Validation and Potential Mechanisms of Red Cell Distribution Width as a Prognostic Marker in Heart Failure

Allen, Larry A.; Felker, G. Michael; Mehra, Mandeep R.; Chiong, Jun R.; Dunlap, Stephanie H.; Ghali, Jalal K.; Lenihan, Daniel J.; Oren, Ron M.; Wagoner, Lynne E.; Schwartz, Todd A.; Adams, Kirkwood F.

doi:10.1016/j.cardfail.2009.11.003

« Previous Next »Journal of Cardiac Failure
Volume 16, Issue 3 , Pages 230-238, March 2010

Validation and Potential Mechanisms of Red Cell Distribution Width as a Prognostic Marker in Heart Failure

Larry A. Allen, MD, MHS
- Division of Cardiology, University of Colorado Denver, Aurora, CO
G. Michael Felker, MD, MHS
- Department of Medicine, Duke University School of Medicine, Duke Clinical Research Institute, Durham, NC
Mandeep R. Mehra, MBBS
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
Jun R. Chiong, MD, MPH
- Department of Medicine, Loma Linda University School of Medicine, Loma Linda, CA
Stephanie H. Dunlap, DO
- Department of Internal Medicine, University of Cincinnati, Cincinnati, OH
Jalal K. Ghali, MD
- Detroit Medical Center, Detroit, MI
Daniel J. Lenihan, MD
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX
Ron M. Oren, MD
- Mercy Iowa City, Iowa City, IA
Lynne E. Wagoner, MD
- Greater Cincinnati Cardiovascular Consultants, Cincinnati, OH
Todd A. Schwartz, DRPH
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
Kirkwood F. Adams Jr., MD
- Department of Medicine and Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Reprint requests: Kirkwood F. Adams, Jr., MD, Associate Professor of Medicine and Radiology, UNC Heart Failure Program, 730 Martin Luther King Jr. Blvd, Suite 206, Chapel Hill, NC 27514. Tel: 919-966-2877; Fax: 919-966-2888.

Received 26 March 2009; received in revised form 3 November 2009; accepted 6 November 2009. published online 28 December 2009.

Abstract

Background

Adverse outcomes have recently been linked to elevated red cell distribution width (RDW) in heart failure. Our study sought to validate the prognostic value of RDW in heart failure and to explore the potential mechanisms underlying this association.

Methods and Results

Data from the Study of Anemia in a Heart Failure Population (STAMINA-HFP) registry, a prospective, multicenter cohort of ambulatory patients with heart failure supported multivariable modeling to assess relationships between RDW and outcomes. The association between RDW and iron metabolism, inflammation, and neurohormonal activation was studied in a separate cohort of heart failure patients from the United Investigators to Evaluate Heart Failure (UNITE-HF) Biomarker registry. RDW was independently predictive of outcome (for each 1% increase in RDW, hazard ratio for mortality 1.06, 95% CI 1.01-1.12; hazard ratio for hospitalization or mortality 1.06; 95% CI 1.02-1.10) after adjustment for other covariates. Increasing RDW correlated with decreasing hemoglobin, increasing interleukin-6, and impaired iron mobilization.

Conclusions

Our results confirm previous observations that RDW is a strong, independent predictor of adverse outcome in chronic heart failure and suggest elevated RDW may indicate inflammatory stress and impaired iron mobilization. These findings encourage further research into the relationship between heart failure and the hematologic system.

Key Words: Anemia, biomarker, laboratory tests