| Objective: To explore the prognostic value of red blood cell distribution width(RDW)in patients with heart failure of mid-range ejection fraction(HFmrEF).Methods: A total of 138 patients with HFmrEF(LVEF40-49%)who were hospitalized in the first affiliated Hospital of Guangxi Medical University from January 2017 to January 2019 were collected.The patients were followed up by telephone from 6 months to 12 months after discharge,of which 121 cases completed follow-up and 17 cases lost follow-up.According to the prognosis,the patients were divided into poor prognosis group(55 cases died of recurrence of acute heart failure or re-admission of acute heart failure)and good prognosis group(66 cases without adverse events).SPSS22.0 software was used for statistical analysis.The group with good prognosis was compared with the group with poor prognosis.The measurement data in accordance with normal distribution were analyzed by independent sample T test and expressed as mean ±standard deviation((?) ± S).The measurement data that do not conform to the normal distribution are analyzed by Mann-Whitney rank sum test and expressed by quartile spacing.The counting data were analyzed by chi-square test and expressed as a percentage.The collected data were analyzed by univariate analysis,and the data with statistical significance in univariate analysis were included in binary Logistic regression analysis.Then all the candidate predictors related to the prognosis of heart failure in binary Logistic regression analysis were included in binary Logistic regression analysis.The data with statistical significance in binary Logistic regression analysis were analyzed by analysis of receiver’s working characteristic curve(ROC),and the cutoff value,corresponding sensitivity and specificity were derived,and the predictive value of RDW in the prognosis of heart failure was analyzed.Results:(1)General data: There was no significant difference in sex,age,BMI,smoking,drinking history,atrial fibrillation,hypertension,diabetes,chronic obstructive pulmonary disease(COPD),hyperlipidemia,myocardial infarction,antiplatelet drugs,aldosterone receptor antagonists,loop diuretics and β-receptor blockers between the two groups in terms of sex,age,BMI,smoking,drinking history,atrial fibrillation,hypertension,diabetes,chronic obstructive pulmonary disease,hyperlipidemia,myocardial infarction,antiplatelet drugs,aldosterone receptor antagonists,loop diuretics and β-blockers.The patients with good prognosis and poor prognosis used ACEI/ARB/ARNI in 56 cases(84.85%)and 37 cases(67.27%),respectively.The difference was statistically significant(P=0.022<0.05),that is,the use of ACEI/ARB/ARNI was a factor affecting the prognosis of heart failure.(2)Laboratory examination: There was no significant difference in total cholesterol,triglyceride,hemoglobin,white blood cell count,platelet count,serum creatinine(Scr),troponin I,alanine aminotransferase(ALT),platelet distribution width(PDW),creatine kinase(CK)and creatine kinase isoenzyme MB(CKMB)between the two groups.There were significant differences in RDW(P=0.007<0.05),N terminal pro B type natriuretic peptide(NT-proBNP)(P<0.001<0.05),C-reactive protein(CRP)(P=0.023<0.05),lactate dehydrogenase(LD)(P=0.015<0.05),cystatin C(Cys C)(P=0.002<0.05)between the two groups,and those in the poor prognosis group were significantly higher than those in the good prognosis group.(3)The results of binary Logistic regression analysis showed that:RDW(OR=1.301,95% CI1.064,P=0.006<0.05)、 Cys C(OR=0.018,95%CI 1.085--2.419,P=0.018<0.05)、CRP(OR=0.045,95%CI 1.000--1.029,P=0.045<0.05)、NT-proBNP(OR=1.102,95%CI 1.042--1.164,P=0.001<0.05)、LD(OR=1.002,95%CI 1.000--1.004,P=0.041<0.05)、ACEI/ARB/ARNI(OR=0.367,95%CI0.153--0.883,P=0.025<0.05).The results were statistically significan and the results were significantly higher than those of the control group.All the data that were statistically significant by binary Logistic regression analysis were included in binary Logistic regression analysis.The results showed that: RDW(OR=1.450,95%CI 1.111--1.839,P=0.006<0.05),NT-proBNP(OR=1.450,95%CI 1.111--1.839,P=0.006<0.05).RDW and NT-proBNP are independent risk factors for the prognosis of HFmrEF.The ROC curve of the working characteristics of RDW subjects showed that RDW had predictive value for the prognosis of HFmrEF(P = 0.048 < 0.05).The AUC predicted by RDW is 0.605,and the best truncation value is taken when the Jordan index reaches its maximum.The best truncation value is 13.5,the sensitivity is 45.5%,and the specificity is 70.9%.The results of ROC curve of working characteristics of NT-proBNP subjects showed that NT-proBNP had predictive value for the prognosis of HFmrEF(P < 0.001).The AUC predicted by NT-proBNP was 0.734,the best cutoff value was 4.2845,the sensitivity was 72.7%,and the specificity was 68.7%.Conclusion:RDW,Cys C,CRP,NT-proBNP,LD and use of ACEI/ARB/ARNI are associated with poor prognosis of heart failure.NT-proBNP and RDW are independent risk factors affecting HFmrEF and have certain predictive value for the prognosis of HFmrEF. |
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