There is limited evidence for the correlation between short‐term mortality and red cell distribution width (RDW) in critical patients with heart failure. Herein, a retrospective cohort study was conducted to investigate whether RDW was independently associated with short‐term mortality in critically ill patients with heart failure.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/ehf2.14023

Red cell distribution width is associated with short‐term mortality in critically ill patients with heart failure

AIMS
A high red blood cell distribution width (RDW) at admission or discharge is associated with a worse prognosis in hospitalized patients with heart failure (HF), and the prognostic value of the in-hospital change in RDW (∆RDW) remains debatable.


METHODS AND RESULTS
We included 5514 patients with critical illness and HF from the MIMIC-IV database. The ΔRDW was calculated by the RDW at discharge minus that at admission. Clinical outcomes included all-cause mortality at 90 day, 180 day, and 1 year after discharge. The median age of the patients was 73.91 years, and 46.37% were women. Kaplan-Meier curve and Cox regression analyses were used to examine the association between the ΔRDW and all-cause mortality at different time points. A multivariable Cox proportional hazard model showed that the ΔRDW (per 1% increase) was independently associated with all-cause mortality at 90 day, 180 day, and 1 year after adjusting for confounding factors (hazard ratio [HR] = 1.17, 95% confidence interval [CI] = 1.13-1.21, P < 0.001; HR = 1.17, 95% CI = 1.14-1.20, P < 0.001; and HR = 1.18, 95% CI = 1.15-1.20, P < 0.001, respectively). Restricted cubic splines showed a non-linear relationship between the ΔRDW and the risk of clinical outcomes. High ΔRDW was associated with a high risk of mortality at different time points. A subgroup analysis showed that this positive association remained consistent in pre-specified subgroups.


CONCLUSIONS
Our study suggests that an increased RDW during hospitalization is independently associated with short- or long-term all-cause mortality in critical-ill patients with HF.

In-hospital changes in the red blood cell distribution width and mortality in critically ill patients with heart failure.

Abstract Background The red cell distribution width (RDW) reflects the degree of heterogeneity of red blood cells. Elevated RDW is associated both with frailty and with increased mortality in hospital-admitted patients. In this study we evaluate whether high RDW values are associated with mortality in older emergency department (ED) patients with frailty, and if the association is independent of the degree of frailty. Methods We included ED patients with the following criteria: ≥ 75 years of age, Clinical Frailty Scale (CFS) score of 4 to 8, and RDW % measured within 48 h of ED admission. Patients were allocated to six classes by their RDW value: ≤ 13%, 14%, 15%, 16%, 17%, and ≥ 18%. The outcome was death within 30 days of ED admission. Crude and adjusted odds ratios (OR) with 95% confidence intervals (CI) for a one-class increase in RDW for 30-day mortality were calculated via binary logistic regression analysis. Age, gender and CFS score were considered as potential confounders. Results A total of 1407 patients (61.2% female), were included. The median age was 85 with an inter-quartile range (IQR) of 80–89, median CFS score 6 (IQR: 5–7), and median RDW 14 (IQR: 13–16). Of the included patients, 71.9% were admitted to hospital wards. A total of 85 patients (6.0%) died during the 30-day follow-up. Mortality rate was associated with RDW increase ( p for trend &lt; .001). Crude OR for a one-class increase in RDW for 30-day mortality was 1.32 (95% CI: 1.17–1.50, p &lt; .001). When adjusted for age, gender and CFS-score, OR of mortality for one-class RDW increase was still 1.32 (95% CI: 1.16–1.50, p &lt; .001). Conclusion Higher RDW values had a significant association with increased 30-day mortality risk in frail older adults in the ED, and this risk was independent of degree of frailty. RDW is a readily available biomarker for most ED patients. It might be beneficial to include it in risk stratification of older frail ED patients to identify those who could benefit from further diagnostic assessment, targeted interventions, and care planning. 

