Red blood cell distribution width adds prognostic value for outpatients with chronic heart failure
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Juan C Bonaque1, Domingo A Pascual-Figal, Sergio Manzano-Fernández
1Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
Insights
Red cell distribution width is an independent prognostic marker in chronic heart failure patients. This measurement improves risk prediction for death and hospitalization, suggesting its inclusion in patient management.
Area of Science:
- Cardiology
- Hematology
- Clinical Biomarkers
Background:
- Red blood cell distribution width (RDW) is a recognized prognostic biomarker in cardiovascular diseases.
- The utility of RDW in risk stratification for chronic heart failure (CHF) patients remains to be fully established.
Purpose of the Study:
- To evaluate the prognostic value of RDW in predicting mortality and hospitalization for heart failure in outpatients with CHF.
- To determine if RDW improves existing risk stratification models.
Main Methods:
- A cohort of 698 outpatients with CHF was studied.
- RDW, clinical, biochemical, and echocardiographic data were collected. Patients were followed for a median of 2.5 years.
- Kaplan-Meier and ROC analyses were performed to assess RDW's predictive accuracy.
Main Results:
- Higher RDW quartiles were associated with increased risk of death and heart failure hospitalization (P<.001).
- An RDW of 15.4% was identified as an optimal cut-off for increased risk (HR=2.63 for death, HR=2.37 for hospitalization).
- RDW independently predicted outcomes and significantly improved risk prediction models (IDI 33%, NRI 10.3%).
Conclusions:
- RDW is an independent risk marker in outpatients with chronic heart failure.
- RDW provides significant additional prognostic information beyond traditional risk factors.
- Incorporating RDW measurement into the management of CHF patients is recommended.
Introduction And Objectives:
Red blood cell distribution width has emerged as a new prognostic biomarker in cardiovascular diseases. Its additional value in risk stratification of patients with chronic heart failure has not yet been established.
Methods:
A total of 698 consecutive outpatients with chronic heart failure were studied (median age 71 years [interquartile range, 62-77], 63% male, left ventricular ejection fraction 40 [14]%). On inclusion, the red cell distribution width was measured and clinical, biochemical, and echocardiographic variables were recorded. The median follow-up period was 2.5 years [interquartile range 1.2-3.7].
Results:
A total of 211 patients died and 206 required hospitalization for decompensated heart failure. Kaplan-Meier analysis showed an increase in the probability of death and hospitalization for heart failure with red cell distribution width quartiles (log rank, P<.001). A ROC analysis identified a red cell distribution width of 15.4% as the optimal cut-off point for a significantly higher risk of death (P<.001; hazard ratio=2.63; 95% confidence interval, 2.01-3.45) and hospitalization for heart failure (P<.001; hazard ratio=2.37; 95% confidence interval, 1.80-3.13). This predictive value was independent of other covariates, and regardless of the presence or not of anaemia. Importantly, the addition of red cell distribution width to the clinical risk model for the prediction of death or hospitalization for heart failure at 1 year had a significant integrated discrimination improvement of 33% (P<.001) and a net reclassification improvement of 10.3% (P=.001).
Conclusions:
Red cell distribution width is an independent risk marker and adds prognostic information in outpatients with chronic heart failure. These findings suggest that this biological measurement should be included in the management of these patients. Full English text available from:www.revespcardiol.org.