{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:00:29Z","timestamp":1753891229354,"version":"3.41.2"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T00:00:00Z","timestamp":1747699200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Recent studies have identified a co-occurrence of chronic obstructive pulmonary disease and congestive heart failure in ICU patients. Abnormal red cell distribution width (RDW) frequently manifests in critically ill patients, but its clinical significance remains a subject of debate. This study aims to investigate the relationship between RDW and in-hospital mortality in patients with concurrent congestive heart failure and chronic obstructive pulmonary disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective cohort study using the Medical Information Mart for Intensive Care (MIMIC) IV version 2.0 database. RDW levels were assessed within 24 h of admission. The impact of RDW at ICU admission on in-hospital mortality was analyzed through multivariable logistic regression models, generalized additive models, and subgroup analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We enrolled 6,309 patients with congestive heart failure and concomitant chronic obstructive pulmonary disease, with an in-hospital mortality rate of 12.4% (783\/6,309). The fully adjusted model revealed a positive association between RDW and in-hospital mortality in congestive heart failure patients with concurrent chronic obstructive pulmonary disease, even after accounting for confounding factors (OR = 1.07, 95% CI: 1.03\u20131.12, <jats:italic>p<\/jats:italic> &amp;lt; 0.001). When comparing the highest quartile (Q4) to the lowest quartile (Q1), the odds ratio (OR) was 1.62, with a 95% confidence interval (CI) of 1.17\u20132.22, p = 0.003. We observed a linear relationship between RDW and in-hospital mortality, which remained consistent in subgroup analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our data suggest that RDW is positively associated with in-hospital mortality in patients with both congestive heart failure and chronic obstructive pulmonary disease. At the same time, large prospective research and longer follow-up time are required to further validate the findings of this study.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1448930","type":"journal-article","created":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T09:52:34Z","timestamp":1747734754000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Associations between red cell distribution width and in-hospital mortality in congestive heart failure patients with chronic obstructive pulmonary disease: a retrospective cohort 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