Abstract
The present study compared short- and long-term prognostic values of red blood cell distribution width (RDW) with those of hemoglobin (Hgb) among patients with acute congestive heart failure (CHF) in a cardiac care unit. The cross-sectional study examined data from 521 patients with acute CHF who were admitted to a cardiac care unit and followed up for 24 months (median). Mean Hgb levels in patients who succumbed (DIH) or remained alive (AIH) were 11.0±1.8 and 11.8±2.6 g/l (P>0.05), respectively. Median values of RDW were 16.2% and 14.4%, respectively (P<0.0001). During the 24-month follow-up, mean levels of Hgb in groups with and without endpoints were 11.4±2.5 and 12.5±2.4 g/dl (P<0.0001), respectively. Median RDW values were 14.9 and 13.8%, respectively (P<0.0001). Logistic regression analysis showed that in-hospital mortality was significantly associated with RDW (P=0.044), New York Heart Association (NYHA) functional class IV (P=0.0037), estimated glomerular filtration rate (eGFR) (P=0.042) and C-reactive protein (P=0.0044), but not with Hgb (P=0.10). The multivariate Cox proportional hazard model selected RDW [hazard ratio (HR), 2.19; P<0.0001], left ventricular ejection fraction (HR 0.81, P=0.0016), age (10-year increase; HR 1.19, P=0.0017) and NYHA functional classes III/IV (HR 1.52, P=0.0029) as independent predictors of long-term outcomes after adjustment, but not Hgb (HR 1.01, P=0.86). Higher RDW values in acute CHF patients at admission were associated with worse short- and long-term outcomes and RDW values were more prognostically relevant than Hgb levels.
Highlights
Congestive heart failure (CHF) is often accompanied by high mortality rates
A number of clinical variables and biological markers have been applied over the last decade in predictive models of survival for patients with CHF [5,6], including inflammatory cytokines [7,8] high-sensitivity C-reactive protein (CRP) [9] natriuretic peptides [10,11] neurohormones [12] and oxidative stress [13], all of which are useful for diagnosis and prognosis
Univariate analysis showed that age, history of CRF, hemodialysis at presentation, history of diabetes mellitus, Hgb, anemia, New York Heart Association (NYHA) classification, left ventricular ejection fraction (LVEF), B-type natriuretic peptide (BNP), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), TG, blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR) and loop diuretics at presentation were significantly correlated with Red blood cell distribution width (RDW) (P
Summary
Congestive heart failure (CHF) is often accompanied by high mortality rates. accurate risk stratification is critically important in identifying high-risk patients who may benefit from advanced treatment [1,2,3,4]. A number of clinical variables and biological markers have been applied over the last decade in predictive models of survival for patients with CHF [5,6], including inflammatory cytokines [7,8] high-sensitivity C-reactive protein (CRP) [9] natriuretic peptides [10,11] neurohormones [12] and oxidative stress [13], all of which are useful for diagnosis and prognosis These biomarkers are very expensive to analyze and cost effectiveness must be considered when including markers in predictive models. The predictive value of RDW for in-hospital, and long-term outcomes for acute CHF and acute CHF predictive value relative to hemoglobin (Hgb) and anemia remain unknown [23]
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