Georges Ephrem1. 1. Department of Cardiovascular Disease, Hofstra-North Shore-LIJ Health System, Manhasset, New York 11030, USA. g.ephrem@gmail.com
Abstract
BACKGROUND: Three-quarters of rehospitalizations ($44 billion yearly estimated cost) may be avoidable. A screening tool for the detection of potential readmission may facilitate more efficient case management. HYPOTHESIS: An elevated red blood cell distribution width (RDW) is an independent predictor of hospital readmission in patients with unstable angina (UA) or non-ST-elevation myocardial infarction (NSTEMI). METHODS: The study is a retrospective observational cohort analysis of adults admitted in 2007 with UA or NSTEMI. Data were gathered by review of inpatient medical records. The rate of 30-day nonelective readmission and time to nonelective readmission were recorded until November 1, 2011, and compared by RDW group using the 95th percentile (16.3%) as a cutoff. RESULTS: The median follow-up time of the 503 subjects (average age, 65 ± 13 years; 56% male) was 3.8 years (interquartile range: 0.3-4.3 years). Those readmitted within 30 days were older, had more comorbidities and higher RDW and creatinine levels, and were more likely to have had an intervention. At 3.8 years of follow-up, subjects with high RDW (>16.3%) were more likely to be readmitted compared to those with normal RDW (≤16.3%) (72.28% vs 59.95%, P = 0.003). In multivariable analyses, high RDW was a statistically significant predictor of readmission in general (hazard ratio: 1.35 (95% confidence interval [CI]:1.02-1.79), P = 0.033) but not of 30-day rehospitalization (odds ratio: 1.34 (95% CI: 0.78-2.31), P = 0.292). Its area under the receiver operating characteristic curve was 0.54 (sensitivity 23% and specificity 85%). CONCLUSIONS: An elevated RDW is an independent predictor of hospital readmission in patients with UA or NSTEMI.
BACKGROUND: Three-quarters of rehospitalizations ($44 billion yearly estimated cost) may be avoidable. A screening tool for the detection of potential readmission may facilitate more efficient case management. HYPOTHESIS: An elevated red blood cell distribution width (RDW) is an independent predictor of hospital readmission in patients with unstable angina (UA) or non-ST-elevation myocardial infarction (NSTEMI). METHODS: The study is a retrospective observational cohort analysis of adults admitted in 2007 with UA or NSTEMI. Data were gathered by review of inpatient medical records. The rate of 30-day nonelective readmission and time to nonelective readmission were recorded until November 1, 2011, and compared by RDW group using the 95th percentile (16.3%) as a cutoff. RESULTS: The median follow-up time of the 503 subjects (average age, 65 ± 13 years; 56% male) was 3.8 years (interquartile range: 0.3-4.3 years). Those readmitted within 30 days were older, had more comorbidities and higher RDW and creatinine levels, and were more likely to have had an intervention. At 3.8 years of follow-up, subjects with high RDW (>16.3%) were more likely to be readmitted compared to those with normal RDW (≤16.3%) (72.28% vs 59.95%, P = 0.003). In multivariable analyses, high RDW was a statistically significant predictor of readmission in general (hazard ratio: 1.35 (95% confidence interval [CI]:1.02-1.79), P = 0.033) but not of 30-day rehospitalization (odds ratio: 1.34 (95% CI: 0.78-2.31), P = 0.292). Its area under the receiver operating characteristic curve was 0.54 (sensitivity 23% and specificity 85%). CONCLUSIONS: An elevated RDW is an independent predictor of hospital readmission in patients with UA or NSTEMI.
Authors: Crystel M Gijsberts; Hester M den Ruijter; Dominique P V de Kleijn; Albert Huisman; Maarten J Ten Berg; Richard H A van Wijk; Folkert W Asselbergs; Michiel Voskuil; Gerard Pasterkamp; Wouter W van Solinge; Imo E Hoefer Journal: Medicine (Baltimore) Date: 2015-11 Impact factor: 1.817