HR=1.08 (95% CI: 1.04-1.13), 1.12 (95% CI: 1.06-1.18)]. Longitudinal RDW (per 1% increasing) was also independently associated with incident anemia [HR=1.10 (95% CI: 1.03-1.18) P=0.002]. CONCLUSIONS Following an admission for AHF, higher longitudinal RDW values over time were associated to an increased risk for both developing anemia and dying. The effect on mortality was more pronounced among non-anemic patients.
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Affiliation(s)
- Julio Núñez
- Cardiology Department, Clinical University Hospital, INCLIVA
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38
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de Freitas MV, Marquez-Bernardes LF, de Arvelos LR, Paraíso LF, Gonçalves e Oliveira AFM, Mascarenhas Netto RDC, Neto MB, Garrote-Filho MS, de Souza PCA, Penha-Silva N. Influence of age on the correlations of hematological and biochemical variables with the stability of erythrocyte membrane in relation to sodium dodecyl sulfate. Hematology 2013; 19:424-30. [DOI: 10.1179/1607845413y.0000000145] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Mariana V. de Freitas
- Institute of Genetics and BiochemistryFederal University of Uberlândia, Uberlândia, MG, Brazil
| | | | - Letícia R. de Arvelos
- Institute of Genetics and BiochemistryFederal University of Uberlândia, Uberlândia, MG, Brazil
| | - Lara F. Paraíso
- Institute of Genetics and BiochemistryFederal University of Uberlândia, Uberlândia, MG, Brazil
| | | | | | - Morun Bernardino Neto
- Institute of Genetics and BiochemistryFederal University of Uberlândia, Uberlândia, MG, Brazil
| | - Mario S. Garrote-Filho
- Institute of Genetics and BiochemistryFederal University of Uberlândia, Uberlândia, MG, Brazil
| | - Paulo César A. de Souza
- Institute of Genetics and BiochemistryFederal University of Uberlândia, Uberlândia, MG, Brazil
| | - Nilson Penha-Silva
- Institute of Genetics and BiochemistryFederal University of Uberlândia, Uberlândia, MG, Brazil
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Pérez-Martín A, Horrillo-Sánchez de Ocaña L, Satué-Bartolomé JA, Belinchón Paraíso JC, Gonzalo-Pascua S, Marrero-Francés J, Zapatero-Gaviria A. [Red cell distribution width and mortality following hospital discharge in patients over 70 years of age]. Med Clin (Barc) 2013; 143:49-56. [PMID: 23891132 DOI: 10.1016/j.medcli.2013.05.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/13/2013] [Accepted: 05/16/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVE To examine whether red cell distribution width (RDW) performs as a mortality predictor after hospital discharge in patients over 70 years of age and if its prognostic power is superior to other laboratory parameters. PATIENTS AND METHODS Longitudinal and prospective study of 426 patients admitted to the Internal Medicine Department who survived hospitalization. Sociodemographic and comorbidity factors, functional and cognitive status as well as disease parameters causing admission (diagnosis, analytical parameters, length of stay) were collected. Patients were followed for one year by telephone interview and data were collected regarding vital status and, if appropriate, death date. RDW effect on mortality was assessed using logistic regression and prognostic capability by the area under the ROC curve. RESULTS Each percentage point rise in RDW was associated with increased mortality at one year with an odds ratio of 1.19 (95% confidence interval [95% CI] 1.08 to 1.31). Mortality in each tertile of RDW was 15.6% in the lowest, 21.5% in the middle and 30.5% in the highest. A clinical model supplemented with RDW improved mortality predictive ability assessed by ROC curve. Net reclassification improvement of the prediction rule was 1.71% (95% CI 0.07 to 3.35) p=0.04. CONCLUSION This study provides new evidence of the RDW association with mortality in a cohort of elderly patients who survived hospitalization. RDW was the only laboratory parameter that improved the one-year prognostic mortality ability.
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Affiliation(s)
- Alejandro Pérez-Martín
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España.
| | | | | | | | - Sonia Gonzalo-Pascua
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
| | - Jorge Marrero-Francés
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
| | - Antonio Zapatero-Gaviria
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
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Amplitud de distribución eritrocitaria, mucha más información con solo mirar el hemograma. Med Clin (Barc) 2013; 140:449-50. [DOI: 10.1016/j.medcli.2012.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 11/29/2012] [Indexed: 11/21/2022]
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Kurt M, Tanboga IH, Buyukkaya E, Karakas MF, Akçay AB, Sen N. Relation of red cell distribution width with CHA2DS2-VASc score in patients with nonvalvular atrial fibrillation. Clin Appl Thromb Hemost 2013; 20:687-92. [PMID: 23430929 DOI: 10.1177/1076029613478157] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Red cell distribution width (RDW) has been shown to be helpful in predicting adverse long-term events in patients with cardiovascular diseases. However, to date, no study has been conducted on the relationship between RDW and thromboembolism risk in atrial fibrillation (AF). Therefore, we aimed to investigate the relationship between RDW and CHA2DS2-VASc score used for the evaluation of thromboembolism risk in patients with AF. METHODS The study population consisted of 320 patients with AF. We calculated CHA2DS2-VASc risk score for each patient and baseline hemoglobin, white blood cell, RDW, mean platelet volume, platelet counts, estimated glomerular filtration rate (eGFR), left ventricular ejection fraction (LVEF), and left atrial volume index (LAVi) were measured. RESULTS High CHA2DS2-VASc score group had higher RDW, lower LVEF, higher LAVi, and lower eGFR values when compared to the low CHA2DS2-VASc score group. The multivariate logistic regression analysis performed to predict high CHA2DS2-VASc scores revealed that RDW eGFR, LVEF, and LAVi were independent predictors. The area under the receiver-operating characteristic curve of RDW was 0.65 (0.59-0.71, P < .001) to predict high CHA2DS2-VASc score. CONCLUSION Our study results indicate that RDW values are significantly correlated with CHA2DS2-VASc score in nonanemic patients with AF, while also being independent predictor of high CHA2DS2-VASc score.
