Abstract
Background
Increased red blood cell distribution (RDW) has been associated with adverse outcomes
in patients with heart failure. We studied the association between baseline RDW and
changes in RDW during hospital course with clinical outcomes in acute decompensated
heart failure (ADHF) patients.
Methods and results
We prospectively studied 614 patients with ADHF. Baseline RDW and RDW change during
hospital course were determined. The relationship between RDW and clinical outcomes
after hospital discharge was tested using Cox regression models, adjusting for clinical
characteristics, echocardiographic findings and brain natriuretic peptide levels.
During follow up (1 year), 286 patients (46.6%) died and 84 were readmitted for ADHF (13.7%). Median RDW
was significantly higher among patients who died compared to patients who survived
(15.6% interquartile range [14.5 to 17.1] vs. 14.9% mg/L interquartile range [14.1
to 16.1], P<0.0001). Compared with patients in the 1st RDW quartile, the adjusted hazard ratio
[HR] for death or rehospitalization was 1.9 [95% CI 1.3–2.6] in patients in the 4th
quartile. Changes in RDW during hospitalization were strongly associated with changes
in mortality risk. Compared with patients with persistent normal RDW (<14.5%), the adjusted HR for mortality was 1.9 [95% CI 1.1–3.1] for patients in whom
RDW increased above 14.5% during hospital course, similar to patients with persistent
elevation of RDW (HR was 1.7, 95% CI 1.2–2.3).
Conclusion
In patients hospitalized with ADHF, RDW is a strong independent predictor of greater
morbidity and mortality. An increase in RDW during hospitalization also portends adverse
clinical outcome.
Keywords
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Article info
Publication history
Published online: May 04, 2012
Accepted:
April 8,
2012
Received in revised form:
March 29,
2012
Received:
September 17,
2011
Identification
Copyright
© 2012 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
