Red blood cell distribution width predicts all-cause, CV death in HF
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Red blood cell distribution width is an independent predictor of all-cause and CV death across all subtypes of HF, and its prognostic value improves when incorporating N‐terminal pro-B-type natriuretic peptide level, data show.
“Many prognostic biomarkers, including natriuretic peptide (B‐type natriuretic peptide [BNP] and NT‐proBNP) have been well‐studied in HF patients, but their clinical application is limited due to challenges in risk stratification,” Yuhui Zhang, MD, PhD, of the Chinese Academy of Medical Sciences and Peking Union Medical College in Beijing, and colleagues wrote in the study background. “Red blood cell distribution width, an inexpensive and convenient parameter, is reportedly a powerful predictor of prognosis in HF patients. However, the impact of combined red blood cell distribution width and NT‐proBNP levels as a prognostic marker of HF remains unclear.”
In a retrospective study, Zhang and colleagues analyzed data from 3,231 patients with available red blood cell distribution width data after admission to the HF care unit of Fuwai Hospital in Beijing with a diagnosis of HF from November 2008 to November 2018. The median age of patients was 58 years; 71.9% were men; 39.7% had CHD and 68.6% had NYHA class III or IV HF.
Median red blood cell distribution width and NT‐proBNP at admission were 13.4% and 1,723 pg/mL, respectively. During a median 2.9 years of follow‐up, 33.27% of patients died of any cause.
In Kaplan-Meier survival curve and Cox proportional hazard models, patients in the top quartile of red blood cell distribution width had a 32% increased risk for death compared with patients in the bottom quartile, for an HR of 4.39 (95% CI, 3.59-5.38; P < .001).
Red blood cell distribution width was independently associated with all‐cause and CV mortality in models adjusted for age, sex, additional prognostic indicators of HF and for NT‐proBNP. Risk for all‐cause and CV mortality in top quartile increased by 120% (HR = 2.2; 95% CI, 1.68-2.89) and 114% (HR = 2.14; 95% CI, 1.53-2.98), respectively, compared with the bottom quartile (P for trend < .001).
“To our knowledge, this is the first time that these associations have been demonstrated for short‐, medium‐ and long‐term outcomes, among different clinical subtypes of HF (HF with reduced ejection fraction, HF with midrange ejection fraction, HF with preserved ejection fraction) and various patient subgroups,” the researchers wrote. “Of special clinical relevance, we suggest cutoff values for red blood cell distribution width and NT‐proBNP to identify those with highest mortality risk.”
The researchers noted further studies are needed to establish whether red blood cell distribution width or a combination of biomarkers can inform treatment decisions and follow‐up in a cost‐effective manner.
“At present, even the most established HF biomarkers, the natriuretic peptides, remain controversial for serial follow‐up,” the researchers wrote. “Additionally, the mechanisms behind the prognostic significance of red blood cell distribution width in HF patients merits investigation.”
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