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Butt JH, McDowell K, Kondo T, Desai AS, Lefkowitz MP, Packer M, Petrie MC, Pfeffer MA, Rouleau JL, Vaduganathan M, Zile MR, Jhund PS, Køber L, Solomon S, McMurray JJ. Heart failure with preserved ejection fraction, red cell distribution width, and sacubitril/valsartan. ESC Heart Fail 2024; 11:65-77. [PMID: 37813587 PMCID: PMC10804200 DOI: 10.1002/ehf2.14558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/12/2023] [Accepted: 09/21/2023] [Indexed: 10/17/2023] Open
Abstract
AIMS Red cell distribution width (RDW) is a strong prognostic marker in patients with heart failure (HF) and reduced ejection fraction and other conditions. However, very little is known about its prognostic significance in HF with preserved ejection fraction. We examined the relationship between RDW and outcomes and the effect of sacubitril/valsartan, compared with valsartan, on RDW and clinical outcomes in PARAGON-HF. METHODS AND RESULTS PARAGON-HF enrolled patients with a left ventricular ejection fraction of ≥45%, structural heart disease, and elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP). The primary endpoint was a composite of total HF hospitalizations and cardiovascular deaths. Median RDW at randomization was 14.1% (interquartile range 13.5-15.0%). Patients with higher RDW levels were more often men and had more comorbidity, a higher heart rate and NT-proBNP concentration, more advanced New York Heart Association class, and worse Kansas City Cardiomyopathy Questionnaire scores. There was a graded relationship between quartiles of RDW at randomization and the primary endpoint, with a significantly higher risk associated with increasing RDW, even after adjustment for NT-proBNP and other prognostic variables {Quartile 1, reference; Quartile 2, rate ratio 1.03 [95% confidence interval (CI) 0.83 to 1.28]; Quartile 3, 1.25 [1.01 to 1.54]; Quartile 4, 1.70 [1.39 to 2.08]}. This association was seen for each of the secondary outcomes, including cardiovascular and all-cause death. Compared with valsartan, sacubitril/valsartan reduced RDW at 48 weeks [mean change -0.09 (95% CI -0.15 to -0.02)]. The effect of sacubitril/valsartan vs. valsartan was not significantly modified by RDW levels at randomization. CONCLUSIONS RDW, a routinely available and inexpensive biomarker, provides incremental prognostic information when added to established predictors. Compared with valsartan, sacubitril/valsartan led to a small reduction in RDW.
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Affiliation(s)
- Jawad H. Butt
- British Heart Foundation Cardiovascular Research CentreUniversity of Glasgow126 University PlaceGlasgowG12 8TAUK
- Department of CardiologyRigshospitalet Copenhagen University HospitalCopenhagenDenmark
| | - Kirsty McDowell
- British Heart Foundation Cardiovascular Research CentreUniversity of Glasgow126 University PlaceGlasgowG12 8TAUK
| | - Toru Kondo
- British Heart Foundation Cardiovascular Research CentreUniversity of Glasgow126 University PlaceGlasgowG12 8TAUK
| | - Akshay S. Desai
- Cardiovascular DivisionBrigham and Women's HospitalBostonMAUSA
| | | | - Milton Packer
- Baylor Heart and Vascular InstituteBaylor University Medical CenterDallasTXUSA
| | - Mark C. Petrie
- British Heart Foundation Cardiovascular Research CentreUniversity of Glasgow126 University PlaceGlasgowG12 8TAUK
| | - Marc A. Pfeffer
- Cardiovascular DivisionBrigham and Women's HospitalBostonMAUSA
| | - Jean L. Rouleau
- Institut de Cardiologie de MontréalUniversité de MontréalMontrealQCCanada
| | | | - Michael R. Zile
- Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical CenterCharlestonSCUSA
| | - Pardeep S. Jhund
- British Heart Foundation Cardiovascular Research CentreUniversity of Glasgow126 University PlaceGlasgowG12 8TAUK
| | - Lars Køber
- Department of CardiologyRigshospitalet Copenhagen University HospitalCopenhagenDenmark
| | - Scott Solomon
- Cardiovascular DivisionBrigham and Women's HospitalBostonMAUSA
| | - John J.V. McMurray
- British Heart Foundation Cardiovascular Research CentreUniversity of Glasgow126 University PlaceGlasgowG12 8TAUK
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Zhong L, Zhang Z, Ji X, Wang H, Xie B, Yang X. Relationship between initial red cell distribution width and ΔRDW and mortality in cardiac arrest patients. ESC Heart Fail 2024; 11:433-443. [PMID: 38030411 PMCID: PMC10804170 DOI: 10.1002/ehf2.14602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/22/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