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Affiliation(s)
- Mustafa Kurt
- Department of Cardiology, Mustafa Kemal University Medical School, Hatay, Turkey
| | | | - Eyup Buyukkaya
- Department of Cardiology, Mustafa Kemal University Medical School, Hatay, Turkey
| | - Mehmet Fatih Karakas
- Department of Cardiology, Mustafa Kemal University Medical School, Hatay, Turkey
| | - Adnan Burak Akçay
- Department of Cardiology, Mustafa Kemal University Medical School, Hatay, Turkey
| | - Nihat Sen
- Department of Cardiology, Mustafa Kemal University Medical School, Hatay, Turkey
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Aung N, Ling HZ, Cheng AS, Aggarwal S, Flint J, Mendonca M, Rashid M, Kang S, Weissert S, Coats CJ, Richards T, Thomas M, Woldman S, Okonko DO. Expansion of the red cell distribution width and evolving iron deficiency as predictors of poor outcome in chronic heart failure. Int J Cardiol 2013; 168:1997-2002. [PMID: 23351789 DOI: 10.1016/j.ijcard.2012.12.091] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 11/26/2012] [Accepted: 12/28/2012] [Indexed: 01/13/2023]
Abstract
BACKGROUND An elevated red cell distribution width (RDW) and iron deficiency (ID) at baseline predict enhanced mortality in chronic heart failure (CHF), but little is known about the prognostic implications of their temporal trends. We sought to determine the survival implications of temporal changes in RDW and evolving ID in patients with CHF. METHODS The relation between red cell indices on first consultation and over time with mortality in 274 stable patients with systolic CHF was analysed. The combination of a rising RDW with a falling mean cell volume (MCV) over time defined evolving ID. RESULTS Over a median 12 month period, 51% and 23% of patients had a rise in RDW and evolving ID, respectively. After a median follow-up of 27 months, 60 (22%) patients died. A rising RDW predicted enhanced all-cause mortality (unadjusted HR for 1% per week rise 9.27, 95% CI 3.58 to 24.00, P<0.0001) independently and incrementally to baseline RDW, with an absolute increase >0.02% per week optimally predictive. Evolving ID also related to higher rates of mortality (HR 2.78, 95% CI 1.64 to 4.73, P<0.001) and was prognostically worse than a rising RDW alone (P<0.005). Patients with evolving ID who maintained their Hb levels over time had a 2-fold greater risk of death than those whose Hb levels declined without evolving ID. CONCLUSIONS An expanding RDW and evolving iron deficiency over time predict an amplified risk of death in CHF and should be utilised for risk stratification and/or therapeutically targeted to potentially improve outcomes.
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Affiliation(s)
- Nay Aung
- University College London Hospital, London, UK
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Olivares Jara M, Santas Olmeda E, Miñana Escrivà G, Palau Sampio P, Merlos Díaz P, Sanchis Forés J, Núñez Villota J. [Red cell distribution width and mortality risk in acute heart failure patients]. Med Clin (Barc) 2013; 140:433-8. [PMID: 23337456 DOI: 10.1016/j.medcli.2012.09.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 08/01/2012] [Accepted: 09/01/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Red cell distribution width (RDW) is a quantitative measure of the variability in size of erythrocytes, and it is used for the differential diagnosis of anemia. Recent reports have suggested that high RDW could play a role for risk stratification in patients with chronic heart failure. However, the prognostic role of RDW in unselected population with acute heart failure (AHF), after a thoroughly multivariate adjustment, has not been well established. The aim of this study was to establish the association between RDW and long-term mortality in patients admitted for AHF. PATIENTS AND METHOD We analyzed 1,190 consecutive patients admitted for AHF in our center. RDW measurement was performed on admission. RDW values were stratified into quartiles (Q) and the association of RDW with total mortality was assessed using Cox regression. RESULTS After a median follow-up of 15 months (interquartile range 3-33 months) 458 (38%) deaths were identified. There was a progressive increase in mortality rates from Q1 to Q4: 1.34, 1.82, 2.56 and 3.53 per 10 patients-year of follow-up (for Q1, Q2, Q3 and Q4 respectively, P for trend <.001). In the multivariate analysis, this association remained independent for patients in Q3 (15-16%) and Q4 (>16%) versus Q1 (≤14%), hazard ratio (HR): 1.66, 95% confidence interval (95% CI) 1.24-2.22, P<.01, HR: 1.80, 95% CI 1.33-2.43, p<.01, respectively, in a model adjusted for established prognostic markers in AHF. CONCLUSION In patients with AHF, higher RDW values were associated with increased long-term mortality.
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Affiliation(s)
- Miryam Olivares Jara
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, Valencia, España.
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