Platelet distribution width-a prognosis marker in patients with chronic heart failure
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Published on: July 10, 2017
Ana Neves1, Rita Gouveia1, Sérgio Madureira1
1Internal Medicine Department, Unidade Local de Saúde São João, Porto, Portugal.
Insights
High platelet distribution width (PDW) levels are associated with an increased risk of all-cause mortality in patients with chronic heart failure (HF). This finding suggests PDW can aid in risk stratification for chronic HF patients.
Area of Science:
- Cardiology
- Hematology
- Clinical Medicine
Background:
- Platelet distribution width (PDW) predicts adverse outcomes in acute myocardial infarction and acute heart failure (HF).
- The prognostic value of PDW in chronic HF remains largely unexplored.
Purpose of the Study:
- To investigate the association between PDW levels and all-cause mortality in patients with chronic HF.
Main Methods:
- Retrospective analysis of 766 outpatients with chronic HF and left ventricular systolic dysfunction (LVSD).
- Multivariable Cox regression was used to assess the relationship between PDW and mortality, adjusting for clinical factors and biomarkers.
- Exclusion criteria included missing PDW data or preserved/recovered ejection fraction.
Main Results:
- The median PDW was 13.5 fL. During a median follow-up of 49 months, 48.6% of patients died.
- Patients with PDW ≥ 14.3 fL had a 32% higher risk of all-cause death (HR: 1.32, 95% CI: 1.05-1.64) compared to those with lower PDW.
- This association remained significant after multivariate adjustment.
Conclusions:
- Elevated PDW (≥ 14.3 fL) is an independent predictor of mortality in chronic HF patients.
- PDW offers a practical, inexpensive, and accessible parameter for risk stratification in chronic HF.
- Clinicians can utilize PDW to better identify high-risk individuals within a chronic HF population.
Background:
Increased levels of platelet distribution width (PDW) can predict cardiac death and infarction recurrence in acute myocardial infarction. PDW appears to be a prognosis marker in acute heart failure (HF); however, its impact on chronic HF is still unknown. We investigated the impact of PDW on chronic HF.
Methods:
We retrospectively analyzed outpatients with chronic HF with left ventricular systolic dysfunction (LVSD) from January 2012 to May 2018. Patients with no data on PDW levels or with preserved or recovered ejection fraction were excluded. The primary end point was all-cause mortality. Multivariable Cox regression analysis was used to evaluate the association between PDW and mortality. A multivariate model was built adjusting for age, sex, comorbidities, brain-type natriuretic peptide, New York Heart Association (NYHA) class, evidence-based therapy, and severity of LVSD.
Results:
In our cohort of 766 patients, 65.7% were male, the mean age was 70 years, and 35.4% were in NYHA class I; 38.3% had diabetes mellitus, 51.4% had severe LVSD, and 3.9% had an inflammatory or autoimmune disease. The median (interquartile range) PDW was 13.5 (12.1-14.9) fL. During a median follow-up of 49 (30-79) months, 372 patients (48.6%) died. Patients with PDW ≥ 14.3 fL presented a multivariate-adjusted higher risk of all-cause death than those with lower values (hazard ratio: 1.32, 95% confidence interval [CI]: 1.05-1.64, P = .2).
Conclusions:
Patients with PDW ≥14.3 fL (upper tercile for PDW) presented a multivariate-adjusted 32% (95% CI: 5-64%) higher risk of all-cause death than those with lower values. PDW can help clinicians stratify patients with chronic HF; it is a practical, inexpensive, and widely available parameter.
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