Red cell distribution width as a novel prognostic marker in heart failure: data from the CHARM Program and the Duke Databank.
OBJECTIVE
The goal of this study was to identify potentially novel laboratory markers of risk in chronic heart failure patients.


BACKGROUND
Although a variety of prognostic markers have been described in heart failure, a systematic assessment of routine laboratory values has not been reported.


METHODS
All 2,679 symptomatic chronic heart failure patients from the North American CHARM (Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity) program had a wide range of laboratory measures performed at a core facility, enabling us to assess the relationship between routine blood tests and outcomes using a Cox proportional hazards model. We then replicated our findings in a cohort of 2,140 heart failure patients from the Duke Databank.


RESULTS
Among 36 laboratory values considered in the CHARM program, higher red cell distribution width (RDW) showed the greatest association with morbidity and mortality (adjusted hazard ratio 1.17 per 1-SD increase, p < 0.001). Higher RDW was among the most powerful overall predictors, with only age and cardiomegaly showing a better independent association with outcome. This finding was replicated in the Duke Databank, in which higher RDW was strongly associated with all-cause mortality (adjusted hazard ratio 1.29 per 1 SD, p < 0.001), second only to age as a predictor of outcome.


CONCLUSIONS
In 2 large contemporary heart failure populations, RDW was found to be a very strong independent predictor of morbidity and mortality. Understanding how and why this marker is associated with outcome may provide novel insights into heart failure pathophysiology.
Felker
G Michael
GM
Duke Clinical Research Institute, Durham, North Carolina, USA. michael.felker@duke.edu
Allen
Larry A
LA
Pocock
Stuart J
SJ
Shaw
Linda K
LK
McMurray
John J V
JJ
Pfeffer
Marc A
MA
Swedberg
Karl
K
Wang
Duolao
D
Yusuf
Salim
S
Michelson
Eric L
EL
Granger
Christopher B
CB
D000368:Aged; D001562:Benzimidazoles / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D001713:Biphenyl Compounds; D002423:Cause of Death; D015331:Cohort Studies; D019992:Databases as Topic; D018450:Disease Progression; D004912:Erythrocytes / Q000166:cytology*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016019:Survival Analysis; D013777:Tetrazoles / Q000627:therapeutic use*
D001562:Benzimidazoles; D015415:Biomarkers; D001713:Biphenyl Compounds; D013777:Tetrazoles; C081643:candesartan