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. 2018 Jul 1;37(3):299-306.
doi: 10.1515/jomb-2017-0054. eCollection 2018 Jul.

Red Blood Cell Distribution Width Improves Reclassification of Patients Admitted to the Emergency Department with Acute Decompensated Heart Failure

Gianni Turcato  1 , Gianfranco Cervellin  2 , Antonio Bonora  3 , Danieli Prati  4 , Elisabetta Zorzi  5 , Giorgio Ricci  3 , Gian Luca Salvagno  4 , Antonio Maccagnani  3 , Giuseppe Lippi  4
Affiliations

Red Blood Cell Distribution Width Improves Reclassification of Patients Admitted to the Emergency Department with Acute Decompensated Heart Failure

Gianni Turcato et al. J Med Biochem. .

Abstract
in English, Serbian

Background: The usual history of chronic heart failure (HF) is characterized by frequent episodes of acute decompensation (ADHF), needing urgent management in the emergency department (ED). Since the diagnostic accuracy of routine laboratory tests remains quite limited for predicting short-term mortality in ADHF, this retrospective study investigated the potential significance of combining red blood cell distribution width (RDW) with other conventional tests for prognosticating ADHF upon ED admission.

Methods: We conducted a retrospective study including visits for episodes of ADHF recorded in the ED of the Uni versity Hospital of Verona throughout a 4-year period. Demo - graphic and clinical features were recorded upon patient presentation. All patients were subjected to standard Chest X-ray, electrocardiogram (ECG) and laboratory testing in - cluding creatinine, blood urea nitrogen, B-type natriuretic peptide (BNP), complete blood cell count (CBC), sodium, chloride, potassium and RDW. The 30-day overall mortality after ED presentation was defined as primary endpoint.

Results: The values of sodium, creatinine, BNP and RDW were higher in patients who died than in those who survived, whilst hypochloremia was more frequent in patients who died than in those who survived. The multivariate model, incorporating these parameters, displayed a modest efficiency for predicting 30-day mortality after ED admission (AUC, 0.701; 95% CI, 0.662-0.738; p=0.001). Notably, the inclusion of RDW in the model significantly enhanced prediction efficiency, with an AUC of 0.723 (95% CI, 0.693-0.763; p<0.001). These results were confirmed with net reclassification improvement (NRI) analysis, showing that combination of RDW with conventional laboratory tests resulted in a much better prediction performance (net reclassification index, 0.222; p=0.001).

Conclusions: The results of our study show that prognostic assessment of ADHF patients in the ED can be significantly improved by combining RDW with other conventional laboratory tests.

Uvod: Istoriju hronične srčane insuficijencije (SI) obično karakterišu česte epizode akutne dekompenzacije (ASD), koja zahteva urgentno lečenje u odeljenjima hitne službe (HS). Kako dijagnostička tačnost rutinskih laboratorijskih testova i dalje ima znatna ograničenja kad se radi o predviđanju kratkoročnog smrtnog ishoda u ASD, ova retrospektivna studija istraživala je potencijalni značaj kombinovanja širine distribucije eritrocita (ŠDE) i drugih uobičajenih testova za prognoziranje ASD posle prijema u HS.

Metode: Sproveli smo retrospektivnu studiju koja je uključila posete zbog epizoda ASD zabeležene u HS Univerzitetske bolnice u Veroni tokom perioda od 4 godine. Demografske i kliničke odlike su zabeležene posle prijema pacijenata. Svi pacijenti su podvrgnuti standardnom rendgenu grudnog koša, elektrokardiogramu (EKG) i laboratorijskom testiranju koje je obuhvatilo kreatinin, ureu u krvi, natriuretski peptid B-tipa (BNP), kompletnu krvnu sliku (CBC), natrijum, hlorid, kalijum i širinu distribucije eritrocita. Ukupan broj smrtnih ishoda u roku od 30 dana posle prijema u HS je definisan kao primarna krajnja tačka.

Rezultati: Vrednosti natrijuma, kreatinina, BNP i ŠDE bile su više kod pacijenata koji su umrli nego kod onih koji su preživeli, dok je hipohloremija bila češća kod pacijenata koji su umrli nego kod onih koji su preživeli. Multivarijantni model koji je uključio ove parametre pokazao je umerenu efikasnost za predviđanje smrtnog ishoda u roku od 30 dana po prijemu u HS (AUC, 0,701; 95% CI, 0,662–0,738; p=0,001). Primećeno je da je uključivanje ŠDE u ovaj model značajno poboljšalo efikasnost predikcije, sa AUC od 0,723 (95% CI, 0,693–0,763; p<0,001). Ovi rezultati su potvrđeni analizom neto pobošljanja reklasifikacije (net reclassification improvement, NRI), koja je pokazala da kombinovanje ŠDE sa uobičajenim laboratorijskim testovima ima za rezultat mnogo bolju predikciju (indeks neto reklasifikacije, 0,222; p=0,001).

Zaključak: Rezultati ove studije pokazuju da prognostička procena pacijenata sa ASD u HS može biti značajno pobošljana ukoliko se ŠDE kombinuje sa drugim uobičajenim laboratorijskim testovima.

Keywords: acute decompensated heart failure; laboratory parameters; net reclassification improvement; red blood cell distribution width.

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Conflict of interest statement

Conflict of interest statement The authors stated that they have no conflicts of interest regarding the publication of this article.

Figures

Figure 1
Figure 1
Receiver operating characteristics (ROC) curve analysis of a predictive model for 30-day mortality in patients with acute decompensated heart failure (ADHF). Comparison of a predictive model based on conventional laboratory tests (i.e., B-type natriuretic peptide, creatinine, sodium and chloride), with or without red blood cell distribution width (RDW).
Figure 2
Figure 2
Results of the net reclassification improvement (NRI) after including red blood cell distribution width (RDW) in a predictive model based on conventional laboratory tests (i.e., B-type natriuretic peptide, creatinine, sodium and chloride).
Figure 3
Figure 3
Survival curve analysis after including red blood cell distribution width (RDW) in a predictive model based on conventional laboratory tests (i.e., B-type natriuretic peptide, creatinine, sodium and chloride).
See this image and copyright information in PMC

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