Red cell distribution width as a prognostic marker for patients with heart failure

Introduction: Heart failure (HF) is among the increasing concerns in the Indian population. Since HF shows close association with increasing inflammation, the present study was conducted with an aim to study the role of red cell distribution width (RDW) as a prognostic marker for heart failure (HF) and to correlate RDW with severity of HF and outcomes. Materials and Methods: A cross-sectional observational study was done on 100 adult patients with HF. Demographic, clinical, comorbidities, and New York Heart Association (NYHA) grading were noted. Laboratory investigations included complete blood counts, troponin T, RDW, NT-proBNP, and kidney function test. Electrocardiogram and echocardiography were done. The outcomes noted were intensive care unit admission, use of mechanical ventilation, duration of hospital stay, and in-hospital mortality. Association of RDW with outcomes was assessed. Results: Patients with HF had reduced ejection fraction in 81% of cases and preserved ejection fraction in 19% of cases. The rate of in-hospital mortality was 2%. The mean duration of hospital stay was 4.71 +/- 2.68 days. RDW showed a significant association with dyspnea NYHA grade (P = 0.002) and fatigue NYHA grade (P = 0.006). RDW was significantly higher in HF with reduced ejection fraction as compared to HF with preserved ejection fraction (16.47 +/- 2 vs. 15.09 +/- 1.7, P = 0.007). At the cutoff value of >17.4%, RDW proved to be the significant predictor of in-hospital mortality with area under the curve of 0.801 to accurately predict in-hospital mortality. Conclusion: RDW independently predicts outcomes in critically ill HF patients. RDW proved to be a predictor of preserved and reduced ejection fraction and hospital mortality. The prognostic significance of RDW suggests that RDW can help with risk stratification upon admission and for prognostication of mortality in patients with HF. The core competencies addressed in this article are: Patient care, Medical knowledge, Systems-based practice, and Practice-based learning and improvement.