title: Red blood cell distribution width and 1-year mortality in acute heart failure.
abstract: OBJECTIVE
  Red blood cell distribution width (RDW) predicts mortality in chronic heart failure (HF) and stable coronary artery disease. The prognostic value of RDW in more acute settings such as acute HF, and its relative prognostic value compared with more established measures such as N-terminal pro-brain natriuretic peptide (NT-proBNP), remains unknown.
  
  
  RESULTS
  In a cohort of 205 patients with acute HF, independent predictors of RDW were identified using linear regression analysis. The association between RDW and 1-year survival in the context of other predictors was assessed using Cox's proportional hazards analysis. Red blood cell distribution width was elevated in 67 (32.7%) patients; RDW was independently associated with haematological variables such as haemoglobin (P < 0.001) as well as the use of loop diuretics (P = 0.006) and beta-blockers (P = 0.015) on presentation, but not with nutritional deficiencies, recent transfusion, or inflammatory variables. Log-transformed RDW values independently predicted mortality in multivariable Cox's proportional hazards analysis (hazards ratio, 1.03; 95% confidence interval, 1.00-1.06; P = 0.04); when stratified on the basis of RDW and NT-proBNP status, the combination provided additional prognostic information.
  
  
  CONCLUSIONS
  Red blood cell distribution width is frequently elevated among patients with acute HF and does not appear to be associated with nutritional status, transfusion history, or inflammation. Red blood cell distribution width independently predicts 1-year mortality in acute HF. The value of RDW appears additive to other established prognostic variables such as NT-proBNP.
authors.affiliation: Cardiology Division and Department of Medicine, Massachusetts General Hospital, Yawkey 5984, 55 Fruit Street, Boston, MA 02114, USA.
authors.forename: Roland R J
authors.initials: RR
authors.lastname: van Kimmenade
authors.forename: Asim A
authors.initials: AA
authors.lastname: Mohammed
authors.forename: Shanmugam
authors.initials: S
authors.lastname: Uthamalingam
authors.forename: Peter
authors.initials: P
authors.lastname: van der Meer
authors.forename: G Michael
authors.initials: GM
authors.lastname: Felker
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000740:Anemia / Q000175:diagnosis* / Q000209:etiology; D048429:Cell Size; D015331:Cohort Studies; D004912:Erythrocytes / Q000166:cytology*; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D006454:Hemoglobins; D006801:Humans; D016014:Linear Models; D008297:Male; D008404:Massachusetts; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain; D010446:Peptide Fragments; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D000319:Adrenergic beta-Antagonists; D006454:Hemoglobins; D010446:Peptide Fragments; D049994:Sodium Potassium Chloride Symporter Inhibitors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain