Frontiers in Cardiovascular Medicine · Oct 30, 2026
Combined RDW-CV and NT-proBNP for All-Cause Mortality Prognostication in Frail Older Cancer Patients Hospitalized With Anticancer Treatment-Related Cardiac Dysfunction: A Retrospective Cohort Study
By Nana Li, Jie Yang, Qin Xiao
Background and Aims: Frail older adults hospitalized with established anticancer treatment-related cardiac dysfunction (CTRCD)/heart failure represent a selected, high-risk cardio-oncology population. Red cell distribution width-coefficient of variation (RDW-CV) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are routinely available biomarkers, but their individual and joint associations with subsequent mortality in this setting remain incompletely characterized. We evaluated their associations with all-cause mortality and explored multiplicative interaction and prognostic discrimination. Methods: This retrospective cohort study enrolled 399 patients aged ≥65 years who were hospitalized with established anticancer treatment-related heart failure/CTRCD and confirmed frailty (Fried phenotype score ≥3) from January 2018 to December 2023, with follow-up through January 2025 (median 28 months). For the reported four-group survival analyses, patients were stratified using the cohort medians of RDW-CV (14.8%) and NT-proBNP (4562 pg/mL). Kaplan-Meier and Cox regression analyses evaluated associations with all-cause mortality. A multiplicative interaction term [RDW-CV × ln(NT-proBNP)] and restricted cubic spline analyses were exploratory. Conventional ROC analyses were also exploratory and were performed in the same derivation cohort. Results: Among 399 patients (mean age 78.6±7.2 years; 56.9% male), 168 all-cause deaths (42.1%) occurred during follow-up. Each 1% increment in RDW-CV was associated with an 11% higher mortality hazard after full multivariable adjustment (HR=1.11, 95%CI: 1.04-1.18; P=0.002), and high versus low NT-proBNP was associated with a 1.68-fold higher mortality hazard (HR=1.68, 95%CI: 1.19-2.37; P=0.003). Median-defined combined biomarker groups showed a mortality gradient from 19.4% in the dual-low group to 60.7% in the dual-high group (log-rank χ²=44.86, P<0.001). The multiplicative interaction term was statistically significant (HR=1.04, 95%CI: 1.01-1.08; P=0.032) and should be interpreted as exploratory statistical effect modification rather than evidence of biological synergy. In the same cohort, the combined panel had an apparent AUC of 0.762 (95%CI: 0.713-0.811), compared with 0.672 for RDW-CV alone and 0.718 for NT-proBNP alone. Conclusion: In frail older cancer patients already hospitalized with established anticancer treatment-related cardiac dysfunction/heart failure, higher RDW-CV and NT-proBNP were associated with greater subsequent all-cause mortality, and the median-defined dual-high group had the poorest prognosis. The combined panel showed greater apparent discrimination than either biomarker alone in this single derivation cohort.