AIMS There has been a lack of research examining the relationship between red cell distribution width (RDW) and the prognosis of cardiac arrest (CA) patients. The prognostic value of the changes in RDW during intensive care unit (ICU) hospitalization for CA patients has not been investigated. This study aims to investigate the correlation between RDW measures at ICU admission and RDW changes during ICU hospitalization and the prognosis of CA patients and then develop a nomogram that predicts the risk of mortality of these patients. METHODS AND RESULTS A retrospective cohort study is used to collect clinical characteristics of CA patients (>18 years) that are on their first admission to ICU with RDW data measured from the Medical Information Mart for Intensive Care IV Version 2.0 database. Patients are randomly divided into a development cohort (75%) and a validation cohort (25%). The primary outcome is 30 and 360 day all-cause mortality. ΔRDW is defined as the RDW on ICU discharge minus RDW on ICU admission. A multivariate Cox regression model is applied to test whether the RDW represents an independent risk factor that affects the all-cause mortality of these patients. Meanwhile, the dose-response relationship between the RDW and the mortality is described by restricted cubic spine (RCS). A prediction model is constructed using a nomogram, which is then assessed using receiver operating characteristic curves, calibration curves, and decision curve analysis (DCA). A total of 1278 adult CA patients are included in this study. We found that non-survivors have a higher level of RDW and ΔRDW compared with survivors, and the mortality rate is higher in the high RDW group than in the normal RDW group. The Kaplan-Meier survival curve indicates that patients in the normal RDW group had a higher cumulative survival rate at 30 and 360 days than those in the high RDW group (log-rank test, χ2 = 36.710, χ2 = 54.960, both P values <0.05). The multivariate Cox regression analysis shows that elevated RDW at ICU admission (>15.50%) is an independent predictor of 30 [hazard ratio = 1.451, 95% confidence interval (CI) = 1.181-1.782, P < 0.001] and 360 day (hazard ratio = 1.393, 95% CI = 1.160-1.671, P < 0.001) all-cause mortality among CA patients, and an increase in RDW during ICU hospitalization (ΔRDW ≥ 0.4%) can serve as an independent predictor of mortality among these patients. A non-linear relationship between the RDW measured at ICU admission and the increased risk of mortality rate of these patients is shown by the RCS. This study established and validated a nomogram based on six variables, anion gap, first-day Sequential Organ Failure Assessment score, cerebrovascular disease, malignant tumour, norepinephrine use, and RDW, to predict mortality risk in CA patients. The consistency indices of 30 and 360 day mortality of CA patients in the validation cohort are 0.721 and 0.725, respectively. The nomogram proved to be well calibrated in the validation cohort. DCA curves indicated that the nomogram provided a higher net benefit over a wide, reasonable range of threshold probabilities for predicting mortality in CA patients and could be adapted for clinical decision-making. CONCLUSIONS Elevated RDW levels on ICU admission and rising RDW during ICU hospitalization are powerful predictors of all-cause mortality for CA patients at 30 and 360 days, and they can be used as potential clinical biomarkers to predict the bad prognosis of these patients. The newly developed nomogram, which includes RDW, demonstrates high efficacy in predicting the mortality of CA patients.
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Affiliation(s)
- Lei Zhong
- Department of Intensive Care UnitHuzhou Central Hospital (The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University), Affiliated Central Hospital of Huzhou UniversityHuzhouZhejiangChina
- Emergency and Critical Care Center, Intensive Care UnitZhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical CollegeHangzhouZhejiangChina
| | - Zeng‐Yu Zhang
- The Second School of Clinical MedicineZhejiang Chinese Medical UniversityHangzhouZhejiangChina
| | - Xiao‐Wei Ji
- Department of Intensive Care UnitHuzhou Central Hospital (The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University), Affiliated Central Hospital of Huzhou UniversityHuzhouZhejiangChina
| | - Hai‐Li Wang
- Department of Obstetrics and GynecologyHuzhou Central Hospital (The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University), Affiliated Central Hospital of Huzhou UniversityHuzhouZhejiangChina
| | - Bo Xie
- Department of Intensive Care UnitHuzhou Central Hospital (The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University), Affiliated Central Hospital of Huzhou UniversityHuzhouZhejiangChina
| | - Xiang‐Hong Yang
- Emergency and Critical Care Center, Intensive Care UnitZhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical CollegeHangzhouZhejiangChina
