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

Abstract

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. 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 90day, 180day, and 1year after discharge. The median age of the patients was 73.91years, 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 90day, 180day, and 1year 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. 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.