Early in-hospital variation of red blood cell distribution width predicts mortality in patients with acute heart failure

Background: Some studies showed that the value of red blood cell distribution width (RDW) at admission may predict clinical outcomes in patients with acutely decompensated heart failure (ADHF). Therefore, this study was planned to investigate whether in-hospital variations of RDWmay also predict mortality in this condition. Methods: The final study population consisted of 588 patients admitted to the local Emergency Department (ED), who were hospitalized for ADHF. The RDW was measured at ED admission and after 48 h and 96 h of hospital stay. In-hospital variations from admission value, expressed as absolute variation (DeltaRDW) or percent variation (Delta% RDW), were then correlated with 30- and 60-day mortality. Results: Overall, 87 (14.8%) and 118 (20.1%) patients with ADHF died at 30 or 60 days of follow-up. Delta% RDW after 96 h of hospital stay independently predicted 30-day mortality (odds ratio, 1.12; 95% CI, 1.07-1.18). An increase N1% of Delta% RDWafter 96 h of hospital stay independently predicted both 30-day (odds ratio, 2.86; 95% CI, 1.67-4.97) and 60-day (odds ratio, 3.06; 95% CI, 1.89-4.96) mortality. A similar trend was observed for DeltaRDW, since an increase after 96 h of hospital stay was associatedwith a nearly 4-fold higher 30-day mortality (odds ratio, 3.65; 95% CI, 2.02-6.15). Conclusion: Despite it remains unclear whether RDW is a real risk factor or an epiphenomenon in ADHF, these results suggest that more aggressive management may be advisable in ADHF patients with increasing anisocytosis during the first days of hospitalization. (C) 2017 Elsevier B.V. All rights reserved.