Usefulness of initial red blood cell distribution width as a prognostic factor for predicting 30-day mortality in acute decompensated heart failure patients

Ahn, Tae Kyu; Ham, Eun Mi; Pyo, Chang Hae; Choi, Han Jo; Park, Sang Hyun; Park, Keun Hong; Kim, Hahn Bom; Oh, Sang Hee

J Korean Soc Emerg Med > Volume 30(3); 2019 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2019;30(3): 217-223.

응급의료센터에 내원한 급성 비대상성 심부전 환자의 초기 적혈구 분포 계수를 이용한 30일 사망률 예측의 유용성

안태규¹

¹서울특별시 서울의료원 응급의학과
²서울특별시 서남병원 응급의학과

Usefulness of initial red blood cell distribution width as a prognostic factor for predicting 30-day mortality in acute decompensated heart failure patients

¹Department of Emergency Medicine, Seoul Medical Center, Seoul, Korea
²Department of Emergency Medicine, Seonam Hospital, Seoul, Korea

Correspondence

Eun Mi Ham ,Tel: 02-2276-7424, Fax: 02-2276-7418, Email: lkitty99@naver.com,

Received: September 5, 2018; Revised: October 26, 2018 Accepted: October 26, 2018. Published online: June 30, 2019.

ABSTRACT

Objective:
This study evaluated the efficacy of the initial red blood cell distribution width (RDW) level in the emergency department (ED) to predict the 30-day mortality in patients with acute decompensated heart failure (ADHF).
Method:
A retrospective analysis study of patients who visited the ED and were diagnosed with ADHF from January 2015 to December 2016 was conducted. The patients were divided into the 30-day survival group and non-survival group. The data were obtained from the medical records of the patients, and the blood test results were taken from the initial blood test at the ED. The data and blood test results were compared between the 30-day survival and non-survival groups. Multivariate logistic regression analysis was performed to determine the risk factors for mortality.
Results:
A total of 626 patients were included. The mean age was 78.5 years and the overall mortality was 15.5%. The non-survival group had higher RDW levels than the survival group (18.0% vs. 14.6%). In a multivariate logistic regression analysis, RDW (odds ratio, 2.242; 95% confidence interval [CI], 1.673-3.005; P<0.001) were considered to be a useful factor for predicting the prognosis. The area under the receiver operating characteristic curve of RDW to predict mortality was 0.848 (95% CI, 0.811-0.886; P<0.001), and the sensitivity and specificity of predicting mortality was 76.3% and 78.1%, respectively, after setting the RDW cutoff value to 15.95%.
Conclusion:
The initial RDW level is a useful prognostic marker for predicting the 30-day mortality in ADHF patients.

Key words: Heart failure; Mortality; Red cell index