Association Between Red Cell Distribution Width and Cardiovascular Outcomes – Systematic Review and Meta-Analysis
Main Article Content
Abstract
Objective: Increased red cell distribution width (RDW) has been associated with poor prognosis in patients with heart failure (HF) and coronary heart disease (CHD) in multiple observation studies. We conducted this meta-analysis to determine composite impact of RDW on cardiovascular outcomes in patients with HF and CHD.
Methodology: Literature search of databases such as PubMed/Medline, Google Scholar, and Cochrane library was conducted from inception till 16 th August, 2020 to identify all the relevant studies reporting all-cause mortality based on the RDW levels in patients with HF and CHD (ST- elevation & non-ST elevation myocardial infarction, coronary artery disease). The data was extracted from retrieved results for performing this systematic review and meta-analysis.
Results: A total of 32 studies were included with a total of 58, 518 patients. The ages ranged from 49-80 years with males being 47%–98% in proportion. We observed that the pooled estimate of hazard ratio (HR) for all-cause mortality among patients with congestive heart failure (CHF) was 1.16 (95% CI 1.10–1.23; p <0.001), and the pooled HR for all-cause mortality among CHD patients was 1.19 (95% CI 1.09–1.29; p = 0.001) in patients with elevated RDW levels.
Conclusion: Elevated RDW levels either at the time of admission, during the course of stay in hospital, or at the time of discharge significantly correlate with the increased all-cause mortality among CHF and CHD patients. Elevated RDW can have prognostic importance in anticipating the risk of death in these subset of patients.
Keywords: Red cell distribution width; congestive heart failure; coronary artery/heart disease; all-cause mortality.
Keywords:
Red cell distribution width, congestive heart failure, coronary artery/heart disease, all-cause mortality
Article Details
How to Cite
RANKA, Sagar et al.
Association Between Red Cell Distribution Width and Cardiovascular Outcomes – Systematic Review and Meta-Analysis.
Medical Research Archives, [S.l.], v. 9, n. 7, july 2021.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/2468>. Date accessed: 05 nov. 2024.
doi: https://doi.org/10.18103/mra.v9i7.2468.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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37. Arbel Y, Shacham Y, Finkelstein A, et al. Red blood cell distribution width (RDW) and long-term survival in patients with ST elevation myocardial infarction. Thromb Res. 2014;134(5):976-979.
38. Azab B, Torbey E, Hatoum H, et al. Usefulness of red cell distribution width in predicting all-cause long-term mortality after non-ST-elevation myocardial infarction. Cardiology. 2011;119(2):72-80.
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40. Machado GP, de Araujo GN, Carpes CK, et al. Long-term Pattern of Red Cell Distribution Width in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Crit Pathw Cardiol. 2020;19(1):43-48.
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43. Yao HM, Sun TW, Zhang XJ, et al. Red blood cell distribution width and long-term outcome in patients undergoing percutaneous coronary intervention in the drug-eluting stenting era: a two-year cohort study. PLoS One. 2014;9(4):e94887.
44. Dabbah S, Hammerman H, Markiewicz W, Aronson D. Relation between red cell distribution width and clinical outcomes after acute myocardial infarction. Am J Cardiol. 2010;105(3):312-317.
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46. Uyarel H, Ergelen M, Cicek G, et al. Red cell distribution width as a novel prognostic marker in patients undergoing primary angioplasty for acute myocardial infarction. Coron Artery Dis. 2011;22(3):138-144.
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51. Felker GM, Adams KF, Jr., Gattis WA, O'Connor CM. Anemia as a risk factor and therapeutic target in heart failure. J Am Coll Cardiol. 2004;44(5):959-966.
52. Anand IS, Gupta P. Anemia and Iron Deficiency in Heart Failure: Current Concepts and Emerging Therapies. Circulation. 2018;138(1):80-98.
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57. Speidl WS, Graf S, Hornykewycz S, et al. High-sensitivity C-reactive protein in the prediction of coronary events in patients with premature coronary artery disease. Am Heart J. 2002;144(3):449-455.
58. Loprinzi PD. Comparative evaluation of red blood cell distribution width and high sensitivity C-reactive protein in predicting all-cause mortality and coronary heart disease mortality. Int J Cardiol. 2016;223:72-73.
