title: Red blood cell distribution width is a predictor of readmission in cardiac patients.
abstract: BACKGROUND
  Three-quarters of rehospitalizations ($44 billion yearly estimated cost) may be avoidable. A screening tool for the detection of potential readmission may facilitate more efficient case management.
  
  
  OBJECTIVE
  An elevated red blood cell distribution width (RDW) is an independent predictor of hospital readmission in patients with unstable angina (UA) or non-ST-elevation myocardial infarction (NSTEMI).
  
  
  METHODS
  The study is a retrospective observational cohort analysis of adults admitted in 2007 with UA or NSTEMI. Data were gathered by review of inpatient medical records. The rate of 30-day nonelective readmission and time to nonelective readmission were recorded until November 1, 2011, and compared by RDW group using the 95th percentile (16.3%) as a cutoff.
  
  
  RESULTS
  The median follow-up time of the 503 subjects (average age, 65 ± 13 years; 56% male) was 3.8 years (interquartile range: 0.3-4.3 years). Those readmitted within 30 days were older, had more comorbidities and higher RDW and creatinine levels, and were more likely to have had an intervention. At 3.8 years of follow-up, subjects with high RDW (>16.3%) were more likely to be readmitted compared to those with normal RDW (≤16.3%) (72.28% vs 59.95%, P = 0.003). In multivariable analyses, high RDW was a statistically significant predictor of readmission in general (hazard ratio: 1.35 (95% confidence interval [CI]:1.02-1.79), P = 0.033) but not of 30-day rehospitalization (odds ratio: 1.34 (95% CI: 0.78-2.31), P = 0.292). Its area under the receiver operating characteristic curve was 0.54 (sensitivity 23% and specificity 85%).
  
  
  CONCLUSIONS
  An elevated RDW is an independent predictor of hospital readmission in patients with UA or NSTEMI.
authors.affiliation: Department of Cardiovascular Disease, Hofstra-North Shore-LIJ Health System, Manhasset, New York 11030, USA. g.ephrem@gmail.com
authors.forename: Georges
authors.initials: G
authors.lastname: Ephrem
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000097:blood* / Q000175:diagnosis / Q000628:therapy; D019540:Area Under Curve; D016009:Chi-Square Distribution; D004909:Erythrocyte Indices; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000628:therapy; D016017:Odds Ratio; D010359:Patient Readmission; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
references.citation: Int J Cardiol. 2010 May 28;141(2):141-6
references.pmid: 19144426
references.citation: J Am Coll Cardiol. 2009 Sep 1;54(10):908-10
references.pmid: 19712800
references.citation: Circulation. 2008 Sep 23;118(13):1394-7
references.pmid: 18725492
references.citation: J Hosp Med. 2011 Feb;6(2):54-60
references.pmid: 20945293
references.citation: Cardiology. 2012;123(3):135-41
references.pmid: 23095247
references.citation: J Card Fail. 2010 Mar;16(3):230-8
references.pmid: 20206898
references.citation: Am J Cardiol. 2010 Feb 1;105(3):312-7
references.pmid: 20102941
references.citation: Chest. 2009 Oct;136(4):1079-1085
references.pmid: 19395580
references.citation: Arch Intern Med. 2012 Jan 23;172(2):112-7
references.pmid: 22123752
references.citation: J Gen Intern Med. 2010 Mar;25(3):211-9
references.pmid: 20013068
references.citation: Circ Heart Fail. 2011 May;4(3):308-16
references.pmid: 21430286
references.citation: Clin Chem Lab Med. 2009;47(3):353-7
references.pmid: 19676148
references.citation: Am Heart J. 2011 Aug;162(2):254-261.e3
references.pmid: 21835285
references.citation: Med Care. 1999 May;37(5):490-501
references.pmid: 10335751
references.citation: Am J Clin Nutr. 1997 Jun;65(6):1714-20
references.pmid: 9174465
references.citation: JACC Cardiovasc Interv. 2011 May;4(5):569-76
references.pmid: 21596331
references.citation: Arch Intern Med. 2009 Mar 23;169(6):588-94
references.pmid: 19307522
references.citation: Am J Cardiol. 2001 Jun 15;87(12):1367-71
references.pmid: 11397355
references.citation: Am J Cardiol. 2009 Jan 1;103(1):17-21
references.pmid: 19101223
references.citation: Arch Cardiovasc Dis. 2010 Jun-Jul;103(6-7):363-75
references.pmid: 20800800
references.citation: Arch Intern Med. 2008 Jul 14;168(13):1416-22
references.pmid: 18625922
references.citation: J Gerontol A Biol Sci Med Sci. 2010 Mar;65(3):258-65
references.pmid: 19880817
references.citation: Circulation. 2008 Jan 15;117(2):163-168
references.pmid: 18172029
references.citation: QJM. 2011 Aug;104(8):639-51
references.pmid: 21558329
references.citation: JAMA. 2012 Jan 4;307(1):66-74
references.pmid: 22215167
references.citation: Circulation. 2011 Jul 19;124(3):289-96
references.pmid: 21709059
references.citation: J Hosp Med. 2011 Feb;6(2):61-7
references.pmid: 20945294
references.citation: Congest Heart Fail. 2009 Jul-Aug;15(4):170-5
references.pmid: 19627290
references.citation: Am J Cardiol. 2010 Oct 1;106(7):988-93
references.pmid: 20854962
references.citation: Thromb Haemost. 2009 Sep;102(3):581-7
references.pmid: 19718480
references.citation: Am J Cardiol. 2007 Oct 1;100(7):1139-44
references.pmid: 17884378
references.citation: Int J Cardiol. 2013 Apr 5;164(2):193-200
references.pmid: 21775001
references.citation: N Engl J Med. 2009 Apr 2;360(14):1418-28
references.pmid: 19339721