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. 2025 Mar 15;64(6):807-816.
doi: 10.2169/internalmedicine.3691-24. Epub 2024 Aug 10.

Prognostic Impact of the Ratio of Hemoglobin to Red Blood Cell Distribution Width in Patients after Acute Decompensated Heart Failure

Yusuke Kanzaki  1 , Masatoshi Minamisawa  1 , Hirohiko Motoki  1 , Sho Suzuki  1 , Yukari Okuma  1 , Masafumi Kanai  1 , Keisuke Machida  1 , Kazuhiro Kimura  1 , Yasushi Ueki  1 , Koji Yoshie  1 , Yasutaka Oguchi  1 , Tamon Kato  1 , Tatsuya Saigusa  1 , Soichiro Ebisawa  1 , Ayako Okada  1 , Koichiro Kuwahara  1
Affiliations

Prognostic Impact of the Ratio of Hemoglobin to Red Blood Cell Distribution Width in Patients after Acute Decompensated Heart Failure

Yusuke Kanzaki et al. Intern Med. .

Abstract

Objective The ratio of hemoglobin to red blood cell distribution width (Hb/RDW) is a simple and readily available tool associated with adverse outcomes in chronic heart failure (HF). However, the association between the Hb/RDW ratio and mortality in patients with acute decompensated HF (ADHF) is unclear. The goal of this study was to investigate the relationship between the Hb/RDW ratio and mortality in patients after ADHF. Methods This single-center study included clinical and laboratory data collected at baseline, with patients prospectively followed-up for a median period of 3.1 years. The patients were divided into two groups based on their median Hb/RDW ratio. Patients We evaluated 250 consecutive patients hospitalized for ADHF at Shinshu University Hospital between July 2014 and March 2019. Results In our study cohort [median age, 76 (66-83) years; 62.8% male], all-cause death was observed in 91 patients (incidence rate: 12.7 per 100 patient-years). A Kaplan-Meier analysis revealed that patients in the lower Hb/RDW ratio group (<0.24, n=131) had worse outcomes compared to those in the higher group (≥0.24, n=119) (cumulative incidence 44.1% vs. 19.5%, respectively; log-rank, p<0.001). After adjusting for demographics, HF severity, and laboratory biomarkers, a lower Hb/RDW ratio was significantly associated with a higher risk of mortality (hazard ratio, 1.89; 95% confidence interval, 1.04-3.45; p=0.038). Conclusion A lower Hb/RDW ratio is associated with an increased risk of mortality in patients after ADHF, thus indicating its potential utility in identifying patients at an elevated risk for future cardiovascular events.

Keywords: heart failure; prognosis; red blood cell distribution width.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
Overview of the study design. Clue of Risk Stratification in the Elderly Patients with Heart Failure (CURE-HF) Registry. HF: heart failure, Hb: hemoglobin, RDW-SD: standard deviation of red blood cell distribution width, Hb/RDW-SD: standard deviation of hemoglobin to red blood cell distribution width ratio
Figure 2.
Figure 2.
Distribution of (A) Hb, (B) RDW-SD, and (C) Hb/RDW-SD. Hb: Hemoglobin, RDW-SD: standard deviation of red blood cell distribution width, Hb/RDW-SD: hemoglobin to standard deviation of red blood cell distribution width ratio
Figure 3.
Figure 3.
Association between the Hb/RDW-SD ratio and the incidence rate of all-cause death using restricted cubic spline curves. The figure shows the incidence rate of all-cause death (events per 100 person-years) on the left y-axis and the Hb/RDW-SD ratio on the x-axis. The solid curves depict the incidences, with 95% confidence intervals of the estimates. Poisson models were used to estimate the incidence rates. Histograms show the population distribution of the Hb/RDW ratio. Hb/RDW-SD: hemoglobin-to-standard deviation of red blood cell distribution width ratio
Figure 4.
Figure 4.
Kaplan-Meier curves for all-cause death according to hemoglobin-to-red blood cell distribution width ratio (Hb/RDW-SD).
Figure 5.
Figure 5.
Kaplan-Meier curves for cardiovascular death (A) and non-cardiovascular death (B) according to hemoglobin-to-red blood cell distribution width ratio (Hb/RDW-SD).
See this image and copyright information in PMC

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