LAUSR

Purpose Mortality from cardiogenic shock (CS) approaches 50% over 30 days. Classic risk factors for heart failure are weak predictors of mortality from CS. There is a need to identify pragmatic biomarkers to predict mortality in CS for prognosis and to facilitate the use of temporary mechanical circulatory support (MCS: percutaneous left ventricular assist device [Impella], venoarterial extracorporeal membrane oxygenators [VA-ECMO]). Anisocytosis is a strong predictor of mortality in patients with heart failure. We sought to determine whether RDW is predictive of mortality in patients with CS requiring MCS. Methods This was a retrospective observational study for patients with cardiogenic shock requiring temporary MCS. Data regarding age, sex, race, presenting RDW, and MCS use was collected. The primary outcome was all-cause mortality at 30 days and 1 year. Results 304 patients were identified: mean age 59.1±15.7 years, 214 (70%) male, 221 (72.7%) white. Impella was used in 128 (42%), VA-ECMO in 132 (43%), both Impella and VA-ECMO (ECPELLA) in 44 (14.5%). Mean RDW was 15.7±2.0. Compared with patients who received Impella alone, those who received ECMO/ECPELLA had higher RDW (15.4±2.1 vs 16.0±1.9%, P=0.007). 105 (35%) patients died over 30-days and 141 (46%) over 1-year. A 1% increment in RDW was associated with 14% and 13% relative increases in hazards of 30-day (HR 1.14 [1.06-1.23], P Conclusion In patients with CS receiving temporary MCS, a higher RDW was independently associated with 30-day and 1-year mortality. RDW may serve as a pragmatic biomarker of mortality risk in patients with CS receiving temporary MCS.