59. Veeranna V, Zalawadiya SK, Panaich S, Patel KV, Afonso L. Comparative analysis of red cell distribution width and high sensitivity C-reactive protein for coronary heart disease mortality prediction in multi-ethnic population: findings from the 1999-2004 NHANES. Int J Cardiol. 2013;168(6):5156-5161.
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2. Felker GM, Allen LA, Pocock SJ, et al. Red cell distribution width as a novel prognostic marker in heart failure: data from the CHARM Program and the Duke Databank. J Am Coll Cardiol. 2007;50(1):40-47.
3. Tonelli M, Sacks F, Arnold M, et al. Relation Between Red Blood Cell Distribution Width and Cardiovascular Event Rate in People With Coronary Disease. Circulation. 2008;117(2):163-168.
4. van Kimmenade RR, Mohammed AA, Uthamalingam S, van der Meer P, Felker GM, Januzzi JL, Jr. Red blood cell distribution width and 1-year mortality in acute heart failure. Eur J Heart Fail. 2010;12(2):129-136.
5. Pascual-Figal DA, Bonaque JC, Redondo B, et al. Red blood cell distribution width predicts long-term outcome regardless of anaemia status in acute heart failure patients. Eur J Heart Fail. 2009;11(9):840-846.
6. Zalawadiya SK, Veeranna V, Niraj A, Pradhan J, Afonso L. Red cell distribution width and risk of coronary heart disease events. Am J Cardiol. 2010;106(7):988-993.
7. Shao Q, Korantzopoulos P, Letsas KP, et al. Red blood cell distribution width as a predictor of atrial fibrillation. Journal of clinical laboratory analysis. 2018;32(5):e22378.
8. Danese E, Lippi G, Montagnana M. Red blood cell distribution width and cardiovascular diseases. Journal of thoracic disease. 2015;7(10):E402.
9. Shah N, Pahuja M, Pant S, et al. Red cell distribution width and risk of cardiovascular mortality: Insights from National Health and Nutrition Examination Survey (NHANES)-III. Int J Cardiol. 2017;232:105-110.
10. Shao Q, Li L, Li G, Liu T. Prognostic value of red blood cell distribution width in heart failure patients: a meta-analysis. International Journal of Cardiology. 2015;179:495-499.
11. Su C, Liao L-Z, Song Y, Xu Z-W, Mei W-Y. The role of red blood cell distribution width in mortality and cardiovascular risk among patients with coronary artery diseases: a systematic review and meta-analysis. Journal of thoracic disease. 2014;6(10):1429.
12. Huang Y-L, Hu Z-D, Liu S-J, et al. Prognostic value of red blood cell distribution width for patients with heart failure: a systematic review and meta-analysis of cohort studies. PLoS One. 2014;9(8):e104861.
13. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.
14. Lahan S, Ranka S, Dalia T, Goyal A, Moriarty P. THE ASSOCIATION BETWEEN RED CELL DISTRIBUTION WIDTH AND CARDIOVASCULAR OUTCOMES-A METANALYSIS. Journal of the American College of Cardiology. 2021;77(18_Supplement_1):1629-1629.
15. Biomedicine IoMUCotSaEIoDi. Society's Choices: Social and Ethical Decision Making in Biomedicine. Washington (DC): National Academic Press (US); 1995.
16. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg. 2003;73(9):712-716.
17. Deeks JJ, Higgins J, Altman DG. Cochrane Training. Chapter 10.3.: Analysing data and undertaking meta-analyses. https://training.cochrane.org/handbook/current/chapter-10#section-10-3 Accessed.
18. IntHout J, Ioannidis JP, Borm GF. The Hartung-Knapp-Sidik-Jonkman method for random effects meta-analysis is straightforward and considerably outperforms the standard DerSimonian-Laird method. BMC Med Res Methodol. 2014;14:25.
19. Balduzzi S, Rucker G, Schwarzer G. How to perform a meta-analysis with R: a practical tutorial. Evid Based Ment Health. 2019;22(4):153-160.
20. W V. Conducting Meta-Analyses in R with the metafor Package. Journal of Statistical Software. 2010;36(3):1-48.
21. Al-Najjar Y, Goode KM, Zhang J, Cleland JG, Clark AL. Red cell distribution width: an inexpensive and powerful prognostic marker in heart failure. Eur J Heart Fail. 2009;11(12):1155-1162.
22. Allen LA, Felker GM, Mehra MR, et al. Validation and potential mechanisms of red cell distribution width as a prognostic marker in heart failure. J Card Fail. 2010;16(3):230-238.
