Expansion of the red cell distribution width and evolving iron deficiency as predictors of poor outcome in chronic heart failure
| Autor: | Julia Flint, Mohammed Rashid, Martin Thomas, Darlington O. Okonko, Toby Richards, Hua Zen Ling, Swan Kang, Caroline J. Coats, Adrian S. H. Cheng, Susanne Weissert, Nay Aung, Suneil Aggarwal, Michelle Mendonca, Simon Woldman |
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| Rok vydání: | 2013 |
| Předmět: |
Erythrocyte Indices
Male Pediatrics medicine.medical_specialty Time Factors Anemia Iron Cell volume Risk Factors Internal medicine medicine Humans In patient Aged Retrospective Studies Heart Failure Anemia Iron-Deficiency business.industry RED-CELL INDICES Red blood cell distribution width Iron deficiency Prognosis medicine.disease United Kingdom Survival Rate Heart failure Erythrocyte Count Cardiology Female Risk of death Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | International Journal of Cardiology. 168:1997-2002 |
| ISSN: | 0167-5273 |
| DOI: | 10.1016/j.ijcard.2012.12.091 |
| Popis: | An elevated red cell distribution width (RDW) and iron deficiency (ID) at baseline predict enhanced mortality in chronic heart failure (CHF), but little is known about the prognostic implications of their temporal trends. We sought to determine the survival implications of temporal changes in RDW and evolving ID in patients with CHF.The relation between red cell indices on first consultation and over time with mortality in 274 stable patients with systolic CHF was analysed. The combination of a rising RDW with a falling mean cell volume (MCV) over time defined evolving ID.Over a median 12 month period, 51% and 23% of patients had a rise in RDW and evolving ID, respectively. After a median follow-up of 27 months, 60 (22%) patients died. A rising RDW predicted enhanced all-cause mortality (unadjusted HR for 1% per week rise 9.27, 95% CI 3.58 to 24.00, P0.0001) independently and incrementally to baseline RDW, with an absolute increase0.02% per week optimally predictive. Evolving ID also related to higher rates of mortality (HR 2.78, 95% CI 1.64 to 4.73, P0.001) and was prognostically worse than a rising RDW alone (P0.005). Patients with evolving ID who maintained their Hb levels over time had a 2-fold greater risk of death than those whose Hb levels declined without evolving ID.An expanding RDW and evolving iron deficiency over time predict an amplified risk of death in CHF and should be utilised for risk stratification and/or therapeutically targeted to potentially improve outcomes. |
| Databáze: | OpenAIRE |
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