Wasilewski Jarosław, Pyka Łukasz, Hawranek Michał, Tajstra Mateusz, Skrzypek Michał, Wasiak Michał, Suliga Kamil, Bujak Kamil, Gąsior Mariusz
3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland.
Cardiol J. 2018;25(3):377-385. doi: 10.5603/CJ.a2017.0037. Epub 2017 Mar 29.
Previous studies have reported that in patients with heart failure, an increased value of red cell distribution width (RDW) is associated with adverse outcomes. Nonetheless, data regarding the association between RDW values and long-term mortality in patients with left ventricular systolic dysfunction (LVSD) are lacking. The aim of this investigation was to examine the relationship between mortality and RDW in patients with ischemic and non-ischemic LVSD.
Under analysis was 1734 patients with a left ventricular ejection fraction (LVEF) ≤ 35% of whom were hospitalized between 2009 and 2013. Patients were divided into three groups based on RDW tertiles. Low, medium and high tertiles were defined as RDW ≤ 13.4%, 13.4% < RDW ≤ 14.6% and RDW > 14.6%, respectively.
There was a stepwise relationship between RDW intervals and comorbidities. Patients with the highest RDW values were older and more often diagnosed with anemia, diabetes, atrial fibrillation and chronic kidney disease. The main finding of our analysis was the presence of an 8-fold increase in all-cause mortality in the entire cohort between high and low RDW tertile. Cox hazard analysis identi-fied RDW as an independent predictive factor of mortality in all patients (HR 2.8; 95% CI 2.1-3.8; p < 0.0001) and in subgroups of patients with ischemic (HR 2.8; 95% CI 2.0-3.9; p < 0.0001) and non-ischemic (HR 3.3; 95% CI 2.01-5.5; p < 0.0001) LVSD.
The highest RDW tertile was independently associated with higher long-term mortality compared with low and medium tertiles, both in all patients with a LVEF ≤ 35% and in subgroups of patients with ischemic and non-ischemic LVSD.
既往研究报道，心力衰竭患者中，红细胞分布宽度（RDW）值升高与不良预后相关。然而，关于左心室收缩功能障碍（LVSD）患者RDW值与长期死亡率之间关联的数据尚缺乏。本研究旨在探讨缺血性和非缺血性LVSD患者死亡率与RDW之间的关系。
分析了1734例左心室射血分数（LVEF）≤35%的患者，这些患者于2009年至2013年期间住院。根据RDW三分位数将患者分为三组。低、中、高三分位数分别定义为RDW≤13.4%、13.4%＜RDW≤14.6%和RDW＞14.6%。
RDW区间与合并症之间存在逐步关系。RDW值最高的患者年龄更大，更常被诊断为贫血、糖尿病、心房颤动和慢性肾脏病。我们分析的主要发现是，在整个队列中，高RDW三分位数组与低RDW三分位数组相比，全因死亡率增加了8倍。Cox风险分析确定RDW是所有患者（HR 2.8；95%CI 2.1 - 3.8；p＜0.0001）以及缺血性（HR 2.8；95%CI 2.0 - 3.9；p＜0.0001）和非缺血性（HR 3.3；95%CI 2.01 - 5.5；p＜0.0001）LVSD患者亚组死亡率的独立预测因素。
与低和中三分位数相比，最高RDW三分位数与更高的长期死亡率独立相关，这在所有LVEF≤35%的患者以及缺血性和非缺血性LVSD患者亚组中均成立。
