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      Association of Red Blood Cell Distribution Width-Albumin Ratio for Acute Myocardial Infarction Patients with Mortality: A Retrospective Cohort Study

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          Abstract

          Background

          Red blood cell distribution width (RDW) was a risk factor for poor prognosis in acute myocardial infarction (AMI). Recent reports suggested that combining RDW with other laboratory metrics could provide a better prediction. This retrospective study aimed to investigate whether the RDW-albumin ratio (RAR) may be associated with mortality after an AMI.

          Methods

          This cohort study was conducted among adults (over 16 years old) with AMI in the Medical Information Mart for Intensive Care Database III V1.4 (MIMIC-III). The primary outcome was 30-day mortality, and the secondary outcome was 1-year and 3-year mortality. Cox hazard regression model and Kaplan–Meier survival curves were constructed to estimate the effect of biomarkers on mortality. We used three models to adjust for potential bias. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were analyzed for the excellent performance of RAR on prognosis.

          Results

          A total of 826 patients were eventually enrolled in our study. In multivariate analysis, RAR was found to be associated with 30-day mortality (Model 3: HR = 1.23, 95% CI = 1.09-1.39, P < .001). In addition, Subgroup analysis showed that the effect of RAR was higher in female patients than in male patients ( P for interaction = .026). Kaplan-Meier survival curves showed that patients in the lower RAR quartile tended to have higher survival rates in the short and long term. AMI patients with RAR ≥ 4 had a 122% increase in 3-year mortality. Results of ROC and AUC showed that the prognostic performance of RAR for mortality was the best (30-day mortality: 0.703; 1-year mortality: 0.729; 3-year mortality: 0.737).

          Conclusions

          RAR is a simple and stable predictor of prognosis in AMI patients. Our results support RAR = 4.0 as a criterion for prognostic risk stratification of AMI patients.

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          Atherosclerosis — An Inflammatory Disease

          Franklin H. Epstein, Russell Ross (1999)
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            Multiparameter Intelligent Monitoring in Intensive Care II: a public-access intensive care unit database.

            Mohammed Saeed, Mauricio Villarroel, Andrew Reisner … (2011)
            We sought to develop an intensive care unit research database applying automated techniques to aggregate high-resolution diagnostic and therapeutic data from a large, diverse population of adult intensive care unit patients. This freely available database is intended to support epidemiologic research in critical care medicine and serve as a resource to evaluate new clinical decision support and monitoring algorithms. Data collection and retrospective analysis. All adult intensive care units (medical intensive care unit, surgical intensive care unit, cardiac care unit, cardiac surgery recovery unit) at a tertiary care hospital. Adult patients admitted to intensive care units between 2001 and 2007. None. The Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC-II) database consists of 25,328 intensive care unit stays. The investigators collected detailed information about intensive care unit patient stays, including laboratory data, therapeutic intervention profiles such as vasoactive medication drip rates and ventilator settings, nursing progress notes, discharge summaries, radiology reports, provider order entry data, International Classification of Diseases, 9th Revision codes, and, for a subset of patients, high-resolution vital sign trends and waveforms. Data were automatically deidentified to comply with Health Insurance Portability and Accountability Act standards and integrated with relational database software to create electronic intensive care unit records for each patient stay. The data were made freely available in February 2010 through the Internet along with a detailed user's guide and an assortment of data processing tools. The overall hospital mortality rate was 11.7%, which varied by critical care unit. The median intensive care unit length of stay was 2.2 days (interquartile range, 1.1-4.4 days). According to the primary International Classification of Diseases, 9th Revision codes, the following disease categories each comprised at least 5% of the case records: diseases of the circulatory system (39.1%); trauma (10.2%); diseases of the digestive system (9.7%); pulmonary diseases (9.0%); infectious diseases (7.0%); and neoplasms (6.8%). MIMIC-II documents a diverse and very large population of intensive care unit patient stays and contains comprehensive and detailed clinical data, including physiological waveforms and minute-by-minute trends for a subset of records. It establishes a new public-access resource for critical care research, supporting a diverse range of analytic studies spanning epidemiology, clinical decision-rule development, and electronic tool development.
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              Red cell distribution width in heart failure: prediction of clinical events and relationship with markers of ineffective erythropoiesis, inflammation, renal function, and nutritional state.