/pdf/red-cell-distribution-width-and-mortality-in-older-patients-3fksphn6.pdf

Red cell distribution width and mortality in older patients with frailty in the emergency department

Acute upper gastrointestinal bleeding (UGIB) is a common life-threatening clinical emergency with a poor prognosis. The aim of this study was to develop a risk prediction model for in-hospital mortality in patients with UGIB. We performed a post hoc analysis of a publicly available retrospective clinical data. A total of 360 patients with UGIB were included in this study. The least absolute shrinkage and selection operator regression was used to screen predictors and a restricted cubic spline function was used to investigate the assumption of linear relationships between continuous predictors and the risk of in-hospital mortality. Backward stepwise selection with the Akaike information criterion was used to identify variables for the best prediction model. A nomogram was developed based on the results of the best prediction model. The receiver operating characteristic curve, GiViTI calibration plot, and decision curve analysis were used to evaluate the performance of the nomogram. The optimal prediction model consisting of 4 predictors: red cell distribution width (odds ratio [OR] = 8.44; 95% confidence interval [CI]: 1.77-89.10), platelet count (OR = 0.99; 95% CI: 0.99-1.00), pulse rate (OR = 1.03; 95% CI: 1.01-1.05), and SpO2 (OR = 0.92; 95% CI: 0.86-0.96). The nomogram model had good discrimination (area under the curve  =  0.86, 95% CI: 0.78-0.95), calibration, and clinical usefulness. In this study, we developed a nomogram model for predicting death during hospitalization in patients with UGIB based on blood biomarkers and baseline vital signs at the time of admission. The model has good performance, allowing rapid risk stratification of patients with UGIB.

Development and Validation of a Risk Prediction Model for In-Hospital Mortality in Patients With Acute Upper Gastrointestinal Bleeding

This comprehensive review explores the intricate aspects of left ventricular thrombus (LVT), a potential complication in both ischemic and non-ischemic cardiomyopathies. It provides a thorough understanding of left ventricular thrombus, revealing its uncommon incidence in the general population (7 cases per 10,000 patients), predominantly linked to ischemic heart diseases (ICMs) at an 80% prevalence rate. Diagnostic tools, notably transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (CMR), demonstrate varying sensitivity but remain indispensable in specific clinical contexts related to LVT as non-invasive diagnostic modalities. A detailed comparison between ICM patients and those with non-ischemic cardiomyopathy (NICM) who have left ventricular thrombus reveals subtle distinctions with significant clinical implications. This analysis underscores the importance of these imaging techniques in distinguishing between the two conditions. Additionally, we explored the occurrence of LVT in specific non-ischemic cardiomyopathies, including Takotsubo syndrome, hypertrophic cardiomyopathy, eosinophilic myocarditis, Chagas disease, cardiac amyloidosis, and several other conditions. The article further delves into anticoagulation strategies, thoroughly examining their impact on LVT regression and patient outcomes. Pharmacological interventions, with a focus on direct oral anticoagulants, emerge as promising alternatives; however, there is insufficient information on their efficiency and safety, especially in NICM population. In conclusion, this review highlights the complex nature of LVT, incorporating a range of etiopathogenic factors, diagnostic complexities, and evolving therapeutic approaches. It emphasizes the pressing need for ongoing research in this field.

Emerging Trends in Left Ventricular Thrombus: A Comprehensive Review of Non-Ischemic and Ischemic Cardiopathies, Including Eosinophilic Myocarditis, Chagas Cardiomyopathy, Amyloidosis, and Innovative Anticoagulant Approaches

