Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2010 Mar;16(3):230-8.
doi: 10.1016/j.cardfail.2009.11.003. Epub 2009 Dec 29.

Validation and potential mechanisms of red cell distribution width as a prognostic marker in heart failure

Larry A Allen  1 , G Michael Felker, Mandeep R Mehra, Jun R Chiong, Stephanie H Dunlap, Jalal K Ghali, Daniel J Lenihan, Ron M Oren, Lynne E Wagoner, Todd A Schwartz, Kirkwood F Adams Jr
Affiliations
Comparative Study

Validation and potential mechanisms of red cell distribution width as a prognostic marker in heart failure

Larry A Allen et al. J Card Fail. 2010 Mar.

Abstract

Background: Adverse outcomes have recently been linked to elevated red cell distribution width (RDW) in heart failure. Our study sought to validate the prognostic value of RDW in heart failure and to explore the potential mechanisms underlying this association.

Methods and results: Data from the Study of Anemia in a Heart Failure Population (STAMINA-HFP) registry, a prospective, multicenter cohort of ambulatory patients with heart failure supported multivariable modeling to assess relationships between RDW and outcomes. The association between RDW and iron metabolism, inflammation, and neurohormonal activation was studied in a separate cohort of heart failure patients from the United Investigators to Evaluate Heart Failure (UNITE-HF) Biomarker registry. RDW was independently predictive of outcome (for each 1% increase in RDW, hazard ratio for mortality 1.06, 95% CI 1.01-1.12; hazard ratio for hospitalization or mortality 1.06; 95% CI 1.02-1.10) after adjustment for other covariates. Increasing RDW correlated with decreasing hemoglobin, increasing interleukin-6, and impaired iron mobilization.

Conclusions: Our results confirm previous observations that RDW is a strong, independent predictor of adverse outcome in chronic heart failure and suggest elevated RDW may indicate inflammatory stress and impaired iron mobilization. These findings encourage further research into the relationship between heart failure and the hematologic system.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Unadjusted relationship of red cell distribution width to ad verse outcomes. Kaplan Meier curves for all-cause mortality (A) and hospitalization or mortality (B) by ranges of red cell distribution width.
Fig. 2
Fig. 2
Relationship of red cell distribution width to indices of iron metabolism and inflammation. Association of ranges of red cell distribution width with mean corpuscular volume (A), total iron binding capacity (TIBC) saturation (B), and interleukin (IL)-6 (C). Boxes illustrate the 25th, 50th, and 75th percentiles of the distribution. The mean is given by a square, the median by the horizontal line, and the whiskers extend to the 5th and 95th percentiles.
See this image and copyright information in PMC

References

    1. Al-Ahmad A, Rand WM, Manjunath G, Konstam MA, Salem DN, Levey AS, et al. Reduced kidney function and anemia as risk factors for mortality in patients with left ventricular dysfunction. J Am Coll Cardiol. 2001;38:955–62. - PubMed
    1. Horwich TB, Fonarow GC, Hamilton MA, MacLellan WR, Borenstein J. Anemia is associated with worse symptoms, greater impairment in functional capacity and a significant increase in mortality in patients with advanced heart failure. J Am Coll Cardiol. 2002;39:1780–6. - PubMed
    1. Mozaffarian D, Nye R, Levy WC. Anemia predicts mortality in severe heart failure: the prospective randomized amlodipine survival evaluation (PRAISE) J Am Coll Cardiol. 2003;41:1933–9. - PubMed
    1. Ezekowitz JA, McAlister FA, Armstrong PW. Anemia is common in heart failure and is associated with poor outcomes: insights from a cohort of 12 065 patients with new-onset heart failure. Circulation. 2003;107:223–5. - PubMed
    1. Felker GM, Gattis WA, Leimberger JD, Adams KF, Cuffe MS, Gheorghiade M, et al. Usefulness of anemia as a predictor of death and rehospitalization in patients with decompensated heart failure. Am J Cardiol. 2003;92:625–8. - PubMed

Publication types

MeSH terms