Red Cell Distribution Width Predicting In-Hospital Mortality in Patients with Acute Coronary Syndrome and Chronic Kidney Disease

The prognostic value of red cell distribution width (RDW) in predicting inhospital mortality in patients with acute coronary syndrome (ACS) has been validated in several surveys. Our aim was to assess the predictive value of RDW and whether the RDW has additional prognostic value on the GRACE RS in prediction of in-hospital mortality in patients with ACS and CKD. We retrospectively studied the medical data of 344 consecutive patients with a diagnosis of ACS and CKD between January, 1st 2011 and July, 30th 2014. The discrimination of RDW and GRACE RS to predict in-hospital all-cause mortality was evaluated by the C-statistic test. Multivariate logistic regression analysis was performed to assess the independent predictors of in-hospital mortality. The predictive value and discriminative ability of the model with GRACE RS alone and of the model with inclusion of RDW was both assessed. 66 patients (19.2%) died during hospitalization. RDW of in-hospital death was significantly higher than that of in-hospital survivors [14.3(13.7, 14.8) vs 13.4(12.8, 13.9), P<0.001]. After multivariate logistic analysis, RDW was an independent predictor of inhospital mortality (OR 1.357, 95% CI 1.067 to 1.724, P =0.013). The best cut-off for RDW was 13.6%. Compared with the GRACE RS, inclusion of RDW improved the AUC from 0.866 (95% CI 0.821 to 0.911) to 0.882 (95% CI 0.838 to 0.926) (P=0.035). As an independent predictor of in-hospital mortality, RDW was useful in risk stratification of patients with ACS and CKD. RDW added the predictive value of GRACE RS for in-hospital mortality.