Association of Red Cell Distribution Width with Cardiovascular Complications and Risk Factors in Hypertensive and Cardiac Patients: A Retrospective Study

Abstract

This study addresses an overlooked clinical gap in Libya by evaluating baseline Red Cell Distribution Width (RDW)—a standard measure of erythrocyte size heterogeneity—as a zero-cost prognostic tool for predicting cardiovascular mortality and critical care escalation. While RDW traditionally classifies anemias, modern clinical pathophysiology demonstrates that fluctuating RDW levels actively reflect systemic inflammation and tissue hypoxia, both of which impair bone marrow function during cardiac stress. Currently, no published regional literature has established specific RDW thresholds for cardiac risk stratification in Libya, where managing cardiovascular crises is heavily complicated by strict budgetary constraints and chronic shortages of expensive diagnostic reagents. To provide an accessible predictive alternative, this retrospective investigation analyzed archived clinical and laboratory records of 350 adult cardiac patients at the Tajoura National Center for Cardiac Treatment. The baseline cohort (mean age 61.42 years, 55.7% male) exhibited high rates of hypertension (61.4%) and diabetes mellitus (56.0%), with an elevated overall mean RDW of 16.60%. RDW profiles remained statistically similar between isolated cardiovascular disease and concurrent hypertension (16.72% vs. 16.52%, p = 0.505) but varied significantly with myocardial infarction status (p = 0.035) and peaked in mechanical heart failure (17.33% vs. 15.78%, p < 0.001). Controlling for baseline age, diabetes, and smoking status via multivariate regression, elevated RDW independently outperformed these traditional covariates, emerging as a powerful predictor of death, with optimal thresholds fixed at 16.25% for mortality screening and 16.35% for ICU admission. In conclusion, this study provides the first definitive domestic data confirming that baseline RDW functions as an independent biometric predictor of patient mortality and critical care escalation, offering resource-strained hospitals an immediate, zero-cost screening marker to help save lives.