Red blood cell distribution width predicts survival in patients with Eisenmenger syndrome

Tao Yang; Yun-Juan Sun; Chang-Ming Xiong; Wei-Jie Zeng; Xin-Hai Ni; Zhi-Hui Zhao; Zhi-Hong Liu; Qing Gu; Jian-Guo He

doi:10.1515/cclm-2013-0747

Article

Red blood cell distribution width predicts survival in patients with Eisenmenger syndrome

Tao Yang , Yun-Juan Sun , Chang-Ming Xiong , Wei-Jie Zeng , Xin-Hai Ni , Zhi-Hui Zhao , Zhi-Hong Liu , Qing Gu and Jian-Guo He

Published/Copyright: December 6, 2013

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From the journal Clinical Chemistry and Laboratory Medicine Volume 52 Issue 5

Abstract

Background: Previous studies identified an independent relationship between red blood cell distribution width (RDW) and prognosis in patients with pulmonary hypertension of mixed etiologies and idiopathic pulmonary arterial hypertension. This study aimed to investigate the significance of RDW for predicting survival in patients with Eisenmenger syndrome (ES).

Methods: We retrospectively reviewed the clinical records and collected baseline data for patients newly diagnosed with ES in our hospital between January 2005 and October 2009. Follow-up data were collected periodically using a specifically designed network database until December 31, 2012. The end point was all-cause death.

Results: A total of 109 patients with ES were included in the study. Twenty-one patients (19.3%) died during a median follow-up period of 4.2 years (interquartile range 3.7–5.0 years). Baseline RDW was significantly correlated with mixed venous oxygen saturation (r=−0.286, p=0.003), arterial oxygen saturation (r=−0.423, p<0.001), mean pulmonary arterial pressure (r=0.271, p=0.004) and total pulmonary resistance (r=0.465, p<0.001). The 1-, 3- and 5-year survival rates for all 109 patients were 94%, 87% and 78%, respectively. Kaplan-Meier analysis showed that patients with RDW ≥13.9% had a lower survival rate than patients with RDW <13.9% (p=0.001). Multivariate Cox regression analysis showed that RDW was an independent prognostic marker in ES, with a hazard ratio of 1.162 (95% CI 1.036–1.302; p=0.010).

Conclusions: Baseline RDW correlates with hemodynamics and is an independent prognostic marker in ES.

Keywords: Eisenmenger syndrome; red blood cell distribution width; survival

Corresponding authors: Qing Gu, PhD, MD and Jian-Guo He, PhD, MD, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road, Xicheng District, Beijing, 100037, P.R. China, Phone: +86 10 88398060, Fax: +86 10 68313012, E-mail: gubright831@sohu.com; hejianguofw@gmail.com

References

1. Galiè N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA, et al. ESC Committee for Practice Guidelines (CPG). Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J 2009;30:2493–537.10.1093/eurheartj/ehp297Search in Google Scholar

2. Cantor WJ, Harrison DA, Moussadji JS, Connelly MS, Webb GD, Liu P, et al. Determinants of survival and length of survival in adults with Eisenmenger syndrome. Am J Cardiol 1999;84:677–81.10.1016/S0002-9149(99)00415-4Search in Google Scholar

3. Van De Bruaene A, De Meester P, Voigt JU, Delcroix M, Pasquet A, De Backer J, et al. Right ventricular function in patients with Eisenmenger syndrome. Am J Cardiol 2012;109:1206–11.10.1016/j.amjcard.2011.12.003Search in Google Scholar PubMed

4. Moceri P, Dimopoulos K, Liodakis E, Germanakis I, Kempny A, Diller GP, et al. Echocardiographic predictors of outcome in Eisenmenger syndrome. Circulation 2012;126:1461–8.10.1161/CIRCULATIONAHA.112.091421Search in Google Scholar PubMed

5. Van De Bruaene A, Delcroix M, Pasquet A, De Backer J, De Pauw M, Naeije R, et al. Iron deficiency is associated with adverse outcome in Eisenmenger patients. Eur Heart J 2011;32:2790–9.10.1093/eurheartj/ehr130Search in Google Scholar PubMed

6. Diller GP, Dimopoulos K, Broberg CS, Kaya MG, Naghotra US, Uebing A, et al. Presentation, survival prospects, and predictors of death in Eisenmenger syndrome: a combined retrospective and case-control study. Eur Heart J 2006;27: 1737–42.10.1093/eurheartj/ehl116Search in Google Scholar PubMed

7. Oya H, Nagaya N, Satoh T, Sakamaki F, Kyotani S, Fujita M, et al. Haemodynamic correlates and prognostic significance of serum uric acid in adult patients with Eisenmenger syndrome. Heart 2000;84:53–8.10.1136/heart.84.1.53Search in Google Scholar PubMed PubMed Central

8. Reardon LC, Williams RJ, Houser LS, Miner PD, Child JS, Aboulhosn JA. Usefulness of serum brain natriuretic peptide to predict adverse events in patients with the Eisenmenger syndrome. Am J Cardiol 2012;110:1523–6.10.1016/j.amjcard.2012.06.061Search in Google Scholar PubMed

9. Reardon LC, Williams RJ, Houser LS, Miner PD, Child JS, Aboulhosn JA. B-type natriuretic peptide concentrations in contemporary Eisenmenger syndrome patients: predictive value and response to disease targeting therapy. Heart 2012;98:736–42.10.1136/heartjnl-2011-301522Search in Google Scholar PubMed