23. Bonaque JC, Pascual-Figal DA, Manzano-Fernandez S, et al. Red blood cell distribution width adds prognostic value for outpatients with chronic heart failure. Rev Esp Cardiol (Engl Ed). 2012;65(7):606-612.
24. Cauthen CA, Tong W, Jain A, Tang WH. Progressive rise in red cell distribution width is associated with disease progression in ambulatory patients with chronic heart failure. J Card Fail. 2012;18(2):146-152.
25. Jackson CE, Dalzell JR, Bezlyak V, et al. Red cell distribution width has incremental prognostic value to B-type natriuretic peptide in acute heart failure. Eur J Heart Fail. 2009;11(12):1152-1154.
26. Lappe J, Anderson J, Kfoury A, et al. The Red Cell Distribution Width Predicts 30-Day Readmission Risk among Patients with a Primary Diagnosis of Heart Failure. J Am Coll Cardiol. 2013;61(10).
27. Makhoul BF, Khourieh A, Kaplan M, Bahouth F, Aronson D, Azzam ZS. Relation between changes in red cell distribution width and clinical outcomes in acute decompensated heart failure. Int J Cardiol. 2013;167(4):1412-1416.
28. Melchio R, Rinaldi G, Testa E, et al. Red cell distribution width predicts mid-term prognosis in patients hospitalized with acute heart failure: the RDW in Acute Heart Failure (RE-AHF) study. Intern Emerg Med. 2019;14(2):239-247.
29. Oh J, Kang SM, Won H, et al. Prognostic value of change in red cell distribution width 1 month after discharge in acute decompensated heart failure patients. Circ J. 2012;76(1):109-116.
30. Rickard J, Kumbhani DJ, Gorodeski EZ, et al. Elevated red cell distribution width is associated with impaired reverse ventricular remodeling and increased mortality in patients undergoing cardiac resynchronization therapy. Congest Heart Fail. 2012;18(2):79-84.
31. Topaz G, Haim M, Kusniec J, et al. Association between Red Cell Distribution Width and Mortality after Cardiac Resynchronization Therapy. Isr Med Assoc J. 2015;17(8):505-509.
32. Tseliou E, Terrovitis JV, Kaldara EE, et al. Red blood cell distribution width is a significant prognostic marker in advanced heart failure, independent of hemoglobin levels. Hellenic J Cardiol. 2014;55(6):457-461.
33. Forhecz Z, Gombos T, Borgulya G, Pozsonyi Z, Prohaszka Z, Janoskuti L. Red cell distribution width in heart failure: prediction of clinical events and relationship with markers of ineffective erythropoiesis, inflammation, renal function, and nutritional state. Am Heart J. 2009;158(4):659-666.
34. Aung N, Ling HZ, Cheng AS, et al. Expansion of the red cell distribution width and evolving iron deficiency as predictors of poor outcome in chronic heart failure. Int J Cardiol. 2013;168(3):1997-2002.
35. Jung C, Fujita B, Lauten A, et al. Red blood cell distribution width as useful tool to predict long-term mortality in patients with chronic heart failure. Int J Cardiol. 2011;152(3):417-418.
36. Yu SB, Cui HY, Qin M, et al. [Impact of red cell distribution width on outcome of 16 681 patients with chronic systolic heart failure]. Zhonghua Xin Xue Guan Bing Za Zhi. 2012;40(3):237-242.
37. Arbel Y, Shacham Y, Finkelstein A, et al. Red blood cell distribution width (RDW) and long-term survival in patients with ST elevation myocardial infarction. Thromb Res. 2014;134(5):976-979.
38. Azab B, Torbey E, Hatoum H, et al. Usefulness of red cell distribution width in predicting all-cause long-term mortality after non-ST-elevation myocardial infarction. Cardiology. 2011;119(2):72-80.
39. Gijsberts CM, den Ruijter HM, de Kleijn DP, et al. Hematological Parameters Improve Prediction of Mortality and Secondary Adverse Events in Coronary Angiography Patients: A Longitudinal Cohort Study. Medicine (Baltimore). 2015;94(45):e1992.
40. Machado GP, de Araujo GN, Carpes CK, et al. Long-term Pattern of Red Cell Distribution Width in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Crit Pathw Cardiol. 2020;19(1):43-48.