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Elbayiyev S, Şimşek GK, Ceran B, Akın MŞ, Kanmaz Kutman HG, Canpolat FE. Could red cell distribution width be used for predicting cardiac injury in neonates with COVID-19? J Med Virol 2022; 94:5739-5745. [PMID: 35938314 PMCID: PMC9538182 DOI: 10.1002/jmv.28050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) can affect people of all age groups and it can occasionally cause life-threatening clinical illnesses in immunologically immature populations, especially in newborns. High red cell distribution width (RDW) values were used as an early prognostic biomarker of some neonatal diseases. We aimed to determine the prognostic value of RDW in severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infected neonates. METHODS Newborns with positive SARS-CoV-2 polymerase chain reaction (PCR) test from a nasopharyngeal swab sample, who had refractory fever (>38°C and lasting more than 24 h during hospitalization), were screened for multisystem inflammatory syndrome in newborns (MIS-N), systemic inflammatory indexes calculated and cardiologic evaluations. Due to troponin levels (high: >45 ng/L and low: ≤45 ng/L) patients were grouped. RESULTS Out of the 68 SARS-CoV-2 PCR-positive newborns, 26 patients had refractory fever. Comparison of laboratory findings between the high and low-troponin groups showed that RDW and neutrophil/lymphocyte ratio values were significantly higher in patients with high troponin levels (p = 0.022 and p = 0.030, respectively). The cut-off values with optimal sensitivity and specificity were determined as 1.00 for neutrophil/lymphocyte ratio (p = 0.205) and 16.6 for RDW (p = 0.014). None of the patients died. CONCLUSIONS Neonatal COVID-19 generally has a benign prognosis, but can progress to severe disease and cases of MIS-N are rare. RDW could be prognostic in the diagnosis and management of neonates with SARS-CoV-2 infection with high troponin levels.
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Affiliation(s)
- Sarkhan Elbayiyev
- Department of NeonatologyAnkara City Hospital University of Health SciencesAnkaraBilkentTurkey
| | - Gülsüm K. Şimşek
- Department of NeonatologyAnkara City Hospital University of Health SciencesAnkaraBilkentTurkey
| | - Burak Ceran
- Department of NeonatologyAnkara City Hospital University of Health SciencesAnkaraBilkentTurkey
| | - Mustafa Ş. Akın
- Department of NeonatologyAnkara City Hospital University of Health SciencesAnkaraBilkentTurkey
| | - H. Gözde Kanmaz Kutman
- Department of NeonatologyAnkara City Hospital University of Health SciencesAnkaraBilkentTurkey
| | - Fuat E. Canpolat
- Department of NeonatologyAnkara City Hospital University of Health SciencesAnkaraBilkentTurkey
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Deng X, Gao B, Wang F, Zhao MH, Wang J, Zhang L. Red Blood Cell Distribution Width Is Associated With Adverse Kidney Outcomes in Patients With Chronic Kidney Disease. Front Med (Lausanne) 2022; 9:877220. [PMID: 35755057 PMCID: PMC9218182 DOI: 10.3389/fmed.2022.877220] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/09/2022] [Indexed: 12/08/2022] Open
Abstract
Background Chronic kidney disease (CKD) is a global public health issue. Red blood cell distribution width (RDW) is a recently recognized potential inflammatory marker, which mirrors the variability in erythrocyte volume. Studies indicate that elevated RDW is associated with increased risk of mortality in CKD patients, while evidence regarding the impact of RDW on kidney outcome is limited. Methods Altogether 523 patients with CKD stage 1-4 from a single center were enrolled. We identified the cutoff point for RDW level using maximally selected log-rank statistics. The time-averaged estimated glomerular filtration rate (eGFR) slope was determined using linear mixed effects models. Rapid CKD progression was defined by an eGFR decline >5 ml/min/1.73 m2/year. The composite endpoints were defined as doubling of serum creatinine, a 30% decline in initial eGFR or incidence of eGFR < 15 ml/min/1.73 m2, whichever occurred first. Multivariable logistic regression or Cox proportional hazards regression was performed, as appropriate. Results During a median follow-up of 26 [interquartile range (IQR): 12, 36] months, 65 (12.43%) patients suffered a rapid CKD progression and 172 (32.89%) composite kidney events occurred at a rate of 32.3/100 patient-years in the high RDW group, compared with 14.7/100 patient-years of the remainder. The annual eGFR change was clearly steeper in high RDW group {-3.48 [95% confidence interval (CI): -4.84, -2.12] ml/min/1.73 m2/year vs. -1.86 [95% CI: -2.27, -1.45] ml/min/1.73 m2/year among those with RDW of >14.5% and ≤14.5%, respectively, P for between-group difference <0.05}. So was the risk of rapid renal function loss (odds ratio = 6.79, 95% CI: 3.08-14.97) and composite kidney outcomes (hazards ratio = 1.51, 95% CI: 1.02-2.23). The significant association remained consistent in the sensitivity analysis. Conclusion Increased RDW value is independently associated with accelerated CKD deterioration. Findings of this study suggest RDW be a potential indicator for risk of CKD progression.