10. van Kimmenade RR, Mohammed AA, Uthamalingam S, van der Meer P, Felker GM, Januzzi JL Jr. Red blood cell distribution width and 1-year mortality in acute heart failure. Eur J Heart Fail 2010;12:129–36.10.1093/eurjhf/hfp179Search in Google Scholar PubMed

11. Gul M, Uyarel H, Ergelen M, Karacimen D, Ugur M, Turer A, et al. The relationship between red blood cell distribution width and the clinical outcomes in non-ST elevation myocardial infarction and unstable angina pectoris: a 3-year follow-up. Coron Artery Dis 2012;23:330–6.10.1097/MCA.0b013e3283564986Search in Google Scholar

12. Zorlu A, Bektasoglu G, Guven FM, Dogan OT, Gucuk E, Ege MR, et al. Usefulness of admission red cell distribution width as a predictor of early mortality in patients with acute pulmonary embolism. Am J Cardiol 2012;109:128–34.10.1016/j.amjcard.2011.08.015Search in Google Scholar

13. Montagnana M, Cervellin G, Meschi T, Lippi G. The role of red blood cell distribution width in cardiovascular and thrombotic disorders. Clin Chem Lab Med 2011;50:635–41.Search in Google Scholar

14. Hampole CV, Mehrotra AK, Thenappan T, Gomberg-Maitland M, Shah SJ. Usefulness of red cell distribution width as a prognostic marker in pulmonary hypertension. Am J Cardiol 2009;104:868–72.10.1016/j.amjcard.2009.05.016Search in Google Scholar

15. Rhodes CJ, Wharton J, Howard LS, Gibbs JS, Wilkins MR. Red cell distribution width outperforms other potential circulating biomarkers in predicting survival in idiopathic pulmonary arterial hypertension. Heart 2011;97:1054–60.10.1136/hrt.2011.224857Search in Google Scholar

16. Brooks D, Solway S, Gibbons WJ. ATS statement on six-minute walk test. Am J Respir Crit Care Med 2003;167:1287.10.1164/ajrccm.167.9.950Search in Google Scholar

17. Perkins SL. Examination of blood and bone marrow. In: Greer JP, Foerster J, Lukens JN, Rodgers GM, Paraksevas F, Glader BE, editors. Wintrobe’s Clinical Hematology, 11th ed. Salt Lake City, Utah: Lippincott Wilkins & Williams, 2003:5–25.Search in Google Scholar

18. Dimopoulos K, Inuzuka R, Goletto S, Giannakoulas G, Swan L, Wort SJ, et al. Improved survival among patients with Eisenmenger syndrome receiving advanced therapy for pulmonary arterial hypertension. Circulation 2010;121:20–5.10.1161/CIRCULATIONAHA.109.883876Search in Google Scholar

19. Manes A, Palazzini M, Leci E, Bacchi Reggiani ML, Branzi A, Galiè N. Current era survival of patients with pulmonary arterial hypertension associated with congenital heart disease: a comparison between clinical subgroups. Eur Heart J Epub ahead of print 1 Mar 2013. DOI:10.1093/eurheartj/eht072.10.1093/eurheartj/eht072Search in Google Scholar

20. Rosove MH, Perloff JK, Hocking WG, Child JS, Canobbio MM, Skorton DJ. Chronic hypoxaemia and decompensated erythrocytosis in cyanotic congenital heart disease. Lancet 1986;2:313–5.10.1016/S0140-6736(86)90005-XSearch in Google Scholar

21. Tay EL, Peset A, Papaphylactou M, Inuzuka R, Alonso-Gonzalez R, Giannakoulas G, et al. Replacement therapy for iron deficiency improves exercise capacity and quality of life in patients with cyanotic congenital heart disease and/or the Eisenmenger syndrome. Int J Cardiol 2011;151:307–12.10.1016/j.ijcard.2010.05.066Search in Google Scholar PubMed

22. Van Craenenbroeck EM, Pelle AJ, Beckers PJ, Possemiers NM, Ramakers C, Vrints CJ, et al. Red cell distribution width as a marker of impaired exercise tolerance in patients with chronic heart failure. Eur J Heart Fail 2012;14:54–60.10.1093/eurjhf/hfr136Search in Google Scholar PubMed

23. Makhoul BF, Khourieh A, Kaplan M, Bahouth F, Aronson D, Azzam ZS. Relation between changes in red cell distribution width and clinical outcomes in acute decompensated heart failure. Int J Cardiol 2013;167:1412–6.10.1016/j.ijcard.2012.04.065Search in Google Scholar PubMed

24. Van Craenenbroeck EM, Conraads VM, Greenlaw N, Gaudesius G, Mori C, Ponikowski P, et al. The effect of intravenous ferric carboxymaltose on red cell distribution width: a subanalysis of the FAIR-HF study. Eur J Heart Fail 2013;15:756–62.10.1093/eurjhf/hft068Search in Google Scholar PubMed

Received: 2013-9-8

Accepted: 2013-11-6

Published Online: 2013-12-6

Published in Print: 2014-5-1

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Articles in the same Issue

https://doi.org/10.1515/cclm-2013-0747

Keywords for this article

Eisenmenger syndrome; red blood cell distribution width; survival