Förhécz Zsolt, Gombos Tímea, Borgulya Gábor, Pozsonyi Zoltán, Prohászka Zoltán, Jánoskuti Lívia
3rd Department of Internal Medicine, and Szentágothai Knowledge Center, Semmelweis University, Budapest, Hungary.
Am Heart J. 2009 Oct;158(4):659-66. doi: 10.1016/j.ahj.2009.07.024. Epub 2009 Aug 26.
The goal of this study was to independently validate the recent observations on the predictive role of red cell distribution width (RDW) for outcomes in chronic heart failure and to provide epidemiologic data on the biological correlates of RDW in heart failure (HF). Understanding the mechanism underlying this observation is unclear, largely hampered by the lack of epidemiologic studies demonstrating factors that are associated with anisocytosis in cardiovascular diseases.
One hundred ninety-five patients (145 men, 50 women) with systolic HF were enrolled and followed up for a median of 14.5 months. Primary end points were all-cause mortality and hospital readmission due to worsening HF symptoms. A total of 19 clinical chemistry, hematology, and biochemical variables were considered for analysis together with clinical parameters in Cox proportional hazards and multiple regression models.
Red cell distribution width was found to be an N-terminal pro-brain natriuretic peptide independent predictor of all-cause mortality (adjusted HR 1.61 per 1 SD increase) in our study. Multiple correlations between biomarkers of ineffective erythropoiesis (serum iron, ferritin, and soluble transferrin receptor levels), inflammation and acute-phase reaction (interleukin-6, soluble tumor necrosis factor (TNF) receptor I and soluble TNF receptor II, C-reactive protein, and prealbumin concentrations), undernutrition (total cholesterol and albumin levels), and renal function were observed. In the multiple regression model, the strongest relationship for RDW was obtained with soluble transferrin receptor, soluble TNF receptor I, soluble TNF receptor II, and total cholesterol.
Here we validate the strong, independent prediction of morbidity and mortality in HF by RDW. The described correlations between RDW and inflammation, ineffective erythropoiesis, undernutrition, and impaired renal function may facilitate the understanding why this marker is associated with adverse outcomes in HF.
本研究的目的是独立验证近期关于红细胞分布宽度（RDW）对慢性心力衰竭预后预测作用的观察结果，并提供心力衰竭（HF）中RDW生物学相关性的流行病学数据。目前尚不清楚该观察结果背后的机制，这在很大程度上受到缺乏流行病学研究的阻碍，这些研究未能证明与心血管疾病中红细胞大小不均相关的因素。
纳入195例收缩性HF患者（145例男性，50例女性），中位随访时间为14.5个月。主要终点为全因死亡率和因HF症状恶化导致的再次住院。在Cox比例风险模型和多元回归模型中，共纳入19项临床化学、血液学和生化变量与临床参数一起进行分析。
在我们的研究中，红细胞分布宽度被发现是全因死亡率的独立预测因子（每增加1个标准差，校正后风险比为1.61），独立于N末端脑钠肽前体。观察到无效红细胞生成的生物标志物（血清铁、铁蛋白和可溶性转铁蛋白受体水平）、炎症和急性期反应（白细胞介素-6、可溶性肿瘤坏死因子（TNF）受体I和可溶性TNF受体II、C反应蛋白和前白蛋白浓度）、营养不良（总胆固醇和白蛋白水平）与肾功能之间存在多重相关性。在多元回归模型中，RDW与可溶性转铁蛋白受体、可溶性TNF受体I、可溶性TNF受体II和总胆固醇之间的关系最为密切。
在此，我们验证了RDW对HF发病率和死亡率的强大独立预测作用。所描述的RDW与炎症、无效红细胞生成、营养不良和肾功能受损之间的相关性可能有助于理解为什么该标志物与HF的不良结局相关。
