High red cell distribution width as a prognostic indicator in heart failure

Abstract

BACKGROUND Red cell distribution width (RDW) measures the red blood cell size variation. Elevated RDW has been associated with various adverse health outcomes, including cardiovascular diseases. AIM To analyze current evidence on the prognostic significance of high RDW in patients with heart failure (HF). METHODS A comprehensive literature search was conducted across multiple databases, including PubMed, EMBASE, and Google Scholar, up to May 2024. Studies were included if they investigated the relationship between RDW levels and outcomes in HF patients. compared to those in the lowest quartile. The primary outcome was all-cause mortality. compared to those in the lowest quartile. Heterogeneity was assessed using the I 2 statistic, we assessed the impact of individual studies on the overall estimate using a leave-one-out sensitivity analysis and publication bias was evaluated through a contour-enhanced funnel plot and Luis Furuya-Kanamori (LFK) index. RESULTS Seven studies, including a total of 11460 HF patients, were analyzed. The participants' mean age varied between 60 years and 80 years, with 6562 (57.26%) in the lower quartile. Patients in the highest quartile of RDW ( 15.21%) had a significantly increased risk of all-cause mortality, with an odds ratio of 1.84 (95%CI: 1.31-2.57, P 0.001), compared to those in the lowest quartile (RDW: 14.1%-15.20%). There was significant variability in the included studies' results (I 2 = 93%, P 0.01), as well as potential publication bias suggested by the high LFK index (8.47). Sensitivity analysis reinforced the robustness of these findings, showing that the results were not unduly influenced by any single study. CONCLUSION This meta-analysis confirms that high RDW is a robust predictor of adverse outcomes in patients with HF, highlighting its potential utility as a simple, cost-effective biomarker for risk stratification. Future research should focus on elucidating the mechanisms underlying this association and exploring the potential benefits of RDW-guided therapeutic strategies in HF management.

Key findings

• ▸Elevated RDW is associated with increased all-cause mortality in patients with heart failure.
• ▸The study included a total of 11,460 HF patients across seven distinct studies.
• ▸Statistical heterogeneity was assessed using the I2 statistic alongside sensitivity and publication bias analyses.

Keywords

Identifiers

DOI

10.5662/wjm.v16.i1.108611

Journal

World Journal of Methodology

Year

2026