Clin Res Cardiol 100, Suppl 1, April 2011

P399 - Red Blood Cell Distribution Width as Useful Tool to Predict Long-term Mortality in Patients with Chronic Heart Failure
C. Jung1, A. Lauten1, M. Fritzenwanger1, M. Ferrari1, M. Kiehntopf2, B. Fujita1, F. Kuethe1, H.-R. Figulla1
1Klinik für Innere Medizin I, Universitätsklinikum Jena, Jena; 2Universitätsklinikum Jena, Jena;
Objectives: Low blood hemoglobin content has been identified to be highly prevalent and to be associated with poor outcome in patients with chronic heart failure (CHF). The etiology of anemia in patients with CHF is multifactorial, although iron deficiency was confirmed to be the most common cause.  Red blood cell distribution width (RDW) is a measure of the variability in size of circulating erythrocytes and is expressed as the coefficient of variation of the erythrocyte size and therefore this parameter was tested to predict outcome.
Methods: Patients with CHF admitted electively in our referral heart failure centre were recruited between 1999 and 2005. The criteria for study inclusion were: a documented history of CHF of ≥6 months and clinical stability. The primary endpoint was all-cause death or heart transplantation (HTX, whatever occurred first). RDW was measured according the internal hospital standards. Kaplan-Meier curves for cumulative survival were constructed for the different variables. The associations between analyzed variables and survival were established using multivariate Cox proportional hazards analyses, including the following parameters as potential predictors: age, sex, BMI, NYHA class, hemoglobin, and RDW, CRP, erythrocyte sedimation rate (ESR). 
Results: 354 patients included into the study (268 males, median age: 49years). The mean follow-up was 2430 (6.6 years) ± 350 days (median 2579 days, range: 1-4573 days). The proportion of patients surviving free from HTX was 70%.  In multivariate Cox proportional hazard regression models, the following variables were shown to predict increased rate of death or HTX: age (Hazard ratio (HR): 1.040 (Confidence interval: 1.002-1.081), p<0.041, per year), and RDW (HR: 1.527 (CI: 1.274-1.831), p<0.001, per 1.0). Sex, weight, NYHA class, hemoglobin, CRP and ESR were not significant. Considering the 50th percentile, RDW predicts mortality, in contrast to hemoglobin (RDW: p<0.001, hemoglobin: not significant). 
Conclusions: In this study RDW was confirmed as independent and most powerful predictor of long-term mortality in chronic heart failure patients. Due to the inexpensive nature of the test as part of a complete blood count RDW has the potential to be used to estimate the prognosis by family physicians and in heart failure clinics. This might be explained by the fact that alternations of RDW also occur with inflammation, ineffective erythropoiesis, undernutrition, and impaired renal function. RDW has the potential to indicate poor prognosis and accompanying comorbidities.
Clin Res Cardiol 100, Suppl 1, April 2011
Zitierung mit Vortrags- oder Posternummer s.o.
DOI 10.1007/s00392-011-1100-y