title: Red cell distribution width predicts short- and long-term outcomes of acute congestive heart failure more effectively than hemoglobin.
abstract: The present study compared short- and long-term prognostic values of red blood cell distribution width (RDW) with those of hemoglobin (Hgb) among patients with acute congestive heart failure (CHF) in a cardiac care unit. The cross-sectional study examined data from 521 patients with acute CHF who were admitted to a cardiac care unit and followed up for 24 months (median). Mean Hgb levels in patients who succumbed (DIH) or remained alive (AIH) were 11.0±1.8 and 11.8±2.6 g/l (P>0.05), respectively. Median values of RDW were 16.2% and 14.4%, respectively (P<0.0001). During the 24-month follow-up, mean levels of Hgb in groups with and without endpoints were 11.4±2.5 and 12.5±2.4 g/dl (P<0.0001), respectively. Median RDW values were 14.9 and 13.8%, respectively (P<0.0001). Logistic regression analysis showed that in-hospital mortality was significantly associated with RDW (P=0.044), New York Heart Association (NYHA) functional class IV (P=0.0037), estimated glomerular filtration rate (eGFR) (P=0.042) and C-reactive protein (P=0.0044), but not with Hgb (P=0.10). The multivariate Cox proportional hazard model selected RDW [hazard ratio (HR), 2.19; P<0.0001], left ventricular ejection fraction (HR 0.81, P=0.0016), age (10-year increase; HR 1.19, P=0.0017) and NYHA functional classes III/IV (HR 1.52, P=0.0029) as independent predictors of long-term outcomes after adjustment, but not Hgb (HR 1.01, P=0.86). Higher RDW values in acute CHF patients at admission were associated with worse short- and long-term outcomes and RDW values were more prognostically relevant than Hgb levels.
authors.affiliation: Department of Cardiology, Juntendo University School of Medicine, Tokyo 113-8421, Japan ; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China.
authors.forename: Yuxiang
authors.initials: Y
authors.lastname: Dai
authors.affiliation: Department of Cardiology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
authors.forename: Hakuoh
authors.initials: H
authors.lastname: Konishi
authors.affiliation: Department of Cardiology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
authors.forename: Atsutoshi
authors.initials: A
authors.lastname: Takagi
authors.affiliation: Department of Cardiology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
authors.forename: Katsumi
authors.initials: K
authors.lastname: Miyauchi
authors.affiliation: Department of Cardiology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Daida
keywords: anemia; biomarker; heart failure; prognosis; red blood cell distribution width