Evaluation of the prognostic value of Red Blood Cell Distribution Width in determining mortality and prognosis of infective endocar-ditis patients admitted to Shahid Madani Heart center during 1389-1399

Abstract

Infective endocarditis (IE) is a rare but life-threatening condition that requires rap-id diagnosis and prompt treatment. Red blood cell distribution width (RDW) is a hematological index for determining RBC size heterogeneity (anisocytosis). Recent studies have demonstrated an association between RDW alterations and the inci-dence and prognosis of various pathologies, including cardiovascular and infec-tious diseases. Methods and materials: To investigate the relationship between RDW and in-hospital and two-year mortality among IE patients, through a retrospective hospi-tal-based cohort study, Tabriz Shahid Madani Hospital archives were queried for inpatients with infective endocarditis from Farvardin 1389 to Esfand 1398, corre-sponding to March 2010 to March 2020; and the patients hospitalized with IE in Tabriz Shahid Madani Hospital who fulfilled the eligibility criteria during the re-cruitment period were enrolled. The primary outcomes were in-hospital and two-year mortality data and were analyzed in relationship to the RDW value on admis-sion. Demographic, echocardiographic, laboratory, microbiologic, hospitalization, and cardiac surgery data were collected from patient records. Two-year survival status was identified for each case. Statistical analysis was performed using R 4.2.0 (The R Foundation for Statistical Computing, Austria), and a p-value < 0.05 was considered statistically significant. Results: 147 definite IE patients with a mean age of 48.53 ± 18.67 years were en-rolled in the study. According to the receiver operating characteristic curve analy-sis, the optimal cutoff of RDW value on admission for predicting mortality was 15.05%. Univariate Cox proportional-hazards analysis demonstrated RDW > 15.05% was associated with higher in-hospital mortality (OR 1.23, 95%CI 1.07-1.42, p = 0.004). Multivariate Cox proportional-hazards analysis also revealed RDW > 15.05% to be an independent predictor of in-hospital mortality (OR 1.18, 95%CI 1.02-1.36, p = 0.027). Univariate Cox proportional-hazards analysis showed RDW > 15.05% was sig-nificantly associated with 2-year mortality (HR 1.16 95%CI 1.08-1.26, p = 0.000). Multivariate Cox proportional-hazards analysis revealed that RDW > 15.05% was an independent predictor of two-year mortality. (HR 1.15 95%CI 1.05-1.36, p = 0.003). In the Kaplan-Meier survival analysis, there was a significant reduction in survival rates within two years in patients with RDW > 15.05% vs. those with RDW ≤ 15.05% (p = 0.001).