Effect Of BMI, ALB, RDW And Their Combination On All-cause Readmission Of Patients With Heart Failure

Objective: This study intends to explore the effects of body mass index(BMI),albumin(ALB),red blood cell distribution width(RDW)and their combination on allcause readmission of patients with heart failure(HF),hoping to find more efficient single or combined indicators to screen high,risk groups from patients with heart failure,and guide clinicians to conduct early intervention on controllable high,risk factors,with a view to improving the prognosis of patients,reducing the rate of rehospitalization and mortality,and reducing the economic burden of society and families.Method: 270 patients with acute decompensated heart failure were first diagnosed in the Affiliated Hospital of Yangzhou University from January 2018 to December 2020.The basic information and biochemical indicators of the subjects were collected through the electronic medical record system of our hospital,including gender,age,height,weight,BMI,past medical history,smoking history,heart rate,blood pressure,blood routine,liver and kidney function,electrolyte,blood glucose,blood lipids,cardiac color Doppler ultrasound,etc.Follow-up was conducted through outpatient interview and telephone inquiry.According to whether all-cause re-admission occurred,the population was divided into event group and non-event group.According to the lower limit of clinical reference values of BMI,ALB and left ventricular ejection fraction(LVEF),the population was divided into high BMI group(BMI ≥ 24 Kg/m2)and low BMI group(<24Kg/m2),high ALB group(ALB ≥ 35 g/L)and low ALB group(<35 g/L),high LVEF group(LVEF ≥ 50%)and low LVEF group(<50%),According to the median of 13.5%of RDW,the population was divided into high RDW group(RDW ≥ 13.5%)and low RDW group(RDW < 13.5%),and the baseline data of patients between the groups were observed respectively.Spearman correlation analysis was used to analyze the correlation between BMI,ALB,RDW and LVEF.The ROC curve was used to analyze the predictive value of BMI,ALB,RDW and their combination on the readmission of HF patients.The single-factor and multi-factor Cox analysis was used to explore the risk factors of all-cause readmission of HF patients.The Kaplan-Meier survival curve was used to analyze the readmission of BMI,ALB,RDW and their combination of HF patients.Result:1.In this study,a total of 270 patients with HF diagnosed for the first time were included,with a median age of 77.0(69.8,84.0)years,of which 143 were male patients(53.0%),with a median follow-up time of 25.0(7.0,42.0)months,and an all-cause rehospitalization rate of 54.1%;2.Compared with the non-event group,the proportion of male patients and patients with coronary heart disease in the event group is higher.RDW of patients in the event group was higher than that in the non-event group,while BMI,ALB and LVEF of patients in the event group were lower than those in the event group(P<0.05);3.Compared with the low BMI group,the high BMI group has a higher proportion of patients with hypertension.The systolic blood pressure,diastolic blood pressure,red blood cell count,hemoglobin,ALB,total cholesterin and total triglyceride in the patients with high BMI were higher than those in the patients with low BMI,but the age was lower than that in the patients with low BMI,the difference was statistically significant(P<0.05);4.Compared with patients with low ALB,patients with high ALB have a higher proportion of hypertension.BMI,systolic blood pressure,red blood cell count,hemoglobin value,glutamic oxaloacetic transaminase,total cholesterin,low density lipoprotein cholesterin and high density lipoprotein cholesterin in patients with high ALB were higher than those in patients with low ALB,while RDW was lower than those in patients with low ALB(P<0.05);5.Compared with the low RDW group,RBC,Hb,ALB,TC,TG,LDL-C and LVEF in the high RDW group were lower than those in the low RDW group,while UA and sodium were higher than those in the low RDW group,the difference was statistically significant(P<0.05);6.Compared with patients with low LVEF,patients with high LVEF have a higher proportion of hypertension and smoking history.The age,total triglyceride and high density lipoprotein cholesterin in the high LVEF group were higher than those in the low LVEF group,while the heart rate,diastolic blood pressure,hemoglobin,total bilirubin,glutamic transaminase,creatinine,urea nitrogen,uric acid and sodium in the high LVEF group were lower than those in the low LVEF group(P<0.05);7.In correlation analysis,BMI was positively correlated with ALB(r=0.266,p<0.01),while ALB was negatively correlated with RDW(r=-0.190,p<0.01),but the three had no significant correlation with LVEF;8.Low BMI,low ALB,low LVEF,and high RDW have certain predictive value for the all-cause readmission of HF patients(their AUC are 0.588,0.610,0.607,and 0.582,respectively,P<0.05).Combining BMI,RDW and ALB,it was found that the combined index of BMI,RDW and ALB had better predictive value than the single index in predicting the all-cause readmission of HF patients(AUC: 0.635 P<0.01);9.Univariate and multivariate Cox proportional risk regression analysis showed that BMI(HR: 0.956,95% CI: 0.915,0.998,p=0.040),LVEF(HR: 0.983,95% CI: 0.969,0.997,p=0.015)were independent protective factors for HF patients’ all-cause readmission,while coronary heart disease history(HR: 1.503,95% CI: 1.046,2.159,p=0.027)and RDW(HR: 1.144,95% CI: 1.022,1.280,p=0.020)were independent risk factors for HF patients’ all-cause readmission;10.Compared with the low BMI group,the high BMI group had a longer median time of all-cause readmission(P=0.004).According to the lower limit(35g/L)of the normal range of ALB commonly used in China,ALB is divided into high ALB group and low ALB group.Compared with low ALB group,the median time of all-cause readmission in high ALB group is longer(P=0.030).The best cutoff value of RDW is 13.5%according to the ROC curve.RDW is divided into high RDW group and low RDW group.Compared with high RDW group,the median time of all-cause re-admission of patients in low RDW group is longer(P=0.015).After combining BMI,RDW and ALB,it was found that the median time of all-cause re-admission in the low value group was longer than that in the high value group(P<0.01).Conclusion:1.BMI and LVEF history are protective factors of HF patients’ all,cause readmission,while RDW is an independent risk factor of HF patients’ all,cause readmission;2.BMI is positively correlated with ALB,and ALB is negatively correlated with RDW.BMI,ALB,and RDW have certain predictive value for HF patients’ all,cause readmission.3.The combined prediction ability of BMI,ALB and RDW on the all,cause readmission of HF patients is stronger than that of a single index.