Enlarging Red Blood Cell Distribution Width During Hospitalization Identifies a Very High-Risk Subset of Acutely Decompensated Heart Failure Patients and Adds Valuable Prognostic Information on Top of Hemoconcentration
| Autor: | Miguel Bento Ricardo, Irene Aragão, Etienne Gayat, Pedro Bettencourt Medeiros, Faiez Zannad, Heli Tolppanen, Alexandre Rola, João Pedro Ferreira, Christian Mueller, Mattia Arrigo, Patrick Rossignol, Nicolas Girerd, Said Laribi, Alexandre Mebazaa, Tiago Almeida |
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| Přispěvatelé: | CIC-Nancy, Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy]-Institut National de la Santé et de la Recherche Médicale (INSERM), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Université de Lorraine (UL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy] (INI-CRCT), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], Universidade do Porto [Porto], Biomarqueurs CArdioNeuroVASCulaires (BioCANVAS), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), French-Clinical Research Infrastructure Network - F-CRIN [Paris] (Cardiovascular & Renal Clinical Trialists - CRCT ), Centro Hospitalar do Porto, Service d'Anesthésie-Réanimation [AP-HP Hôpitaux Saint-Louis Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Lariboisière-Université Paris Diderot - Paris 7 (UPD7), Cardiovascular Research Institute Basel (CRIB), University Hospital Basel [Basel], University of Zurich, Ferreira, João Pedro, Centre d'investigation clinique [Nancy] (CIC), Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Universidade do Porto, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP) |
| Rok vydání: | 2016 |
| Předmět: |
Erythrocyte Indices
Male Peripheral edema 2700 General Medicine MESH: Hospitalization 030204 cardiovascular system & hematology MESH: Risk Assessment Cohort Studies 0302 clinical medicine Medicine 030212 general & internal medicine MESH: Cohort Studies MESH: Aged MESH: Follow-Up Studies General Medicine Prognosis Hemoconcentration 3. Good health Hospitalization Acute Disease ComputingMethodologies_DOCUMENTANDTEXTPROCESSING 10209 Clinic for Cardiology Cardiology MESH: Acute Disease Female medicine.symptom Risk assessment Research Article Cohort study medicine.medical_specialty Observational Study 610 Medicine & health MESH: Erythrocyte Count Risk Assessment MESH: Prognosis 03 medical and health sciences [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system Internal medicine Humans Pathological Aged Retrospective Studies Heart Failure MESH: Humans MESH: Erythrocyte Indices business.industry MESH: Retrospective Studies Retrospective cohort study Red blood cell distribution width medicine.disease MESH: Male Surgery Heart failure MESH: Heart Failure Erythrocyte Count business MESH: Female Follow-Up Studies |
| Zdroj: | Medicine Medicine, Lippincott, Williams & Wilkins, 2016, 95 (14), pp.e3307. ⟨10.1097/MD.0000000000003307⟩ Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) Agência para a Sociedade do Conhecimento (UMIC)-FCT-Sociedade da Informação instacron:RCAAP |
| ISSN: | 0025-7974 1536-5964 |
| DOI: | 10.1097/md.0000000000003307 |
| Popis: | Supplemental Digital Content is available in the text Red blood cell distribution width (RDW) may serve as an integrative marker of pathological processes that portend worse prognosis in heart failure (HF). The prognostic value of RDW variation (ΔRDW) during hospitalization for acute heart failure (AHF) has yet to be studied. We retrospectively analyzed 2 independent cohorts: Centro Hospitalar do Porto (derivation cohort) and Lariboisière hospital (validation cohort). In the derivation cohort a total of 170 patients (age 76.2 ± 10.3 years) were included and in the validation cohort 332 patients were included (age 76.4 ± 12.2 years). In the derivation cohort the primary composite outcome of HF admission and/or cardiovascular death occurred in 78 (45.9%) patients during the 180-day follow-up period. Discharge RDW and ΔRDW were both increased when hemoglobin levels were lower; peripheral edema was also associated with increased discharge RDW (all P 15% at discharge was associated with a 2-fold increase in event rate, HR = 1.95 (1.05–3.62), P = 0.04, while a ΔRDW >0 also had a strong association with outcome, HR = 2.47 (1.35–4.51), P = 0.003. The addition of both discharge RDW > 15% and ΔRDW > 0 to hemoconcentration was associated with a significant improvement in the net reclassification index, NRI = 18.3 (4.3–43.7), P = 0.012. Overlapping results were found in the validation cohort. As validated in 2 independent AHF cohorts, an in-hospital RDW enlargement and an elevated RDW at discharge are associated with increased rates of mid-term events. RDW variables improve the risk stratification of these patients on top of well-established prognostic markers. |
| Databáze: | OpenAIRE |
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