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Red cell distribution width predicts mid-term prognosis in patients hospitalized with acute heart failure: the RDW in Acute Heart Failure (RE-AHF) study

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Abstract

The aim of the study was to evaluate the prognostic role of red cell distribution width (RDW) in a broad population of patients hospitalized for acute heart failure (AHF). In a retrospective cohort observational study, 451 consecutive patients discharged for AHF were categorized in patients with low RDW (≤ 14.8%) and high RDW (> 14.8%). The rates of death from all causes or of hospital readmission for worsening heart failure and death were determined after a median follow-up of 18 months. The overall population has a median age of 80 years (IQR 72–85), 235 patients (52%) were males. Patients with a higher RDW have more comorbidities and a higher Charlson Index. At follow-up, 200 patients (44%) had died and 247 (54%) had died or were readmitted for HF: in the cohort with low RDW, 70 patients (36.4%) had died, whereas in the cohort with high RDW, 165 patients (63.7%) had died: the unadjusted risk ratio of patients with high RDW was 2.03 (log-rank test: p < 0.0001). In a multivariate Cox regression model, the hazard ratio for death from any cause in the ‘high RDW’ cohort is 1.73 (95% confidence interval 1.2–2.48; p = 0.003); the RDW adds prognostic information beyond that provided by conventional predictors, including age; etiology of HF; anemia; hyponatremia; estimated glomerular filtration rate; NT-proBNP levels; Charlson comorbidity score, atrial fibrillation, functional status, therapy with renin–angiotensin–aldosterone system inhibitors, beta-blockers. RDW is a powerful marker of worse long-term outcomes in patients with AHF, and its prognostic value is maintained beyond that provided by other well-established risk factors or biomarkers.

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Acknowledgements

The authors want to acknowledge the members of the Clinical Audit Group on Acute Heart Failure of S. Croce e Carle Hospital, Cuneo: Letizia Barutta (Emergency Department), Margherita Bonferroni (Division of Haematology), Antonio Capo and Danilo Bernardi (Division of Cardiosurgery), Antonella Deorsola (Division of Cardiology), Marco Marabotto (Division of Geriatrics), Stefania Musso (Intensive Care Unit), Antonella Dutto, Nadia Somale e Bruna Aimar (Hospital Quality Unit).

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Correspondence to Remo Melchio.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later revisions.

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Because of the retrospective design, informed consent was not obtained from individual patients, but permission for data analysis and to perform the study was granted by the Institutional Research Ethics Committee, in accord with national and international recommendations and Helsinki declaration.

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Melchio, R., Rinaldi, G., Testa, E. et al. Red cell distribution width predicts mid-term prognosis in patients hospitalized with acute heart failure: the RDW in Acute Heart Failure (RE-AHF) study. Intern Emerg Med 14, 239–247 (2019). https://doi.org/10.1007/s11739-018-1958-z

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