Key result
Elevated red cell distribution width was independently associated with an increased risk of a 30-day composite complication endpoint in patients following aortic valve replacement surgery (OR 3.274, p=0.0003).
Why the study?
The prognostic utility of elevated red cell distribution width (RDW) in patients undergoing aortic valve replacement surgery was unknown.
Does elevated red cell distribution width predict adverse clinical outcomes in patients with severe symptomatic aortic stenosis undergoing aortic valve replacement surgery?
Cohort (n=191)
No
Does elevated red cell distribution width predict adverse clinical outcomes in patients with severe symptomatic aortic stenosis undergoing aortic valve replacement surgery?
Odds Ratio: 3.274 (95% CI 1.285–8.344)
p-value: p=0.0003
Elevated red cell distribution width is an easily accessible, independent prognostic marker for early postoperative complications following aortic valve replacement surgery.
BACKGROUND AND AIM: Several studies have reported that elevated red cell distribution width (RDW) is associated with poor outcomes in patients with coronary artery disease, chronic heart failure and aortic stenosis following transcatheter aortic valve replacement. Their prognostic utility in patients undergoing aortic valve replacement (AVR) surgery is unknown. METHODS: We prospectively evaluated the prognostic value of RDW in a group of 191 consecutive patients with severe symptomatic aortic stenosis undergoing AVR. The pre-defined primary endpoint at the 30-day follow-up was composed of: all cause mortality, perioperative myocardial infarction, perioperative renal failure, prolonged mechanical ventilation, stroke, heart failure, successfully resuscitated cardiac arrest, the occurrence of multiple-organ failure, and the need for additional surgery for any reason. The secondary endpoint was total mortality. RESULTS: The composite endpoint occurred in 54 patients. In univariate analysis RDW (p < 0.0001), haemoglobin level (p = 0.005), haematocrit (p = 0.01), red blood cell count (RBC; p = 0.002), glomerular filtration rate (p = 0.003), New York Heart Association classification (p = 0.02), atrial fibrillation (p = 0.0044), and pulmonary blood pressure (p = 0.004) were associated with the occurrence of the composite endpoint. RDW (p = 0.0005), haemoglobin level (p = 0.004), haematocrit (p = 0.004), RBC (p = 0.0009) and mean corpuscular volume (p = 0.01) were associated with an increased risk of death. In multivariate analysis, RDW (OR 3.274; 95% CI 1.285-8.344; p = 0.0003) and RBC (OR 0.373; 95% CI 0.176-0.787; p = 0.0097) remained independent predictors of the composite endpoint. Receiver operating characteristic analysis determined a cut-off value of RDW for the prediction of the occurrence of the combined endpoint at 14.1%. CONCLUSIONS: Elevated RDW is associated with a worse outcome following AVR, independent of RBC.
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Duchnowski et al. (2015) conducted a cohort in Severe symptomatic aortic stenosis (n=191). Elevated red cell distribution width (RDW) vs. Lower red cell distribution width was evaluated on Composite of all cause mortality, perioperative myocardial infarction, perioperative renal failure, prolonged mechanical ventilation, stroke, heart failure, successfully resuscitated cardiac arrest, multiple-organ failure, and need for additional surgery at 30 days (OR 3.274, 95% CI 1.285-8.344, p=0.0003). Elevated red cell distribution width was independently associated with an increased risk of a 30-day composite complication endpoint in patients following aortic valve replacement surgery (OR 3.274, p=0.0003).
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