ASSESSING THE PROGNOSTIC VALUE OF THE HEMOGLOBIN-TO-RED CELL DISTRIBUTION WIDTH RATIO IN EMERGENCY DEPARTMENT PATIENTS WITH ACUTE CORONARY SYNDROME

Öz

Objective: Acute coronary syndrome (ACS) is a critical condition requiring rapid evaluation in the emergency department. The hemoglobin-to-red cell distribution width ratio (HRR) has emerged as a potential prognostic biomarker, reflecting the combined effects of hemoglobin and red cell distribution width. This study aims to evaluate the prognostic value of HRR in patients presenting to the emergency department with ACS. Material and Methods: A retrospective cohort study was conducted at a single center, involving adult patients who were diagnosed with acute coronary syndrome upon presentation to the emergency department. HRR was calculated as the ratio of hemoglobin to red cell distribution width, and its association with 30-day cardiac mortality (CM), all-cause mortality (ACM), and major adverse cardiovascular events (MACE) was analyzed using Receiver Operating Characteristics (ROC) curve analysis. Results: The study included 688 patients, with a mean age of 61.9±12.3 years and 57% males. Lower HRR was significantly associated with higher 30-day CM, ACM, and MACE rates. ROC curve analysis showed HRR had acceptable discriminatory power with AUC values of 0.764 for 30-day CM, 0.718 for 30-day ACM, and 0.739 for 30-day MACE. An HRR cut-off value of 0.9 was determined, with sensitivities of 87.8%, 90.2%,and 88.7%, and specificities of 47.6%, 48.4%, and 48.9% for CM, ACM, and MACE, respectively. Conclusion: HRR is a useful prognostic marker for 30-day outcomes in ACS patients. Its easy accessibility and rapid availability makes it a practical tool for risk stratification in the emergency department.

Anahtar Kelimeler

• Acute coronary syndrome
• hemoglobin
• major adverse cardiac events
• mortality

Acil Servisteki Akut Koroner Sendromlu Hastalarda Hemoglobin-Kırmızı Hücre Dağılım Genişliği Oranının Prognostik Değerinin Değerlendirilmesi

Öz

Amaç: Akut koroner sendrom (AKS) acil serviste hızlı değerlendirme gerektiren kritik bir durumdur. Hemoglobin- kırmızı hücre dağılım genişliği oranı (HRR), hemoglobin ve kırmızı hücre dağılım genişliğinin birleşik etkilerini yansıtan potansiyel bir prognostik biyobelirteç olarak ortaya çıkmıştır. Bu çalışma, acil servise AKS ile başvuran hastalarda HRR'nin prognostik değerini değerlendirmeyi amaçlamaktadır. Gereç ve Yöntemler: Tek bir merkezde, acil serviste AKS tanısı konulan yetişkin hastaları kapsayan retrospektif bir kohort çalışması yürütülmüştür. HRR, hemoglobinin kırmızı hücre dağılım genişliğine oranı olarak hesaplanmış ve 30 günlük kardiyak ölüm (KÖ), tüm nedenlere bağlı ölüm (TNBÖ) ve majör istenmeyen kardiyovasküler olaylar (MİKO) ile ilişkisi Receiver Operating Characteristics (ROC) eğrisi analizi kullanılarak analiz edilmiştir. Bulgular: Çalışmaya 688 hasta dahil edilmiştir. Hastaların ortalama yaşı 61.9±12.3 yıl ve hastaların %57’si erkektir. Düşük HRR, daha yüksek 30 günlük KÖ, TNBÖ ve MİKO oranları ile anlamlı olarak ilişkilendirilmiştir. ROC eğrisi analizi, 30 günlük KM için 0,764, 30 günlük TNBM için 0.718 ve 30 günlük MİKO için 0.739 eğrinin altında kalan alan değerleri ile HRR'nin kabul edilebilir ayırt edici güce sahip olduğunu göstermiştir. HRR için eşik değer 0,9 olarak belirlenmiştir ve bu değer için KÖ, TNBÖ ve MİKO için sırasıyla %87.8, %90.2 ve %88.7 duyarlılık ve %47.6, %48.4 ve %48.9 özgüllüğe sahiptir. Sonuç: HRR, AKS hastalarında 30 günlük sonuçlar için faydalı bir prognostik belirteçtir. Kolay erişilebilir olması ve hızlı sonuç vermesi, acil serviste risk sınıflandırması için pratik bir araç olmasını sağlamaktadır.

