Association Between the Red Blood Cell Distribution Width and 30-Day Mortality in Intensive Care Patients Undergoing Cardiac Surgery: A Retrospective Observational Study Based on the Medical Information Mart for Intensive Care-IV Database

Overview

Journal Ann Lab Med

Specialty Pathology

Date 2024 Mar 12

PMID 38469636

Authors

Weiqiang Chen

Peiling Yu

Chao Chen

Shaoyan Cai

Junheng Chen

Chunqin Zheng

Chaojin Chen

Liangjie Zheng

Chunming Guo

Affiliations

Soon will be listed here.

Abstract

Background: Millions of patients undergo cardiac surgery each year. The red blood cell distribution width (RDW) could help predict the prognosis of patients who undergo percutaneous coronary intervention or coronary artery bypass surgery. We investigated whether the RDW has robust predictive value for the 30-day mortality among patients in an intensive care unit (ICU) after undergoing cardiac surgery.

Methods: Using the Medical Information Mart for Intensive Care-IV Database, we retrieved data for 11,634 patients who underwent cardiac surgery in an ICU. We performed multivariate Cox regression analysis to model the association between the RDW and 30-day mortality and plotted Kaplan-Meier curves. Subgroup analyses were stratified using relevant covariates. Receiver operating characteristic (ROC) curves were used to determine the predictive value of the RDWs.

Results: The total 30-day mortality rate was 4.2% (485/11,502). The elevated-RDW group had a higher 30-day mortality rate than the normal-RDW group (&0.001). The robustness of our data analysis was confirmed by performing subgroup analyses. Each unit increase in the RDW was associated with a 17% increase in 30-day mortality when the RDW was used as a continuous variable (adjusted hazard ratio=1.17, 95% confidence interval, 1.10-1.25). Our ROC results showed the predictive value of the RDW.

Conclusions: An elevated RDW was associated with a higher 30-day mortality in patients after undergoing cardiac surgery in an ICU setting. The RDW can serve as an efficient and accessible method for predicting the mortality of patients in ICUs following cardiac surgery.

References

Zante B, Reichenspurner H, Kubik M, Kluge S, Schefold J, Pfortmueller C . Base excess is superior to lactate-levels in prediction of ICU mortality after cardiac surgery. PLoS One. 2018; 13(10):e0205309. PMC: 6173442. DOI: 10.1371/journal.pone.0205309. View

Singer M, Deutschman C, Seymour C, Shankar-Hari M, Annane D, Bauer M . The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8):801-10. PMC: 4968574. DOI: 10.1001/jama.2016.0287. View

Yu Y, Peng C, Zhang Z, Shen K, Zhang Y, Xiao J . Machine Learning Methods for Predicting Long-Term Mortality in Patients After Cardiac Surgery. Front Cardiovasc Med. 2022; 9:831390. PMC: 9110683. DOI: 10.3389/fcvm.2022.831390. View

Otero T, Canales C, Yeh D, Hou P, Belcher D, Quraishi S . Elevated red cell distribution width at initiation of critical care is associated with mortality in surgical intensive care unit patients. J Crit Care. 2016; 34:7-11. PMC: 4903153. DOI: 10.1016/j.jcrc.2016.03.005. View

Smirne C, Grossi G, Pinato D, Burlone M, Mauri F, Januszewski A . Evaluation of the red cell distribution width as a biomarker of early mortality in hepatocellular carcinoma. Dig Liver Dis. 2015; 47(6):488-94. DOI: 10.1016/j.dld.2015.03.011. View

Devereaux P, Lamy A, Chan M, Allard R, Lomivorotov V, Landoni G . High-Sensitivity Troponin I after Cardiac Surgery and 30-Day Mortality. N Engl J Med. 2022; 386(9):827-836. DOI: 10.1056/NEJMoa2000803. View

Lazam S, Vanoverschelde J, Tribouilloy C, Grigioni F, Suri R, Avierinos J . Twenty-Year Outcome After Mitral Repair Versus Replacement for Severe Degenerative Mitral Regurgitation: Analysis of a Large, Prospective, Multicenter, International Registry. Circulation. 2016; 135(5):410-422. DOI: 10.1161/CIRCULATIONAHA.116.023340. View

