Red cell distribution width as a prognosticator in patients with heart failure

Area of Science:

• Cardiology
• Hematology

Background:

• Increased red cell distribution width (RDW) is recognized as a poor prognostic indicator in heart failure (HF).
• Limited large-scale studies have comprehensively evaluated the clinical utility of RDW after accounting for covariates that influence it.

Purpose of the Study:

• To investigate the prognostic value of RDW in patients diagnosed with heart failure.
• To determine if RDW provides incremental predictive value for mortality beyond established clinical risk factors and biomarkers.

Main Methods:

• Retrospective enrollment of 6599 heart failure patients from January 2010 to April 2021.
• Analysis using multivariable Cox regression and stabilized inverse probability of treatment weighting (IPTW) to assess the association between RDW and all-cause mortality.
• Evaluation of the incremental prognostic value of RDW by adding it to models with traditional risk factors, NT-proBNP, and echocardiographic parameters.

Main Results:

• Elevated RDW was significantly associated with poor prognosis (cumulative incidence: 30.2% vs. 11.2%).
• Multivariable analysis confirmed elevated RDW as an independent poor prognostic factor for all-cause mortality (HR 1.11), irrespective of NT-proBNP and ejection fraction (EF).
• RDW demonstrated incremental prognostic value when added to existing predictive models (AUC 0.799-0.826).

Conclusions:

• Increased RDW at diagnosis is a significant predictor of poor prognosis in heart failure patients.
• RDW offers prognostic information independent of clinical risk factors, NT-proBNP, and echocardiographic parameters.
• RDW may enhance the clinical management of heart failure patients by providing additional prognostic insights.