              Zsolt Förhécz, Timea Gombos, Gábor Borgulya … (2009)
              The goal of this study was to independently validate the recent observations on the predictive role of red cell distribution width (RDW) for outcomes in chronic heart failure and to provide epidemiologic data on the biological correlates of RDW in heart failure (HF). Understanding the mechanism underlying this observation is unclear, largely hampered by the lack of epidemiologic studies demonstrating factors that are associated with anisocytosis in cardiovascular diseases. One hundred ninety-five patients (145 men, 50 women) with systolic HF were enrolled and followed up for a median of 14.5 months. Primary end points were all-cause mortality and hospital readmission due to worsening HF symptoms. A total of 19 clinical chemistry, hematology, and biochemical variables were considered for analysis together with clinical parameters in Cox proportional hazards and multiple regression models. Red cell distribution width was found to be an N-terminal pro-brain natriuretic peptide independent predictor of all-cause mortality (adjusted HR 1.61 per 1 SD increase) in our study. Multiple correlations between biomarkers of ineffective erythropoiesis (serum iron, ferritin, and soluble transferrin receptor levels), inflammation and acute-phase reaction (interleukin-6, soluble tumor necrosis factor (TNF) receptor I and soluble TNF receptor II, C-reactive protein, and prealbumin concentrations), undernutrition (total cholesterol and albumin levels), and renal function were observed. In the multiple regression model, the strongest relationship for RDW was obtained with soluble transferrin receptor, soluble TNF receptor I, soluble TNF receptor II, and total cholesterol. Here we validate the strong, independent prediction of morbidity and mortality in HF by RDW. The described correlations between RDW and inflammation, ineffective erythropoiesis, undernutrition, and impaired renal function may facilitate the understanding why this marker is associated with adverse outcomes in HF.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Appl Thromb Hemost
                Journal ID (iso-abbrev): Clin Appl Thromb Hemost
                Journal ID (publisher-id): CAT
                Journal ID (hwp): spcat
                Title: Clinical and Applied Thrombosis/Hemostasis
                Publisher: SAGE Publications (Sage CA: Los Angeles, CA )
                ISSN (Print): 1076-0296
                ISSN (Electronic): 1938-2723
                Publication date (Electronic): 31 August 2022
                Publication date Collection: Jan-Dec 2022
                Volume: 28
                Electronic Location Identifier: 10760296221121286
                Affiliations
                [1 ]The First Clinical College, Ringgold 74738, universityShandong Chinese Medical University; , Ji Nan, People’s Republic of China
                [2 ]Department of Cardiovascular Medicine, Ringgold 159393, universityThe First Affiliated Hospital of Shandong University of Traditional Chinese Medicine; , Jinan, People's Republic of China
                Author notes
                [#]

                Joint first authors: Dan Li, Zhishen Ruan

                [*]Bo Wu, Department of Cardiovascular Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, 42 Wenhua West Road, Ji Nan city, Shandong Province, People’s Republic of China. Email: wubojinan@ 123456163.com
                Author information
                https://orcid.org/0000-0002-4982-3660
                Article
                Publisher ID: 10.1177_10760296221121286
                DOI: 10.1177/10760296221121286
                PMC ID: 9445528
                PubMed ID: 36045634
                SO-VID: 704f40b4-75f6-4aa8-ab94-dca65d7d944b
                Copyright © © The Author(s) 2022
                License:

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Date received : 24 May 2022
                Date revision received : 10 July 2022
                Date accepted : 8 August 2022
                Categories
                Subject: Original Manuscript
                Custom metadata
                typesetter ts19
                cover-date January-December 2022

                Keywords: acute myocardial infarction,red blood cell distribution width,albumin,retrospective cohort study,mortality
                Data availability:
                Keywords: acute myocardial infarction, red blood cell distribution width, albumin, retrospective cohort study, mortality

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