Backgrounds: The associations between red blood cell distribution width and prognosis in patients with heart failure (HF) have been reported. However, the prognostic impact of platelet distribution width (PDW) has been unclear in HF patients. Methods: We conducted a prospective observational study. We analyzed data on 1,746 hospitalized patients with HF who discharged alive and measured PDW at stable condition in prior to discharge. Patients were divided into tertiles based on levels of PDW: 1 st (PDW < 15.9 fL, n = 586), 2 nd (PDW 15.9-16.8 fL, n = 617), and 3 rd (PDW ≥ 16.9, n = 543) tertiles. We compared baseline patients’ characteristics and their post-discharge prognosis such as all-cause death, cardiac death, and cardiac events including cardiac death and re-hospitalization due to worsening HF. Results: Prevalence of diabetes mellitus, anemia, and chronic kidney disease was highest in the 3 rd tertile than in the 1 st and 2 nd tertiles (diabetes mellitus, 42.7% vs. 40.3% and 30.5%, P < 0.001; anemia, 52.5% vs. 48.3% and 41.2%, P < 0.001; chronic kidney disease, 57.5% vs. 49.0% and 49.3%, P = 0.005). Age was oldest and B-type natriuretic peptide levels were highest in the 3 rd tertile compared to the 1 st and 2 nd tertiles (age, 70.0, vs. 69.0 and 68.0 years old, P = 0.038; B-type natriuretic peptide, 241.0 vs. 235.2 and 171.9 pg/mL, P < 0.001). In contrast, sex and left ventricular ejection fraction did not differ among the groups. The Kaplan-Meier analysis ( Figure ) demonstrated that rates of all endpoints were the highest in the 3 rd tertile among the groups (log-rank P < 0.001, respectively). The Cox proportional hazard analysis adjusted for potential confounding factors revealed that the 3 rd tertile was independently associated with adverse prognosis (all-cause death, hazard ratio [HR] 1.312, P = 0.042; cardiac death, HR 1.422, P = 0.046; cardiac event, HR 1.283, P = 0.041). Conclusion: PDW is a novel independent predictor of adverse prognosis in patients with HF.
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