Prognostic Value of Red Blood Cell Distribution Width Combined with Chloride in Predicting Short- and Long-term Mortality in Critically Ill Patients with Congestive Heart Failure: Findings from the MIMIC-IV Database

Overview

Journal Heliyon

Specialty Social Sciences

Date 2024 Jan 16

PMID 38226275

Authors

Chong Zhang

Tian-Hua Hou

Wei-Ru Liang

Cui-Jun Hao

Fei Wang

Jia-Yan Xin

Bin Su

Meng Ning

Ying-Wu Liu

Affiliations

Soon will be listed here.

Abstract

Background: Hypochloremia and red blood cell distribution width (RDW) play important roles in congestive heart failure (CHF) pathophysiology, and they were associated with the prognosis of CHF. However, the prognostic value of chloride combined with RDW in patients with CHF remains unknown.

Methods: We retrospectively analyzed critically ill patients with CHF. The database was derived from the Medical Information Mart for Intensive Care IV v2.0 (MIMIC-IV-v2.0) database.

Results: In the final analysis, 5376 critically ill patients with CHF were included, and 2428 patients (45.2 %) experienced 5-year mortality. The restricted cubic spline model revealed a positive correlation between RDW and 5-year mortality, whereas chloride showed a U-shaped correlation with 5-year mortality. The median values of RDW and chloride were used to classify patients into four groups: high chloride/low RDW, low chloride/low RDW, high chloride/high RDW, and low chloride/high RDW. We observed the prognostic value of RDW combined with chloride in the Cox proportional hazard model, in predicting 5-year mortality, in-hospital mortality and 1-year mortality. Furthermore, we discovered that patients with chronic kidney disease (CKD) had a higher 5-year mortality risk than patients without CKD.

Conclusion: We found the translational potential role of chloride combined with RDW in prioritizing patients at high risk for short- and long-term mortality in a cohort of critically ill patients with CHF. Prospective multicenter investigations are warranted to validate our results.

References

Liang L, Huang L, Zhao X, Zhao L, Tian P, Huang B . Prognostic value of RDW alone and in combination with NT-proBNP in patients with heart failure. Clin Cardiol. 2022; 45(7):802-813. PMC: 9286336. DOI: 10.1002/clc.23850. View

Kouyoumdzian N, Kim G, Rudi M, Rukavina Mikusic N, Fernandez B, Choi M . Clues and new evidences in arterial hypertension: unmasking the role of the chloride anion. Pflugers Arch. 2021; 474(1):155-176. DOI: 10.1007/s00424-021-02649-5. View

Grodin J, Simon J, Hachamovitch R, Wu Y, Jackson G, Halkar M . Prognostic Role of Serum Chloride Levels in Acute Decompensated Heart Failure. J Am Coll Cardiol. 2015; 66(6):659-66. DOI: 10.1016/j.jacc.2015.06.007. View

Kazory A . Chloride and Cardiorenal Interactions in Heart Failure. Nephron. 2022; 147(1):6-8. DOI: 10.1159/000524987. View

Armstrong P, Pieske B, Anstrom K, Ezekowitz J, Hernandez A, Butler J . Vericiguat in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2020; 382(20):1883-1893. DOI: 10.1056/NEJMoa1915928. View

Testani J, Hanberg J, Arroyo J, Brisco M, Ter Maaten J, Wilson F . Hypochloraemia is strongly and independently associated with mortality in patients with chronic heart failure. Eur J Heart Fail. 2016; 18(6):660-8. PMC: 5471359. DOI: 10.1002/ejhf.477. View

Emans M, van der Putten K, van Rooijen K, Kraaijenhagen R, Swinkels D, van Solinge W . Determinants of red cell distribution width (RDW) in cardiorenal patients: RDW is not related to erythropoietin resistance. J Card Fail. 2011; 17(8):626-33. DOI: 10.1016/j.cardfail.2011.04.009. View

