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
. 2023 Dec;10(6):3287-3298.
doi: 10.1002/ehf2.14513. Epub 2023 Sep 6.

In-hospital changes in the red blood cell distribution width and mortality in critically ill patients with heart failure

Qi Zhang  1 , Bingyang Zhou  1 , Ximing Li  1   2   3 , Hongliang Cong  1   2   3
Affiliations

In-hospital changes in the red blood cell distribution width and mortality in critically ill patients with heart failure

Qi Zhang et al. ESC Heart Fail. 2023 Dec.

Abstract

Aims: A high red blood cell distribution width (RDW) at admission or discharge is associated with a worse prognosis in hospitalized patients with heart failure (HF), and the prognostic value of the in-hospital change in RDW (∆RDW) remains debatable.

Methods and results: We included 5514 patients with critical illness and HF from the MIMIC-IV database. The ΔRDW was calculated by the RDW at discharge minus that at admission. Clinical outcomes included all-cause mortality at 90 day, 180 day, and 1 year after discharge. The median age of the patients was 73.91 years, and 46.37% were women. Kaplan-Meier curve and Cox regression analyses were used to examine the association between the ΔRDW and all-cause mortality at different time points. A multivariable Cox proportional hazard model showed that the ΔRDW (per 1% increase) was independently associated with all-cause mortality at 90 day, 180 day, and 1 year after adjusting for confounding factors (hazard ratio [HR] = 1.17, 95% confidence interval [CI] = 1.13-1.21, P < 0.001; HR = 1.17, 95% CI = 1.14-1.20, P < 0.001; and HR = 1.18, 95% CI = 1.15-1.20, P < 0.001, respectively). Restricted cubic splines showed a non-linear relationship between the ΔRDW and the risk of clinical outcomes. High ΔRDW was associated with a high risk of mortality at different time points. A subgroup analysis showed that this positive association remained consistent in pre-specified subgroups.

Conclusions: Our study suggests that an increased RDW during hospitalization is independently associated with short- or long-term all-cause mortality in critical-ill patients with HF.

Keywords: Critical care; Heart failure; Prognosis; Red blood cell.

PubMed Disclaimer

Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Kaplan–Meier curves for outcomes by ΔRDW tertiles. RDW, red cell distribution width.
Figure 2
Figure 2
Relationship between the ΔRDW and the risk of mortality shown by restricted cubic splines. RDW, red cell distribution width.
Figure 3
Figure 3
Risk of mortality for a 1% increase in the ΔRDW in pre‐specified subgroups. CI, confidence interval; HR, hazard ratio; RDW, red cell distribution width.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Bessman JD, Gilmer PR Jr, Gardner FH. Improved classification of anemias by MCV and RDW. Am J Clin Pathol 1983;80:322‐326. doi:10.1093/ajcp/80.3.322 - DOI - PubMed
    1. Fava C, Cattazzo F, Hu ZD, Lippi G, Montagnana M. The role of red blood cell distribution width (RDW) in cardiovascular risk assessment: Useful or hype? Ann Transl Med 2019;7:581. doi:10.21037/atm.2019.09.58 - DOI - PMC - PubMed
    1. Pernow J, Mahdi A, Yang J, Zhou Z. Red blood cell dysfunction: A new player in cardiovascular disease. Cardiovasc Res 2019;115:1596‐1605. doi:10.1093/cvr/cvz156 - DOI - PubMed
    1. Salvagno GL, Sanchis‐Gomar F, Picanza A, Lippi G. Red blood cell distribution width: A simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci 2015;52:86‐105. doi:10.3109/10408363.2014.992064 - DOI - PubMed
    1. Li N, Zhou H, Tang Q. Red blood cell distribution width: A novel predictive indicator for cardiovascular and cerebrovascular diseases. Dis Markers 2017;2017:7089493. doi:10.1155/2017/7089493 - DOI - PMC - PubMed