Correlation of red cell distribution width with the severity of coronary artery disease: a large Chinese cohort study from a single center

Red blood cell distribution width is a short-term mortality predictor in middle-aged and older adults with hip fracture

OBJECTIVE

To study the relationship between red blood cell distribution width (RDW) and short-term mortality of hip fracture in middle-aged and older adults.

METHODS

A retrospective cohort of electronic medical records at a single hospital over a 2-year period between 2020 and 2021. We received the records of 233 patients aged > 50 years who suffered from hip fracture. the clinical data including patients demographics, comorbidities at the time of admission, type of surgery, blood examination, 3-months mortality, 6-months mortality and 1-year mortality. the relationship between RDW and short-term mortality of hip fracture were analyzed. the cohort was then divided into two groups based on their RDW levels at the time of admission: low (RDW < 13.6%) and high (RDW ≥ 13.6%).

RESULTS

Results the mean age was 78.03 ± 12.09 years; 64.81% were woman. At admission, 80 patients (34.33%) had high RDW levels and 153 patients (65.67%) had low RDW levels. there were no statistically significant differences between the groups with regard to sex, type of operation, duration of surgery and hospitalization length. Patients with high RDW had more comorbidities when compared to patients with low RDW levels (p < 0.05). All-cause mortality was higher for patients with high RDW levels, at 3 months (p < 0.05), 6 months (p < 0.05), and 12 months (p < 0.05).

CONCLUSION

RDW is significantly related with short-term mortality in hip fracture. The higher RDW, the higher risk of mortality.

Red Cell Distribution Width as a Marker of Disease Severity and In-hospital Mortality in Patients with ST-segment Elevation Myocardial Infarction

Background

The red cell distribution width (RDW) has been investigated as a predictive factor for complications and mortality in several critical illnesses, including cardiovascular diseases.

Objective

The current study aimed to assess the relationship of RDW with severity and in-hospital mortality in patients with ST-elevation myocardial infarction (STEMI).

Materials and methods

A prospective hospital-based observational study was conducted at a tertiary care institute of Northern India. Fifty patients of STEMI who underwent coronary angiography/primary coronary intervention were enrolled as cases and equal number of age- and sex-matched individuals not suffering from any cardiac disease were taken as controls. The RDW admission values of the cases were compared with that of controls. Red cell distribution width values were also compared across the outcome groups among cases.

Results

The mean RDW-SD of the cases was 49.0 ± 4.6 fL whereas it was 44.7 ± 3.5 fL for controls, the difference being statistically significant (p < 0.001). Among the total patients, 4 (8.0%) expired during hospital stay and the rest 46 (92.0%) were discharged alive. The mean RDW-SD of expired patients was significantly higher than that of patients who remained alive (p = 0.002). There was a significant positive correlation between RDW and global registry of acute coronary events (GRACE) score (p = 0.02) and a significant negative correlation between RDW and left ventricular ejection fraction (LVEF) (p = 0.04). Area under the receiver operating characteristics (ROC) curve for RDW was higher than that of LVEF, showing superiority of RDW to LVEF in predicting mortality among the STEMI patients.

Conclusion

Red cell distribution width may serve as a promising prognostic biomarker and tool for risk stratification in patients with STEMI.

How to cite this article

Raval R, Gupta S, Gupta N, Bashar MA. Red Cell Distribution Width as a Marker of Disease Severity and In-hospital Mortality in Patients with ST-segment Elevation Myocardial Infarction. Indian J Crit Care Med 2024;28(12):1101-1106.

The Prognostic Role of Red Blood Cell Distribution Width in Coronary Artery Disease: A Review of the Pathophysiology

Red blood cell distribution width (RDW) is a measure of red blood cell volume variations (anisocytosis) and is reported as part of a standard complete blood count. In recent years, numerous studies have noted the importance of RDW as a predictor of poor clinical outcomes in the settings of various diseases, including coronary artery disease (CAD). In this paper, we discuss the prognostic value of RDW in CAD and describe the pathophysiological connection between RDW and acute coronary syndrome. In our opinion, the negative prognostic effects of elevated RDW levels may be attributed to the adverse effects of independent risk factors such as inflammation, oxidative stress, and vitamin D₃ and iron deficiency on bone marrow function (erythropoiesis). Elevated RDW values may reflect the intensity of these phenomena and their unfavorable impacts on bone marrow erythropoiesis. Furthermore, decreased red blood cell deformability among patients with higher RDW values impairs blood flow through the microcirculation, resulting in the diminution of oxygen supply at the tissue level, particularly among patients suffering from myocardial infarction treated with urgent revascularization.

Association of N-terminal pro-brain natriuretic peptide with the severity of coronary artery disease in patients with normal left ventricular ejection fraction

Backround N-terminal pro-brain natriuretic peptide (NT-proBNP) is a reliable predictor in acute coronary artery disease (CAD). Little is known about patients with stable CAD, especially Chinese patients with CAD. The aim of the present study was to investigate the association of NT-proBNP levels with the severity of CAD in patients with normal left ventricular ejection fraction.

METHODS

A total of 658 consecutive patients were divided into two groups based on angiograms: CAD group (n = 484) and angiographic normal control group (n = 174). The severity of CAD was evaluated by modified Gensini score, and its relationship with NT-proBNP was analyzed.

RESULTS

The prevalence of risk factors such as age, male gender, diabetes mellitus (DM), dyslipidemia, smoking, and family history of CAD in the CAD group were higher than that in the control group. In multivariate regression model analysis, age, gender, and DM were determinants of the presence of CAD. NT-pro BNP was found to be an independent predictor for CAD (OR:1.66 (95% CI: 1.06-2.61), P < 0.05). In a receiver operating characteristic (ROC) curve analysis, an NT-proBNP value of 641.15 pmol/L was identified as a cut-off value in the diagnosis or exclusion of CAD (area under curve (AUC) = 0.56, 95% CI: 0.51-0.61). Furthermore, NT-proBNP was positively correlated with Gensini score (r = 0.14, P < 0.001) in patients with CAD.

CONCLUSION

NT-proBNP was an independent predictor for Chinese patients with CAD, suggesting that the NT-proBNP level might be associated with the presence and the severity of CAD.