Abstract 16996: Red Cell Distribution Width and C-Reactive Protein in Predicting Mortality in Patients with Coronary Disease and in a Normal Comparison Population
Background: The red cell distribution width (RDW) is associated with increased morbidity and mortality in patients with coronary artery disease (CAD) and heart failure. Early evidence linking an elevated RDW with other factors is equivocal. This study evaluated the association of RDW with mortality with adjustment for high-sensitivity C-reactive protein (hsCRP), complete blood count (CBC) components, and other factors.
Methods: The association of RDW with all-cause mortality was assessed in 1,489 patients with angiographically-defined CAD. Patients were followed for an average of 9.8±2.0 years (range: 4.6-15.0 years) and 39% (n=578) died. Correlations of RDW with hsCRP, albumin, creatinine, BUN, and the other CBC components were assessed and Cox regression was used for survival analysis. The association of RDW with all-cause mortality among 449 normal (non-CAD) patients was evaluated for comparison.
Results: RDW quintiles strongly predicted all-cause mortality in a step-wise manner (HR=1.37 per quintile; 95% CI=1.29, 1.46; p-trend<0.001). A statistically significant but not meaningful correlation between RDW and hsCRP was found (r=0.181; p-trend<0.001). After adjustment for hsCRP, demographics, coronary risk factors, and treatments, RDW remained significant (HR=1.33 per quintile, CI=1.25, 1.41; p-trend<0.001) and the strongest predictor of mortality in the model. HsCRP also predicted mortality in that model (HR=1.18 per quintile, p-trend<0.001). RDW was not correlated with any other study variable and adjustment for those factors had only minor effects on the RDW-mortality association: HR=1.24 per quintile for RDW with BUN added to the hsCRP/clinical factors model, HR=1.31 per quintile with albumin, HR=1.28 per quintile with creatinine, and HR=1.33 per quintile with the other CBC components. RDW also predicted all-cause mortality in normal patients despite multivariable adjustments (HR=1.33 per quintile, p-trend<0.001).
Conclusions: RDW is associated with a strong graded risk of mortality in patients with CAD. HsCRP-associated inflammation, markers of liver and renal function, and hematological factors (i.e., CBC) did not drive the RDW elevation or associated mortality risk.
- © 2010 by American Heart Association, Inc.