Abstract
ABSTRACTThe aim of the study was to evaluate the prognostic value of red cell distribution width (RDW) for multiple organ dysfunction syndrome (MODS) in the early postoperative period in patients undergoing valve replacement or repair surgery. A prospective study was conducted on a group of 713 patients with haemodynamically significant valvular heart disease who underwent elective valvular surgery. The primary end-point at the 30-day follow-up was postoperative MODS. The secondary end-point was death from all causes in patients with MODS. The postoperative MODS occurred in 72 patients. At multivariate analysis: RDW (OR 1.267; 95% CI 1.113-1.441; P=0.0003), creatinine (OR 1.007; 95% CI 1.001-1.013; P=0.02) and age (OR 1.047; 95% CI 1.019-1.077; P=0.001) remained independent predictors of the primary end-point. Receiver operator characteristics analysis determined a cut-off value of RDW for the prediction of the occurrence of the perioperative MODS at 14.3%. RDW (OR 1.448; 95% CI 1.057-1.984; P=0.02) and age (OR 1.057; 95% CI 1.007-1.117; P=0.04) were associated with an increased risk of death in patients with perioperative MODS. Elevated RDW is associated with a higher risk of MODS and death in patients with MODS following heart valve surgery.
Highlights
Postoperative multiple organ dysfunction syndrome (MODS) is a complication that may occur after heart valve surgery, which significantly increases the risk of hospital death
A multiple organ dysfunction syndrome occurred in 72 patients (44 patients required renal replacement therapy, 45 patients prolonged mechanical ventilation, 43 patients supply of catecholamines and 23 patients mechanical circulatory support; extracorporeal membrane oxygenation or an intra-aortic balloon pump)
red cell distribution width (RDW) [odds ratio (OR) 1.267; 95% confidence interval (CI) 1.113-1.441; P=0.0003], creatinine and age remained independent predictors of the primary end-point
Summary
Postoperative multiple organ dysfunction syndrome (MODS) is a complication that may occur after heart valve surgery, which significantly increases the risk of hospital death. Information on the risk factors of postoperative MODS in patients undergoing heart surgery is limited Among these factors, preoperative NYHA functional class, prolonged mechanical ventilation, perioperative hypoxia, time of aortic cross-clamping, older age, surgery on cardiac arrest, severe left ventricular dysfunction and elevated value of creatinine are the most frequently described (Yuan et al, 2018; Litwiński et al, 2018; Fernandez-Zamora et al, 2018; Yeung et al, 2016; Zhao et al, 2016; Eremenko and Minbolatova, 2015; Belletti et al, 2017).
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