title: Validation and potential mechanisms of red cell distribution width as a prognostic marker in heart failure.
abstract: BACKGROUND
  Adverse outcomes have recently been linked to elevated red cell distribution width (RDW) in heart failure. Our study sought to validate the prognostic value of RDW in heart failure and to explore the potential mechanisms underlying this association.
  
  
  RESULTS
  Data from the Study of Anemia in a Heart Failure Population (STAMINA-HFP) registry, a prospective, multicenter cohort of ambulatory patients with heart failure supported multivariable modeling to assess relationships between RDW and outcomes. The association between RDW and iron metabolism, inflammation, and neurohormonal activation was studied in a separate cohort of heart failure patients from the United Investigators to Evaluate Heart Failure (UNITE-HF) Biomarker registry. RDW was independently predictive of outcome (for each 1% increase in RDW, hazard ratio for mortality 1.06, 95% CI 1.01-1.12; hazard ratio for hospitalization or mortality 1.06; 95% CI 1.02-1.10) after adjustment for other covariates. Increasing RDW correlated with decreasing hemoglobin, increasing interleukin-6, and impaired iron mobilization.
  
  
  CONCLUSIONS
  Our results confirm previous observations that RDW is a strong, independent predictor of adverse outcome in chronic heart failure and suggest elevated RDW may indicate inflammatory stress and impaired iron mobilization. These findings encourage further research into the relationship between heart failure and the hematologic system.
authors.affiliation: Division of Cardiology, University of Colorado-Denver, Aurora, CO, USA.
authors.forename: Larry A
authors.initials: LA
authors.lastname: Allen
authors.forename: G Michael
authors.initials: GM
authors.lastname: Felker
authors.forename: Mandeep R
authors.initials: MR
authors.lastname: Mehra
authors.forename: Jun R
authors.initials: JR
authors.lastname: Chiong
authors.forename: Stephanie H
authors.initials: SH
authors.lastname: Dunlap
authors.forename: Jalal K
authors.initials: JK
authors.lastname: Ghali
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Lenihan
authors.forename: Ron M
authors.initials: RM
authors.lastname: Oren
authors.forename: Lynne E
authors.initials: LE
authors.lastname: Wagoner
authors.forename: Todd A
authors.initials: TA
authors.lastname: Schwartz
authors.forename: Kirkwood F
authors.initials: KF
authors.lastname: Adams
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood*; D002423:Cause of Death; D015331:Cohort Studies; D004909:Erythrocyte Indices; D004912:Erythrocytes / Q000166:cytology*; D004920:Erythropoiesis / Q000502:physiology; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D016019:Survival Analysis
chemical_list: D015415:Biomarkers