Universidade Federal da Paraíba, João Pessoa, PB - Brasil.
Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas Instituto do Coração, São Paulo, SP - Brasil.
Arq Bras Cardiol. 2024 Aug 12;121(7):e20230669. doi: 10.36660/abc.20230669. eCollection 2024.
In pulmonary hypertension (PH), the identification of easily obtainable prognostic markers associated with right ventricular (RV) dysfunction and survival is needed.
To evaluate the association of red cell distribution width (RDW) with clinical, echocardiographic parameters and survival in patients with pre-capillary PH, with the development of a mortality prediction model.
Observational, longitudinal, and prospective study conducted from May 2019 to December 2022. Thirty-four patients with pre-capillary PH underwent two-dimensional echocardiography and complete blood count. A cutoff point of 14.5% was considered to define RDW as altered (≥14.5%) or normal (<14.5%). P values <0.05 were considered significant.
The median RDW was 14.4%. There was a significant difference in peripheral arterial oxygen saturation (SpO2) (p=0.028), RV strain (p=0.047), and pericardial effusion (p=0.002) between the normal and elevated RDW groups. During a median follow-up of 15 months, 20.6% died. Patients with increased RDW had a shorter overall survival (44.7%, log-rank p=0.019), which was a predictor of mortality in univariate Cox regression (HR 8.55, p=0.048). The addition of RV strain <16% and SpO2 ≤93% to the model including RDW alone showed incremental value in predicting mortality (χ2=8.2, p=0.049; χ2=12.4, p=0.041), with increased area under the receiver operating characteristic curve (0.729 vs. 0.837 vs. 0.909) and decreased probability of survival (44.7% vs. 35.6% vs. 25%, log-rank p=0.019).
RDW provides information on the severity of pre-capillary PH by correlating with echocardiographic parameters of RV dysfunction and mortality, which is best predicted by a model including RDW, RV strain and SpO2.
在肺动脉高压（PH）中，需要确定与右心室（RV）功能障碍和生存相关的易于获得的预后标志物。
评估红细胞分布宽度（RDW）与毛细血管前 PH 患者的临床、超声心动图参数和生存的相关性，并建立死亡率预测模型。
观察性、纵向和前瞻性研究，于 2019 年 5 月至 2022 年 12 月进行。34 例毛细血管前 PH 患者接受二维超声心动图和全血细胞计数检查。将 RDW 定义为改变（≥14.5%）或正常（<14.5%）的截断点为 14.5%。p 值<0.05 被认为具有统计学意义。
RDW 的中位数为 14.4%。RDW 正常和升高组之间，外周动脉血氧饱和度（SpO2）（p=0.028）、RV 应变（p=0.047）和心包积液（p=0.002）有显著差异。在中位随访 15 个月期间，20.6%的患者死亡。RDW 升高的患者总生存率更短（44.7%，log-rank p=0.019），这是单因素 Cox 回归中死亡的预测因素（HR 8.55，p=0.048）。将 RV 应变<16%和 SpO2≤93%加入到仅包括 RDW 的模型中，预测死亡率具有增量价值（χ2=8.2，p=0.049；χ2=12.4，p=0.041），ROC 曲线下面积增加（0.729 比 0.837 比 0.909），生存率降低（44.7%比 35.6%比 25%，log-rank p=0.019）。
RDW 通过与 RV 功能障碍和死亡率的超声心动图参数相关，提供了毛细血管前 PH 严重程度的信息，通过包括 RDW、RV 应变和 SpO2 的模型可以最好地预测。
