Journal of Cardiac Failure
Volume 17, Issue 4 , Pages 292-298, April 2011

Red Cell Distribution Width and Mortality in Predominantly African-American Population With Decompensated Heart Failure

  • Sandip K. Zalawadiya, MD

      Affiliations

    • Detroit Medical Center/Wayne State University, Detroit, MI
    • ,
  • Hammam Zmily, MD

      Affiliations

    • Detroit Medical Center/Wayne State University, Detroit, MI
    • ,
  • Jareer Farah, MD

      Affiliations

    • Detroit Medical Center/Wayne State University, Detroit, MI
    • ,
  • Suleiman Daifallah, MD

      Affiliations

    • John D. Dingell VA Medical Center, Detroit, MI
    • ,
  • Omaima Ali, MD

      Affiliations

    • Detroit Medical Center/Wayne State University, Detroit, MI
    • ,
  • Jalal K. Ghali, MD

      Affiliations

    • Detroit Medical Center/Wayne State University, Detroit, MI
    • Corresponding Author InformationReprint requests: Jalal K. Ghali, MD, 3990 John R, DMC Cardiovascular Institute, Suite 9370, Detroit, MI 48201. Tel: 313-745-7061; Fax: 313-745-9021.

Received 26 February 2010; received in revised form 1 September 2010; accepted 10 November 2010. published online 27 December 2010.

Abstract 

Introduction

Red-cell distribution width (RDW) has been identified as a novel prognostic marker in heart failure patients. However, evidence is limited for its predictive value in the setting of patients hospitalized with decompensated heart failure (DHF) and no data are available for African Americans (AA).

Methods and Results

Data that included baseline characteristics, laboratory findings, and discharge medications were collected retrospectively on a total of 789 patients with DHF (mean age 62.7 ± 15.1 years, 50% males and 80% AA), admitted to an urban medical center between January 2007 and August 2007, 145 (18.38%) died during median follow-up of 573 days. Unadjusted and adjusted Cox-proportional hazard models were used to analyze predictive value of discharge RDW on mortality. There was a significant negative association between RDW and statin use, blood hemoglobin levels and mean corpuscular volume (MCV); whereas serum creatinine and blood urea nitrogen (BUN) increased with increasing RDW. A statistically significant graded increase in all-cause mortality with higher RDW quartiles (lowest vs highest quartile), independent of hemoglobin and creatinine levels, was found for all patients (adjusted hazard ratio [HR] 3.21; 95% confidence interval [CI]: 1.77–5.83, P < .05) for AAs (adjusted HR 2.92; 95% CI: 1.50–5.71, P < .05) and for non-AAs (adjusted HR-1.27, 95% CI: 1.03–1.55, P = 0.019; RDW evaluated as continuous variable).

Conclusion

Discharge RDW is an independent predictor of all-cause mortality in predominantly AA patients hospitalized with DHF. Further research is warranted to delineate underlying pathophysiological mechanisms including the association between statin use and RDW.

Key Words: African American, anemia, RDW, statin

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 See page 297 for disclosure information.

PII: S1071-9164(10)01215-7

doi:10.1016/j.cardfail.2010.11.006

Journal of Cardiac Failure
Volume 17, Issue 4 , Pages 292-298, April 2011

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