title: Predictive impact on medium-term mortality of hematological parameters in Acute Coronary Syndromes: added value on top of GRACE risk score.
abstract: BACKGROUND
  Red Cell Distribution Width (RDW) prognostic value in patients with Acute Coronary Syndrome (ACS) has been well validated whereas that of Platelet Distribution Width (PDW) is less well known.
  
  
  OBJECTIVE
  Investigate the incremental prognostic value, on top of GRACE risk score, of a new variable resulting from the combination of RDW and PDW.
  
  
  METHODS
  Consecutive patients with ACS. Complete blood count, with RDW and PDW, was obtained. Primary endpoint was one-year all-cause mortality and Cox regression models were used to measure the influence of RDW and PDW on patients' survival time. A new combination categorical variable (RDW/PDW) was created with both discretized RDW and PDW and logistic regression models were used. Predictive value and discriminative ability of the model with GRACE risk score alone and of the model with inclusion of RDW/PDW was assessed.
  
  
  RESULTS
  We included 787 patients. Hospital and one-year mortality rates were 5.1% and 7.8%, respectively. Both continuous RDW and PDW were independent predictors of death. The best cut-off for RDW was 13.9%, and 14.5% for PDW. Inclusion of RDW/PDW in a model with GRACE risk score improved the AUC from 0.81 (95% CI 0.75-0.86) to 0.84 (95% CI 0.79-0.90) (p=0.024) with an improvement in total NRI (56%) and IDI (0.048).
  
  
  CONCLUSIONS
  Simple markers such as RDW and PDW can be useful in risk stratification of death after ACS. Combining both markers with GRACE risk score improved the predictive value for all-cause mortality and reduced the estimated risk of those who did not die.
authors.affiliation: Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Portugal ana_timoteo@yahoo.com.
authors.forename: Ana T
authors.initials: AT
authors.lastname: Timóteo
authors.affiliation: CEAUL, Biostatistics Department, Medical Sciences Faculty, New University of Lisbon, Portugal Epidemiology and Statistics Unit, Reserch Centre, Centro Hospitalar Lisboa Central, Portugal.
authors.forename: Ana L
authors.initials: AL
authors.lastname: Papoila
authors.affiliation: Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Lousinha
authors.affiliation: Epidemiology and Statistics Unit, Reserch Centre, Centro Hospitalar Lisboa Central, Portugal.
authors.forename: Marta
authors.initials: M
authors.lastname: Alves
authors.affiliation: Clinical Pathology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Portugal.
authors.forename: Fernando
authors.initials: F
authors.lastname: Miranda
authors.affiliation: Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Portugal.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Ferreira
authors.affiliation: Cardiology Department, Santa Marta Hospital, Centro Hospitalar Lisboa Central, Portugal.
authors.forename: Rui C
authors.initials: RC
authors.lastname: Ferreira
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis* / Q000401:mortality*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001772:Blood Cell Count / Q000379:methods; D015331:Cohort Studies; D004909:Erythrocyte Indices; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008432:Mathematical Computing; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000401:mortality*; D010976:Platelet Count; D011174:Portugal / Q000453:epidemiology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers
keywords: Acute coronary syndromes; GRACE risk score; platelet distribution width; prognosis; red blood cell distribution width