Predictive value of hematological parameters in prognosis of congestive heart failure patients in a tertiary hospital, Addis Ababa, Ethiopia.

BACKGROUND

Hematological parameters are increasingly recognized as cost-effective prognostic indicators in chronic heart failure (CHF), offering insight into disease severity and progression.

OBJECTIVE

To evaluate selected hematological parameters and their prognostic utility in patients with CHF, using the New York Heart Association (NYHA) as a clinical severity reference.

METHODS

A total of 206 adult CHF patients were recruited from the cardiology department of St. Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa. Venous blood samples (5 mL) were collected in EDTA tubes and analyzed using the DxH 800 Beckman Coulter Hematology Analyzer. Differences in hematological parameters across NYHA classes were evaluated, and prognostic performance was assessed using receiver operating characteristic (ROC) curve analysis on selected parameters. A p-value < 0.05 was considered statistically significant.

RESULTS

All three parameters-Hct, RDW, and ALC-differed significantly between NYHA class II and class IV patients (p = 0.035, p = 0.002, and p = 0.035, respectively). ROC analysis demonstrated that RDW and ALC provided greater predictive value than Hct. For disease progression from NYHA class I to III, RDW yielded an AUC of 0.663 (95% CI, 0.549-0.777; p = 0.009) at a cut-off of 13.5%, while ALC achieved an AUC of 0.657 (95% CI, 0.543-0.771; p = 0.012) at a cut-off of 1.72 × 109/L. For progression from class I to IV, RDW showed an AUC of 0.708 (95% CI, 0.608-0.808; p < 0.001) at a cut-off of 15.9%, and ALC an AUC of 0.622 (95% CI, 0.514-0.729; p = 0.035) at a cut-off of 1.95 × 109/L.

CONCLUSION

Hematocrit (Hct), red cell distribution width (RDW), and absolute lymphocyte count (ALC) varied significantly across NYHA functional classes, indicating prognostic relevance in chronic heart failure. Among these, RDW and ALC demonstrated stronger discriminatory performance. Together, these readily available parameters may serve as practical adjuncts for risk stratification in CHF, particularly in resource-limited settings.