41. Osadnik T, Strzelczyk J, Hawranek M, et al. Red cell distribution width is associated with long-term prognosis in patients with stable coronary artery disease. BMC Cardiovasc Disord. 2013;13:113.
42. Sahin O, Akpek M, Sarli B, et al. Association of red blood cell distribution width levels with severity of coronary artery disease in patients with non-ST elevation myocardial infarction. Med Princ Pract. 2015;24(2):178-183.
43. Yao HM, Sun TW, Zhang XJ, et al. Red blood cell distribution width and long-term outcome in patients undergoing percutaneous coronary intervention in the drug-eluting stenting era: a two-year cohort study. PLoS One. 2014;9(4):e94887.
44. Dabbah S, Hammerman H, Markiewicz W, Aronson D. Relation between red cell distribution width and clinical outcomes after acute myocardial infarction. Am J Cardiol. 2010;105(3):312-317.
45. Lee JH, Yang DH, Jang SY, et al. Incremental predictive value of red cell distribution width for 12-month clinical outcome after acute myocardial infarction. Clin Cardiol. 2013;36(6):336-341.
46. Uyarel H, Ergelen M, Cicek G, et al. Red cell distribution width as a novel prognostic marker in patients undergoing primary angioplasty for acute myocardial infarction. Coron Artery Dis. 2011;22(3):138-144.
47. Li N, Zhou H, Tang Q. Red blood cell distribution width: a novel predictive indicator for cardiovascular and cerebrovascular diseases. Disease markers. 2017;2017.
48. Bazick HS, Chang D, Mahadevappa K, Gibbons FK, Christopher KB. Red Cell Distribution Width and all cause mortality in critically ill patients. Critical care medicine. 2011;39(8):1913.
49. Hou H, Sun T, Li C, et al. An overall and dose-response meta-analysis of red blood cell distribution width and CVD outcomes. Scientific reports. 2017;7(1):1-10.
50. Rymer JA, Rao SV. Anemia and coronary artery disease: pathophysiology, prognosis, and treatment. Coron Artery Dis. 2018;29(2):161-167.
51. Felker GM, Adams KF, Jr., Gattis WA, O'Connor CM. Anemia as a risk factor and therapeutic target in heart failure. J Am Coll Cardiol. 2004;44(5):959-966.
52. Anand IS, Gupta P. Anemia and Iron Deficiency in Heart Failure: Current Concepts and Emerging Therapies. Circulation. 2018;138(1):80-98.
53. Levine B, Kalman J, Mayer L, Fillit HM, Packer M. Elevated circulating levels of tumor necrosis factor in severe chronic heart failure. N Engl J Med. 1990;323(4):236-241.
54. Munger MA, Johnson B, Amber IJ, Callahan KS, Gilbert EM. Circulating concentrations of proinflammatory cytokines in mild or moderate heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol. 1996;77(9):723-727.
55. Tousoulis D, Oikonomou E, Economou EK, Crea F, Kaski JC. Inflammatory cytokines in atherosclerosis: current therapeutic approaches. Eur Heart J. 2016;37(22):1723-1732.
56. Tsutsui H, Kinugawa S, Matsushima S. Oxidative stress and heart failure. American Journal of Physiology-Heart and Circulatory Physiology. 2011.
57. Speidl WS, Graf S, Hornykewycz S, et al. High-sensitivity C-reactive protein in the prediction of coronary events in patients with premature coronary artery disease. Am Heart J. 2002;144(3):449-455.
58. Loprinzi PD. Comparative evaluation of red blood cell distribution width and high sensitivity C-reactive protein in predicting all-cause mortality and coronary heart disease mortality. Int J Cardiol. 2016;223:72-73.
59. Veeranna V, Zalawadiya SK, Panaich S, Patel KV, Afonso L. Comparative analysis of red cell distribution width and high sensitivity C-reactive protein for coronary heart disease mortality prediction in multi-ethnic population: findings from the 1999-2004 NHANES. Int J Cardiol. 2013;168(6):5156-5161.
60. Moriarty PM, Steg PG, Gorby LK, et al. Relation of Red Blood Cell Distribution Width to Risk of Major Adverse Cardiovascular Events, Death, and Effect of Alirocumab After Acute Coronary Syndrome. Circulation. 2019;140.
61. Bujak K, Wasilewski J, Osadnik T, et al. The prognostic role of red blood cell distribution width in coronary artery disease: a review of the pathophysiology. Disease markers. 2015;2015.
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