Comparison between Red Blood Cell Distribution Width and Neutrophil-to-Lymphocyte Ratio in Predicting Mortality among Acute Decompensated Heart Failure Patients

Author : M.P.Wijaya, Y.W.Kusuma, K.A.Rendy, F.Utomo, N.Natasya, L.O.S.Suastika
Upload Date : 19-04-2018

Background: Acute decompensated heart failure (ADHF) is the leading cause of death and disability worldwide. It is critically important to find accurate risk stratification in identifying high-risk patients who may benefit from advanced treatment. Although there is numerous prognostic indicator for ADHF, most of them are costly to evaluate or assessed only in researches. Therefore, there is a need for simple yet accurate prognostic indicator. Red blood cell distribution width (RDW) and neutrophil-to-lymphocyte ratio (NLR) are widely investigated and routinely assessed as a component of complete blood count (CBC).

Method : This retrospective cohort study examined secondary data from 136 ADHF patients who were admitted to Sanglah General Hospital, Bali in 2017. A total of 136 patients who presented with ADHF had CBC measured at admission and then assessed for clinical outcomes such as death, VF, VT, and cardiogenic shock. Data were then analyzed using univariate, bivariate and multivariate analysis.

Result: From 136 patients, 66.9% was male with age range from 15-105 years old. We used median as cut-off point for RDW [14.21(10.80-45.0)] and NLR [5.49(0.10-52.94)]. Among these patients, 49.5% had higher RDW value and 51.5% had higher NLR value. From bivariate analysis, we found significant correlation between NLR and mortality with RR  6.0 (95% CI: 2.5-14.4, p=0.00) and RDW with mortality is 2.89 (95% CI: 1.26-6.61, p=0.01). In multivariate analysis, the HR for both RDW and NLR are 2.05 (95% CI: 1.11-3.8, p=0.03) and 4.27 (95% CI: 2.14-8.5, p=0.00) respectively.

Conclusion: ADHF patients with higher NLR and RDW value had increased risk of mortality which caused by higher inflammatory burden and higher level of oxidative stress. Therefore, measurement of RDW and NLR is a simple, inexpensive and accurate method that may facilitate assessment of risk stratification among ADHF patients.

KEYWORDS : ADHF, RDW, NLR, predictor, mortality

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