Objective: Although influenza vaccination reduces the risk of atrial fibrillation (AF), its protective effect in patients with gout remains unclear. The present study aimed to evaluate the protective effect of influenza vaccination in patients with gout. Methods: A total of 26,243 patients with gout, aged 55 and older, were enrolled from the National Health Insurance Research Database (NHIRD) between 1 January 2001, and 31 December 2012. The patients were divided into vaccinated (n = 13,201) and unvaccinated groups (n = 13,042). After adjusting comorbidities, medications, sociodemographic characteristics, the risk of AF during follow-up period was analyzed. Results: In influenza, non-influenza seasons and all seasons, the risk of AF was significantly lower in vaccinated than in unvaccinated patients (Adjust hazard ratio [aHR]: 0.59, 95% confidence interval [CI]: 0.50–0.68; aHR: 0.50, 95% CI: 0.42–0.63; aHR: 0.55, 95% CI: 0.49–0.62, respectively). In addition, the risk of AF significantly decreased with increased influenza vaccination (aHR: 0.85, 95% CI: 0.69–1.04; aHR: 0.72, 95% CI: 0.60–0.87; aHR: 0.40, 95% CI: 0.33–0.49, after first, 2–3 times, and ≥4 times of vaccination, respectively). Furthermore, sensitivity analysis indicated that the risk of AF significantly decreased after influenza vaccination for patients with different sexes, medication histories, and comorbidities. Conclusions: Influenza vaccination is associated with a lower risk of AF in patients with gout. This potentially protective effect seems to depend on the dose administered.

Influenza vaccination and risk of atrial fibrillation in patients with gout: A nationwide population-based cohort study

Peripartum cardiomyopathy (PPCM) is a form of heart failure that severely affects women during the late stages of pregnancy and in the postpartum period. Currently, the diagnosis of PPCM is not fully understood and is likely multifactorial. Abnormal lipid metabolism plays an important role in the onset of cardiovascular diseases, especially in patients with heart failure. Moreover, animal experiments have confirmed a possible association between abnormal lipid metabolism and PPCM onset. However, clinical evidence is currently lacking, and reliable and effective indicators for predicting the onset of PPCM are insufficient. The ratio of triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) is a novel metabolic marker that is associated with the risk of coronary heart disease. However, the relationship between the TG/HDL-C ratio and the risk of PPCM in parturients remains unknown. Therefore, this study aimed to explore the role of the TG/HDL-C ratio in predicting the risk of PPCM.This study included 600 parturients hospitalized at Qilu Hospital of Shandong University between January 2010 and August 2023 (150 patients with PPCM and 450 healthy parturients). The TG/HDL-C ratio was calculated as triglyceride levels (mmol/L)/high-density lipoprotein cholesterol levels (mmol/L). The relationship between the TG/HDL-C ratio and PPCM was analyzed using logistic regression analysis and receiver operating characteristic curve analysis.Significant differences were observed in the TG/HDL-C ratio between patients with PPCM and healthy parturients. The TG/HDL-C ratio was higher in patients with PPCM than in healthy parturients (p < 0.001). Logistic regression analysis revealed that the TG/HDL-C ratio increased the risk of PPCM and had predictive accuracy for the onset of PPCM (odds ratio, 1.249; 95% confidence interval, 1.004–1.553; p = 0.046). Moreover, the TG/HDL-C ratio was positively correlated with the NT-proBNP levels at the onset of PPCM (R2 = 0.081, p = 0.008).A higher TG/HDL-C ratio was significantly associated with the risk of PPCM.

The triglyceride-to-high-density lipoprotein cholesterol ratio is associated with an increased risk of peripartum cardiomyopathy

Peripartum cardiomyopathy (PPCM) are more vulnerable to intracardiac thrombus than other types of cardiomyopathies, although explicit anticoagulant strategy is not sure. Too aggressive anticoagulation therapy can lead to severe bleeding events. Hence, we want to construct a risk stratification model for intracardiac thrombus in PPCM patients.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/ehf2.14158

Risk factors for intracardiac thrombus in peripartum cardiomyopathy: a retrospective study in China

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Papers

Red cell distribution width is associated with short‐term mortality in critically ill patients with heart failure

Influenza vaccination and risk of atrial fibrillation in patients with gout: A nationwide population-based cohort study

The triglyceride-to-high-density lipoprotein cholesterol ratio is associated with an increased risk of peripartum cardiomyopathy

Risk factors for intracardiac thrombus in peripartum cardiomyopathy: a retrospective study in China