title: Red blood cell distribution width predicts long-term outcome regardless of anaemia status in acute heart failure patients.
abstract: OBJECTIVE
  To study the long-term prognostic value of red blood cell distribution width (RDW) in patients hospitalized with acute heart failure (AHF) and to compare the value of this measurement with haemoglobin levels and anaemia status.
  
  
  RESULTS
  During a 2-year period, we studied 628 consecutive patients (aged 71 years [interquartile range, IQR: 61-77], 68% male) hospitalized with AHF. Demographic, clinical, echocardiographic, and laboratory characteristics were registered at discharge and patients were closely followed-up for 38.1 months [16.5-49.1]. Median RDW was 14.4% [13.5-15.5] and was higher among decedents (15.0% [13.8-16.1] vs. 14.2 [13.3-15.3], P < 0.001). After adjustment for other prognostic factors in a multivariable Cox proportional-hazards model, RDW remained a significant predictor (P = 0.004, HR 1.072, 95% CI 1.023-1.124); whereas, haemoglobin or anaemia status did not add prognostic information. RDW levels above the median were associated with a significantly lower survival rate on long-term follow-up (log rank <0.001). These levels were predictive of death in anaemic patients (n = 263, P = 0.029) and especially in non-anaemic patients (n = 365) (P < 0.001, HR 1.287, 95% CI 1.147-1.445), even after adjustment in the multivariable model.
  
  
  CONCLUSIONS
  Higher RDW levels at discharge were associated with a worse long-term outcome, regardless of haemoglobin levels and anaemia status.
authors.affiliation: Heart Failure Unit, Cardiology Department, Virgen de la Arrixaca Hospital, School of Medicine, University of Murcia, Murcia, Spain. dapascual@servicam.com
authors.forename: Domingo A
authors.initials: DA
authors.lastname: Pascual-Figal
authors.forename: Juan C
authors.initials: JC
authors.lastname: Bonaque
authors.forename: Belen
authors.initials: B
authors.lastname: Redondo
authors.forename: Cesar
authors.initials: C
authors.lastname: Caro
authors.forename: Sergio
authors.initials: S
authors.lastname: Manzano-Fernandez
authors.forename: Jesús
authors.initials: J
authors.lastname: Sánchez-Mas
authors.forename: Iris P
authors.initials: IP
authors.lastname: Garrido
authors.forename: Mariano
authors.initials: M
authors.lastname: Valdes
mesh_terms: D000208:Acute Disease; D000740:Anemia; D016001:Confidence Intervals; D004912:Erythrocytes; D005260:Female; D006304:Health Status; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015233:Models, Statistical; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography