The Ratio of Hemoglobin to Red Cell Distribution Width: A Strong Predictor of Clinical Outcome in Patients with Heart Failure

• Published in: Journal of clinical medicine Vol. 11; no. 3; p. 886
• Main Authors: Rahamim, Eldad, Zwas, Donna R, Keren, Andre, Elbaz-Greener, Gabby, Ibrahimli, Mahsati, Amir, Offer, Gotsman, Israel
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 08-02-2022; MDPI
• Subjects: Anemia; Blood; Clinical medicine; Clinical outcomes; Ejection fraction; Health maintenance organizations; Health services; Heart failure; Hemoglobin; HMOs; Hospitalization; Iron; Laboratories; Mortality; Oxidative stress; Regression analysis; Israel; heart failure; prognosis; hemoglobin; outcome; red cell distribution width
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm11030886

Hemoglobin (Hb) is a standard and widely available clinical parameter that predicts clinical outcomes in heart failure (HF) patients. Red cell distribution width (RDW) is also a routinely measured clinical parameter that is predictive of clinical outcomes in HF. The ratio between Hb and RDW has yet to be evaluated in HF.
We evaluated the predictive value of the Hb/RDW ratio on clinical outcomes in patients with HF. All patients diagnosed with chronic HF at a health maintenance organization were evaluated for Hb/RDW ratio and followed for cardiac-related hospitalizations and death.
The study cohort included 6888 HF patients. The mean Hb/RDW ratio was 0.85 ± 0.18; median was 0.85 (interquartile range 0.72-0.98). Patients with a lower Hb/RDW ratio were more likely to be women and had more comorbidities. The overall two year-mortality rate was 23.2%. Decreasing quantiles of the Hb/RDW ratio were associated with reduced survival rates and reduced event-free survival from death or cardiovascular-hospitalizations. Multivariable Cox regression analysis after adjustment for significant predictors demonstrated that low Hb/RDW ratio was a significant predictor of mortality, with a graded increased risk as Hb/RDW ratio decreased. Lower Hb/RDW ratio was also a significant independent predictor of the combined endpoint of death or cardiovascular hospitalizations. A sensitivity analysis evaluating Hb/RDW ratio as a continuous parameter using restricted cubic splines demonstrated a continuous increase in the mortality risk with decreasing Hb/RDW ratio,
< 0.0001 for the linear model.
Hb/RDW ratio is a significant prognostic tool for predicting HF mortality and cardiovascular hospitalizations.