Deng X, Gao B, Wang F, Zhao M, Wang J, Zhang L . Red Blood Cell Distribution Width Is Associated With Adverse Kidney Outcomes in Patients With Chronic Kidney Disease. Front Med (Lausanne). 2022; 9:877220. PMC: 9218182. DOI: 10.3389/fmed.2022.877220. View

Zandijk A, van Norel M, Julius F, Sepehrvand N, Pannu N, McAlister F . Chloride in Heart Failure: The Neglected Electrolyte. JACC Heart Fail. 2021; 9(12):904-915. DOI: 10.1016/j.jchf.2021.07.006. View

10.

Hullin R, Barras N, Abdurashidova T, Monney P, Regamey J . Red cell distribution width and prognosis in acute heart failure: ready for prime time!. Intern Emerg Med. 2018; 14(2):195-197. DOI: 10.1007/s11739-018-1995-7. View

11.

Grodin J, Testani J, Pandey A, Sambandam K, Drazner M, Fang J . Perturbations in serum chloride homeostasis in heart failure with preserved ejection fraction: insights from TOPCAT. Eur J Heart Fail. 2018; 20(10):1436-1443. DOI: 10.1002/ejhf.1229. View

12.

Mohaissen T, Proniewski B, Targosz-Korecka M, Bar A, Kij A, Bulat K . Temporal relationship between systemic endothelial dysfunction and alterations in erythrocyte function in a murine model of chronic heart failure. Cardiovasc Res. 2021; 118(12):2610-2624. PMC: 9491865. DOI: 10.1093/cvr/cvab306. View

13.

Grodin J, Verbrugge F, Ellis S, Mullens W, Testani J, Tang W . Importance of Abnormal Chloride Homeostasis in Stable Chronic Heart Failure. Circ Heart Fail. 2016; 9(1):e002453. PMC: 4702267. DOI: 10.1161/CIRCHEARTFAILURE.115.002453. View

14.

Grodin J, Sun J, Anstrom K, Chen H, Starling R, Testani J . Implications of Serum Chloride Homeostasis in Acute Heart Failure (from ROSE-AHF). Am J Cardiol. 2016; 119(1):78-83. PMC: 5161696. DOI: 10.1016/j.amjcard.2016.09.014. View

15.

Adkins G, Curtis M . Potential role of cardiac chloride channels and transporters as novel therapeutic targets. Pharmacol Ther. 2014; 145:67-75. DOI: 10.1016/j.pharmthera.2014.08.002. View

16.

Afsar B, Saglam M, Yuceturk C, Agca E . The relationship between red cell distribution width with erythropoietin resistance in iron replete hemodialysis patients. Eur J Intern Med. 2012; 24(3):e25-9. DOI: 10.1016/j.ejim.2012.11.017. View

17.

Hanberg J, Rao V, Ter Maaten J, Laur O, Brisco M, Wilson F . Hypochloremia and Diuretic Resistance in Heart Failure: Mechanistic Insights. Circ Heart Fail. 2016; 9(8). PMC: 4988527. DOI: 10.1161/CIRCHEARTFAILURE.116.003180. View

18.

Kammerlander A . With a grain of salt: Sodium levels in heart failure. Int J Cardiol. 2019; 290:125-126. DOI: 10.1016/j.ijcard.2019.05.027. View

19.

Xanthopoulos A, Giamouzis G, Dimos A, Skoularigki E, Starling R, Skoularigis J . Red Blood Cell Distribution Width in Heart Failure: Pathophysiology, Prognostic Role, Controversies and Dilemmas. J Clin Med. 2022; 11(7). PMC: 8999162. DOI: 10.3390/jcm11071951. View

20.

Grodin J, Mullens W, Dupont M, Taylor D, McKie P, Starling R . Hemodynamic factors associated with serum chloride in ambulatory patients with advanced heart failure. Int J Cardiol. 2017; 252:112-116. DOI: 10.1016/j.ijcard.2017.11.024. View