Sun Xi-peng, Chen Wen-ming, Sun Zhi-jun, Ding Xiao-song, Gao Xiang-yu, Liang Si-wen, Zhao Hui-qiang, Yao Dao-kuo, Chen Hui, Li Hong-wei, Li Dong-bao
Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Cardiology. 2014;128(4):343-8. doi: 10.1159/000359994. Epub 2014 Jun 18.
Recent studies have reported increased red blood cell distribution width (RDW) has been associated with adverse outcomes in heart failure and stable coronary disease. We investigated the association between RDW and risk of all-cause mortality in patients with ST-elevation myocardial infarction (STEMI) who were free of heart failure at baseline.
We enrolled 691 patients with STEMI who were free of heart failure at baseline confirmed by coronary angiography in Beijing Friendship Hospital from January 2007 to December 2008. According to the median RDW at baseline (13.0%) on admission, the patients were divided into two groups: a low-RDW group (RDW <13.0%, n = 329) and a high-RDW group (RDW ≥13.0%, n = 362). All-cause mortality rates were compared between groups. Mean duration of follow-up was 41.8 months. The relation between RDW and clinical outcomes after hospital discharge were tested using Cox regression models, adjusting for clinical variables. At the same time, the sensitivity and specificity of RDW were analyzed by ROC analysis.
Forty-seven patients (6.8%) died during follow-up. The cumulative incidence of all-cause death was significantly higher in the high-RDW group than in the low-RDW group (log-rank p = 0.007). Multivariate analysis revealed that high RDW was associated with all-cause mortality (hazard ratio: 3.43; 95% confidence interval: 1.17-8.32; p = 0.025). The area under the ROC curve was 0.562.
From the statistical point of view, increased RDW is associated with all-cause and cardiac mortality rates in patients with STEMI who were free of heart failure at baseline. But RDW is a marker with a very low prognostic accuracy that does not seem to be clinically helpful.
近期研究报告称，红细胞分布宽度（RDW）升高与心力衰竭和稳定型冠心病的不良预后相关。我们调查了基线时无心力衰竭的ST段抬高型心肌梗死（STEMI）患者中RDW与全因死亡率风险之间的关联。
我们纳入了2007年1月至2008年12月在北京友谊医院经冠状动脉造影证实基线时无心力衰竭的691例STEMI患者。根据入院时基线RDW的中位数（13.0%），将患者分为两组：低RDW组（RDW<13.0%，n = 329）和高RDW组（RDW≥13.0%，n = 362）。比较两组的全因死亡率。平均随访时间为41.8个月。使用Cox回归模型检验RDW与出院后临床结局之间的关系，并对临床变量进行校正。同时，通过ROC分析分析RDW的敏感性和特异性。
47例患者（6.8%）在随访期间死亡。高RDW组的全因死亡累积发生率显著高于低RDW组（对数秩检验p = 0.007）。多变量分析显示，高RDW与全因死亡率相关（风险比：3.43；95%置信区间：1.17 - 8.32；p = 0.025）。ROC曲线下面积为0.562。
从统计学角度来看，RDW升高与基线时无心力衰竭的STEMI患者的全因死亡率和心脏死亡率相关。但RDW是一个预后准确性非常低的标志物，似乎在临床上并无帮助。
