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Red Cell Distribution Width Predicts 90 Day Mortality in Continuous-Flow Left Ventricular Assist Device Patients

Truby, Lauren K.*; Sridharan, Lakshmi*; Flores, Raul J.*; Garan, A. Reshad*; Jennings, Douglas*; Yuzefpolskaya, Melana*; Takeda, Koji; Takayama, Hiroo; Naka, Yoshifumi; Colombo, Paolo C.*; Topkara, Veli K.*

doi: 10.1097/MAT.0000000000000803
Adult Circulatory Support
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Red cell distribution width (RDW) measures the variance in size of circulating red blood cells and is a strong independent predictor of morbidity and mortality in cardiovascular disease and heart failure. Predictive power of RDW on mortality after continuous-flow left ventricular assist device (CF-LVAD) implantation remains largely unknown. Four hundred nine patients who underwent CF-LVAD implantation between April 2004 and December 2015 were retrospectively analyzed. The primary outcome of interest was 90 day mortality after CF-LVAD implantation. Median RDW before CF-LVAD implantation was 15.8%. Patients with elevated RDW (>15.8%) at baseline had significantly lower hemoglobin (10.6 ± 1.8 vs. 11.9 ± 2.1 mg/dl; p < 0.001), lower mean corpuscular volume (84.9 ± 7.7. vs. 88.7 ± 5.9; p < 0.001), higher blood urea nitrogen (BUN; 36.3 ± 21.8 vs. 30.1 ± 17.1; p < 0.001), lower albumin (3.4 ± 0.6 vs. 3.7 ± 0.5; p < 0.001), and higher total bilirubin levels (1.67 ± 2.21 vs. 1.29 ± 0.96). Red cell distribution width was independently predictive of 90 day mortality (odds ratio [OR], 1.16 for 1% increase; CI, 1.04–1.31; p = 0.010). Discriminatory power of RDW alone was comparable to model of end-stage liver disease excluding international normalized ratio (MELD-Xi) and HeartMate II risk scores. Mechanical unloading with CF-LVAD was associated with a reduction in RDW levels. These findings suggest that RDW, a simple and inexpensive test available through routine complete blood count, can be successfully used for mortality risk assessment in CF-LVAD candidates.

From the *Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York Presbyterian, New York, New York

Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York Presbyterian, New York, New York.

Submitted for consideration November 2017; accepted for publication in revised form February 2018.

Disclosure: Yoshifumi Naka received consulting fees from Thoratec. The authors have no conflicts of interest to report.

This study was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant Number UL1TR001873 (V.K.T.) and KL2TR001874 (A.R.G.) as well as by Lisa and Mark Schwartz and the Program to Reverse Heart Failure at New York Presbyterian Hospital/Columbia University.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.asaiojournal.com).

Correspondence: Veli K. Topkara, Center for Advanced Cardiac Care, Columbia University Medical Center, New York Presbyterian, 622 West 168th St, PH9-977. Email: vt2113@cumc.columbia.edu.

Copyright © 2019 by the American Society for Artificial Internal Organs