Maluf C, Barreto S, Giatti L, Ribeiro A, Vidigal P, Azevedo D . Association between C reactive protein and all-cause mortality in the ELSA-Brasil cohort. J Epidemiol Community Health. 2020; 74(5):421-427. PMC: 7307658. DOI: 10.1136/jech-2019-213289. View

Qi X, Dong Y, Lin X, Xin W . Value of Neutrophil to Lymphocyte Ratio, Platelet to Lymphocyte Ratio, and Red Blood Cell Distribution Width in Evaluating the Prognosis of Children with Severe Pneumonia. Evid Based Complement Alternat Med. 2021; 2021:1818469. PMC: 8486541. DOI: 10.1155/2021/1818469. View

10.

Salvagno G, Sanchis-Gomar F, Picanza A, Lippi G . Red blood cell distribution width: A simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci. 2014; 52(2):86-105. DOI: 10.3109/10408363.2014.992064. View

11.

Pinho J, Silva L, Quintas-Neves M, Marques L, Amorim J, Reich A . Red Cell Distribution Width is Associated with 30-day Mortality in Patients with Spontaneous Intracerebral Hemorrhage. Neurocrit Care. 2020; 34(3):825-832. PMC: 8179905. DOI: 10.1007/s12028-020-01103-1. View

12.

Fibach E, Rachmilewitz E . The role of oxidative stress in hemolytic anemia. Curr Mol Med. 2008; 8(7):609-19. DOI: 10.2174/156652408786241384. View

13.

Bouma H, Mungroop H, Scheeren T, Epema A . Very early creatinine changes and 30-day mortality after cardiac surgery. Eur J Anaesthesiol. 2021; 38(6):665. DOI: 10.1097/EJA.0000000000001436. View

14.

Pinna A, Carlino P, Serra R, Boscia F, Dore S, Carru C . Red Cell Distribution Width (RDW) and Complete Blood Cell Count-Derived Measures in Non-Arteritic Anterior Ischemic Optic Neuropathy. Int J Med Sci. 2021; 18(10):2239-2244. PMC: 8040420. DOI: 10.7150/ijms.53668. View

15.

Nashef S, Roques F, Sharples L, Nilsson J, Smith C, Goldstone A . EuroSCORE II. Eur J Cardiothorac Surg. 2012; 41(4):734-44. DOI: 10.1093/ejcts/ezs043. View

16.

Landoni G, Lomivorotov V, Silvetti S, Nigro Neto C, Pisano A, Alvaro G . Nonsurgical Strategies to Reduce Mortality in Patients Undergoing Cardiac Surgery: An Updated Consensus Process. J Cardiothorac Vasc Anesth. 2017; 32(1):225-235. DOI: 10.1053/j.jvca.2017.06.017. View

17.

Johnson A, Bulgarelli L, Shen L, Gayles A, Shammout A, Horng S . MIMIC-IV, a freely accessible electronic health record dataset. Sci Data. 2023; 10(1):1. PMC: 9810617. DOI: 10.1038/s41597-022-01899-x. View

18.

Lindmark E, Diderholm E, Wallentin L, Siegbahn A . Relationship between interleukin 6 and mortality in patients with unstable coronary artery disease: effects of an early invasive or noninvasive strategy. JAMA. 2001; 286(17):2107-13. DOI: 10.1001/jama.286.17.2107. View

19.

Weimann A, Braga M, Carli F, Higashiguchi T, Hubner M, Klek S . ESPEN practical guideline: Clinical nutrition in surgery. Clin Nutr. 2021; 40(7):4745-4761. DOI: 10.1016/j.clnu.2021.03.031. View

20.

Shao Q, Korantzopoulos P, Letsas K, Tse G, Hong J, Li G . Red blood cell distribution width as a predictor of atrial fibrillation. J Clin Lab Anal. 2018; 32(5):e22378. PMC: 6817116. DOI: 10.1002/jcla.22378. View