The Prognostic Value Of Red Blood Cell Distribution Width In Patients With Heart Failure

Objective: The objective of this study was to investigate the relationship between red blood cell distribution width (RDW) and the cardiac function in patients with chronic heart failure and to evalute the prognostic value of RDW in patients with chronic heart failure. Method: 248 cases of patients with chronic heart failure and 105 patients without chronic heart failure patients were consecutively selected from the hospitalized patients from March 2005 to September 2008. Analysis of the relationship between RDW and New York Heart Association (NYHA ) cardiac function classification series, left ventricular ejection fraction (LVEF),amino-terminal B-type natriuretic peptide(NT-proBNP),Hb and eGFR. Follow-up of 21.6 (1 -54) months to observe the end point including all-cause mortality and re-hospitalization due to worsening heart failure. Analysis of the relationship between RDW and different outcomes. Draw and compared the event-free survival curves using Kaplan-Meier survival analysis. The event was entered as a variable, censored follow-up time or event time for the survival time variable.We used COX stepwise regression analysis with gender, age, NYHA class, Hb, RDW, LVEF, eGFR were entered as variables . Results:(1) RDW in heart failure group were significantly higher than in control group (14.92±1.90% vs 12.81±0.73%, P <0.001), and RDW increased significantly with NYHA class elevated (P all <0.001); (2) RDW in LVEF> 40% sub-group was significantly lower than LVEF≤40% sub-group (13.51±0.91% vs 15.43±1.92%, P <0.001) but significantly higher than control group (13.51±0.91% vs12.79±0.68%, P <0.001); RDW between LVEF was significantly negatively correlated, (r =- 0.4505, P <0.001); (3) RDW between log (NT-proBNP) was significant positive correlation in heart failure group (r = 0.4868, P <0.001); (4) RDW in death group and in re-hospitalization group were significantly higher than in survival group without events(16.86±2.55%,15.18±1.91% vs14.29±1.45% , P all <0.001), and RDW in death group was significantly higher than in re-hospitalization group (16.86±2.55% vs15.18±1.91%,P <0.005); The survival curve showed that survival time in sub-group of RDW≥16% was significantly lower than in other sub-groups (P <0.001); COX regression analysis showed that NYHA class, LVEF, eGFR, and RDW are to be the independent predictors of end events in patients with heart failure,(P = 0.015, 0.040,0.000 and 0.000). (5) RDW between Hb was no correlation in heart failure group (P> 0.05), and RDW between eGFR was significantly negative correlation (r = -0.280 , P <0.001), and eGFR remain a negative correlation even after adjusted for LVEF, NYHA class, NT-proBNP and RDW .(r = -0.149, P = 0.019).Conclusion:In this study, We observed that elevated RDW is correlated with the severity in patients with heart failure. Furthermore ,RDW have some value on the prognosis of patients with chronic heart failure and RDW is an independent predictor of events for death and re-hospitalization.