Anahtar Kelimeler

• Akut koroner sendrom
• hemoglobin
• major istenmeyen kardiyak olay
• mortalite

Kaynakça

1. Pitts SR, Niska RW, Xu J, Burt CW. National Hospital Ambulatory Medical Care Survey: 2006 emergency department summary. Natl Health Stat Report. 2008(7):1-38.
2. Gräni C, Senn O, Bischof M, et al. Diagnostic performance of reproducible chest wall tenderness to rule out acute coronary syndrome in acute chest pain: a prospective diagnostic study. BMJ Open. 2015;5(1):e007442.
3. Leite L, Baptista R, Leitão J, et al. Chest pain in the emergency department: risk stratification with Manchester triage system and HEART score. BMC Cardiovasc Disord. 2015;15:48.
4. Goodacre S, Pett P, Arnold J, et al. Clinical diagnosis of acute coronary syndrome in patients with chest pain and a normal or non-diagnostic electrocardiogram. Emerg Med J. 2009;26(12):866-870.
5. Erhardt L, Herlitz J, Bossaert L, et al. Task force on the management of chest pain. Eur Heart J. 2002;23(15):1153-1176.
6. Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023;44(38):3720-3826.
7. Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;144(22):e368-e454.
8. Menekşe TS, Kaçer İ, Hacımustafaoğlu M, Gül M, Ateş C. C-reactive protein to albumin ratio may predict in-hospital mortality in non-ST elevation myocardial infarction. Biomark Med. 2024;18(3):103-113.

9. Chi G, Lee JJ, Montazerin SM, Marszalek J. Prognostic value of hemoglobin-to-red cell distribution width ratio in cancer: a systematic review and meta-analysis. Biomark Med. 2022;16(6):473-482.
10. Akdag G, Sever ON, Dogan A, et al. The association of hemoglobin/red blood distribution width with overall survival: a retrospective analysis of melanoma. Esperienze Dermatol 2023;25:29-37.
11. Yildiz D, Cakir U, Tugcu AU, Ceran B, Tayman C. Hemoglobin/Red Cell Distribution width Ratio (HRR): A Novel and Promising Red Cell Parameter in Ductal Closure. Arq Bras Cardiol. 2023;120(2):e20220339.
12. Cao W, Ren H, Song B, Liao Z, Li H. Red cell distribution width and Glasgow coma scale score as predictors of in-hospital mortality in maintenance hemodialysis patients diagnosed with spontaneous intracerebral hemorrhage. Medicine (Baltimore). 2022;101(42):e31094.
13. Feng X, Zhang Y, Li Q, Wang B, Shen J. Hemoglobin to red cell distribution width ratio as a prognostic marker for ischemic stroke after mechanical thrombectomy. Front Aging Neurosci. 2023;15:1259668.
14. Salvagno GL, Sanchis-Gomar F, Picanza A, Lippi G. Red blood cell distribution width: A simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci. 2015;52(2):86-105.
15. Padda J, Khalid K, Hitawala G, Batra N, Pokhriyal S, Mohan A, et al. Acute Anemia and myocardial infarction. Cureus. 2021;13(8):e17096.
16. Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453-1457.
17. Collet JP, Thiele H, Barbato E, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021;42(14):1289-1367.
18. Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). Glob Heart. 2018;13(4):305-338.
19. Hosmer Jr DW, Lemeshow S, Sturdivant RX. Applied logistic regression: John Wiley & Sons; 2013.
20. Ucar AB, Unal Akoglu E, Cimilli Ozturk T, et al. Diagnostic value of Tei index for acute myocardial infarction in patients presenting to emergency department with ischemic chest pain and correlation with Hs-troponin. Hong Kong J Emerg Med. 2019;26(4):233-241.
21. Puelacher C, Gugala M, Adamson PD, et al. Incidence and outcomes of unstable angina compared with non-ST-elevation myocardial infarction. Heart. 2019;105(18):1423-1431.
22. Coradduzza D, Medici S, Chessa C, et al. Assessing the predictive power of the hemoglobin/red cell distribution width ratio in cancer: a systematic review and future directions. Medicina (Kaunas). 2023;59(12):2124.
23. Rahamim E, Zwas DR, Keren A, et al. The ratio of hemoglobin to red cell distribution width: a strong predictor of clinical outcome in patients with heart failure. J Clin Med. 2022;11(3):886
24. Xiu WJ, Zheng YY, Wu TT, et al. Hemoglobin-to-red-cell distribution width ratio is a novel predictor of long-term patient outcomes after percutaneous coronary intervention: a retrospective cohort study. Front Cardiovasc Med. 2022;9:726025.
25. Kılıç O, Mustu M, Suygun H, Con E, Karakurt A, Özer SF. Hemoglobin/red cell distribution width ratio is associated with poor prognosis in patients with acute coronary syndrome in long-term follow-up. Int J Cardiovasc Sci. 2024;37:e20230099.