Journal of Cardiovascular Development and Disease
Hemoglobin-to-RDW Ratio and All-Cause Mortality in Idiopathic Pulmonary Fibrosis: Complementary Value to Echocardiographic Right Ventricular–Pulmonary Arterial Coupling
By Francesca Coppi, Susan Darroudi, Giulia Renda and 18 others.
Abstract
Background
The hemoglobin-to-red cell distribution width ratio (HRR) is a composite hematologic biomarker that integrates oxygen-carrying capacity and inflammation-related erythrocyte variability. Its prognostic value in idiopathic pulmonary fibrosis (IPF), and its relationship with right ventricular (RV) function, have not been established.
Methods
We conducted a single-center retrospective study of 198 patients with IPF. A total of 165 patients with baseline hemoglobin, red cell distribution width (RDW) and date of diagnosis available constituted the analytical cohort. An HRR cutoff (≤0.86) was derived by time-dependent Receiver Operating Characteristic (ROC) curve analysis at 5 years. All-cause mortality from diagnosis was assessed by Kaplan–Meier and Cox regression, with bootstrap internal validation. Associations between hematologic markers and TAPSE (Tricuspid Annular Plane Systolic Excursion), PAPs (pulmonary arterial systolic pressure) and TAPSE/PASP were examined by linear and logistic regression, followed by joint stratification of HRR and RV–PA coupling.