Red Blood Cell Distribution Width Predicts Myocardial Infarction and Mortality After Vascular Surgery-A Prospective Cohort Study.

Francisca Vieira Da Silva Caldeira De Albuquerque,Pedro José Vinhais Domingues Videira Reis,Marina Felicidade Dias-Neto,João Manuel Palmeira Da Rocha-Neves

doi:10.1007/s00268-022-06441-z

Francisca Vieira Da Silva Caldeira De Albuquerque, Pedro José Vinhais Domingues Videira Reis + Show 2 more

Open Access

https://doi.org/10.1007/s00268-022-06441-z

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Abstract

This study aims to investigate the association between preoperative Red blood cell Distribution Width (RDW) and postoperative outcomes, including myocardial infarction (MI), and mortality. A prospective cohort including all patients submitted to elective vascular arterial surgery at a university hospital. The primary and secondary outcomes were 30-day mortality and 30-day MI, respectively. Atrial fibrillation, chronic kidney disease (CKD), and dependent functional status were more prevalent in deceased patients. After multivariable analysis, age (adjusted OR 1.08, 95% Confidence Interval [1.01-1.15], p = 0.027) and RDW-standard deviation (RDW-SD) (1.08 [1.01-1.16], p = 0.032) remained independent predictors of mortality. Patients with MI had higher rates of diabetes, CKD, dependent functional status, ASA physical status IV, and insulin medication. After multivariable analysis, dependent functional status (4.8 [1.6-15.0], p = 0.007), insulin medication (4.4 [1.5-12.6], p = 0.007) and RDW-SD (1.10 [1.02-1.19], p = 0.020) were independent predictors of MI. RDW-SD independently predicted postoperative MI and mortality, and may provide valuable information for prevention and early management of adverse outcomes.

Highlights

Cardiovascular diseases are a leading cause of morbidity and mortality worldwide 1
Dependent functional status, insulin medication and red blood cell distribution width-standard deviation (RDW-SD) were independent predictors of myocardial infarction (MI). Conclusion: red blood cell distribution width (RDW) may play an important role in the perioperative evaluation of patients submitted to vascular surgery
This study aims to evaluate the potential role of preoperative hematological parameters in predicting perioperative outcomes, including MI and all-cause mortality

Summary

Introduction

Cardiovascular diseases are a leading cause of morbidity and mortality worldwide 1. The term anisocytosis corresponds to an increase in the RDW, meaning that the size distribution of red blood cells has a greater variation when compared to normal RDW values. This blood count parameter has been exhaustively studied in hematological diseases, such as bone marrow dysfunction or anemia due to deficiencies in vitamin B12, folate or iron 7. Variables Data sources/ measurement Bias Study size Quantitative variables Statistical methods Hematological parameters, such as the red blood cell distribution width coefficient variation (RDW-CV) and red blood cell distribution width-standard deviation (RDW-SD), have been shown to be strongly associated with postoperative cardiovascular events and all-cause mortality. RDW-SD independently predicts postoperative MI and mortality, and as such, it may provide valuable information for the prevention and early management of adverse cardiovascular outcomes

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