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Affiliation(s)
- Xinwei Deng
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Bixia Gao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education of China, Beijing, China
| | - Fang Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education of China, Beijing, China
| | - Ming-Hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education of China, Beijing, China.,Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Jinwei Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education of China, Beijing, China
| | - Luxia Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education of China, Beijing, China.,National Institute of Health Data Science, Peking University, Beijing, China
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Ni Q, Wang X, Wang J, Chen P. The red blood cell distribution width-albumin ratio: A promising predictor of mortality in heart failure patients - A cohort study. Clin Chim Acta 2021; 527:38-46. [PMID: 34979101 DOI: 10.1016/j.cca.2021.12.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/30/2021] [Accepted: 12/28/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Epidemiological studies suggest that increases in red blood cell distribution width (RDW) and decreases in albumin level can independently predict adverse cardiovascular outcomes. The prognostic value of RDW-albumin ratio (RAR), an innovate biomarker of inflammation, in heart failure (HF) patients has not been assessed. This study aimed to explore the association between RAR and mortality of HF patients. METHODS Data on patients diagnosed with HF were extracted from MIMIC-III database version 1.4. Cox proportional hazards models were used to investigate the associations between RAR and mortality of HF patients. HF patients admitted to the Second Affiliated Hospital of Wenzhou Medical University were also enrolled to explore the relationship between RAR and existing indicators of HF. RESULTS For 90-day mortality, the HR (95% CI) for the second (4.33<RAR<5.44) and the third (RAR>5.44) tertiles were 2.00 (1.58, 2.54) and 3.63 (2.91, 4.53), respectively, compared to the first tertile (RAR<4.33). When adjusted for age, gender and ethnicity in Model 1, the adjusted HR (95% CI) value of third tertiles was 3.66 (2.93, 4.56). Further adjust the vital signs, blood biochemical indicators, SOFA score and other parameters in Model II, the adjusted HR value of third tertiles was still statistically significant (HR: 2.70, 95% CI: 2.07-3.51, P < 0.0001). A similar trend was observed for 30-day, one-year mortality. For HF patients, high RAR significantly increased the risk of sepsis and requirement for renal replacement therapy. Additionally, there is a positive correlation between RAR, CRP levels, and NT-proBNP respectively. CONCLUSION High level of RAR is associated with increased short- and long-term mortality of patients with heart failure. The RAR is a promising biomarker that is easy to obtain and readily predicts mortality in heart failure patients.
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Affiliation(s)
- Qingwei Ni
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Xueyuanxi Road, No.109, Wenzhou 325000, Zhejiang, China
| | - Xue Wang
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Xueyuanxi Road, No.109, Wenzhou 325000, Zhejiang, China
| | - Jie Wang
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Xueyuanxi Road, No.109, Wenzhou 325000, Zhejiang, China
| | - Peng Chen
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Xueyuanxi Road, No.109, Wenzhou 325000, Zhejiang, China.
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Akkoç MF, Bülbüloğlu S. Investigation of red cell distribution width as a prognostic criterion in severe burns. Int Wound J 2021; 19:1428-1437. [PMID: 34904354 PMCID: PMC9493245 DOI: 10.1111/iwj.13736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/16/2021] [Accepted: 12/01/2021] [Indexed: 11/29/2022] Open
Abstract
This study was conducted to examine red cell distribution width (RDW) as a prognostic criterion in severe burns. The study is a descriptive correlational study and was carried out retrospectively. Patients with high RDW and low albumin values among severe burn injuries in the burn unit of a university hospital constituted half of the sample. Severe burns with RDW within normal range and a prognostic criterion for which albumin level normal and closest to normal accounted for the other half. RDW and albumin values were compared with the clinical results of patients with severe burns. IBM SPSS (Statistical Package for the Social Sciences) Statistics 25 was used for data analysis. Of the burn patients, 38.33% were between the age of 65–80, 51.67% were men, and 92.5% had third‐degree burns. The mean albumin level of the patients was 2.39 ± 0.34 g/dL, and the mean RDW level was 18.47 ± 6.15%. The length of the stay in the intensive care unit was 13.45 ± 7.83 days, and the duration of central venous catheter use was 23.41 ± 8.25 days. High RDW and low albumin values were found to be associated with death, length of stay in the intensive care unit, and more blood transfusion. High RDW and hypoalbuminemia significantly affect the clinical results of severe burns. Both parameters are effective in determining the clinical course of burn patients, the length of hospital stay, presence of catheters and medication treatment protocol.
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Affiliation(s)
- Mehmet Fatih Akkoç
- Division of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Semra Bülbüloğlu
- Division of Surgical Nursing, Nursing Department, Faculty of Health Sciences, Istanbul Aydin University, Istanbul, Turkey
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