title: Enlarging Red Blood Cell Distribution Width During Hospitalization Identifies a Very High-Risk Subset of Acutely Decompensated Heart Failure Patients and Adds Valuable Prognostic Information on Top of Hemoconcentration.
abstract: Red blood cell distribution width (RDW) may serve as an integrative marker of pathological processes that portend worse prognosis in heart failure (HF). The prognostic value of RDW variation (ΔRDW) during hospitalization for acute heart failure (AHF) has yet to be studied.We retrospectively analyzed 2 independent cohorts: Centro Hospitalar do Porto (derivation cohort) and Lariboisière hospital (validation cohort). In the derivation cohort a total of 170 patients (age 76.2 ± 10.3 years) were included and in the validation cohort 332 patients were included (age 76.4 ± 12.2 years). In the derivation cohort the primary composite outcome of HF admission and/or cardiovascular death occurred in 78 (45.9%) patients during the 180-day follow-up period.Discharge RDW and ΔRDW were both increased when hemoglobin levels were lower; peripheral edema was also associated with increased discharge RDW (all P < 0.05). Discharge RDW value was significantly associated with adverse events: RDW > 15% at discharge was associated with a 2-fold increase in event rate, HR = 1.95 (1.05-3.62), P = 0.04, while a ΔRDW >0 also had a strong association with outcome, HR = 2.47 (1.35-4.51), P = 0.003. The addition of both discharge RDW > 15% and ΔRDW > 0 to hemoconcentration was associated with a significant improvement in the net reclassification index, NRI = 18.3 (4.3-43.7), P = 0.012. Overlapping results were found in the validation cohort.As validated in 2 independent AHF cohorts, an in-hospital RDW enlargement and an elevated RDW at discharge are associated with increased rates of mid-term events. RDW variables improve the risk stratification of these patients on top of well-established prognostic markers.
authors.affiliation: From the INSERM, Centre d'Investigations Cliniques Plurithématique 1433, INSERMU1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, Nancy, France (JPF, NG, FZ, PR); Department of Physiology and Cardiothoracic Surgery, Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal (JPF); INSERM UMR-S 942, APHP Lariboisière University Hospital, F-CRIN INI-CRCT, Paris, France (MA, AR, HT, SL, EG, AM); Internal Medicine Department, Centro Hospitalar do Porto, Porto, Portugal (PBM, MBR, TA); Department of Anesthesiology and Critical Care Medicine, Saint Louis Lariboisière University Hospital, Assistance Publique - Hôpitaux de Paris; Université Paris Diderot, Paris, France (EG, AM); Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland (CM); and Department of Cardiology, University Hospital, Basel, Switzerland; Intensive Care Unit, Centro Hospitalar do Porto, Porto, Portugal (IA).
authors.forename: João Pedro
authors.initials: JP
authors.lastname: Ferreira
authors.forename: Nicolas
authors.initials: N
authors.lastname: Girerd
authors.forename: Mattia
authors.initials: M
authors.lastname: Arrigo
authors.forename: Pedro Bettencourt
authors.initials: PB
authors.lastname: Medeiros
authors.forename: Miguel Bento
authors.initials: MB
authors.lastname: Ricardo
authors.forename: Tiago
authors.initials: T
authors.lastname: Almeida
authors.forename: Alexandre
authors.initials: A
authors.lastname: Rola
authors.forename: Heli
authors.initials: H
authors.lastname: Tolpannen
authors.forename: Said
authors.initials: S
authors.lastname: Laribi
authors.forename: Etienne
authors.initials: E
authors.lastname: Gayat
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
authors.forename: Patrick
authors.initials: P
authors.lastname: Rossignol
authors.forename: Irene
authors.initials: I
authors.lastname: Aragão
mesh_terms: D000208:Acute Disease; D000368:Aged; D015331:Cohort Studies; D004906:Erythrocyte Count; D004909:Erythrocyte Indices; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood*; D006760:Hospitalization; D006801:Humans; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment