23 Increased red blood cell distribution width is a marker of adverse cardiorenal outcomes following cardiac surgery

Résumé fourni par la source

There is a paucity of biomarkers for risk stratification following cardiac surgery. The red blood cell distribution width (RDW) – a standard component of routine CBC – quantifies the variation of RBC volumes during their lifespan. Elevated RDW is independently associated with morbidity and mortality across various metabolic and infectious conditions, and is a surrogate measure of fragility. Whether RDW can aid in risk stratification following cardiac surgery is unknown, and was the subject of this investigation. We evaluated the association of RDW with outcomes in patients enrolled in the global TRICS III randomized trial which compared restrictive to liberal blood transfusion in adult patients undergoing cardiac surgery. The primary composite outcome included death from any cause, myocardial infarction, stroke, or new-onset severe renal failure by hospital discharge at 28-days post-operatively. Secondary outcomes included all-cause death at 28 days and 6-months respectively. This analysis included 3658 patients for whom RDW was available (mean age 72±10; 63% male; EuroScore II 7.9±2.0; 26% CABG; 19% CABG+valve; 28% valve; 27% other). Elevated RDW was significantly and independently associated with incident primary adverse cardiorenal events at 28-days (highest RDW quartile vs. lowest RDW quartile, HR 1.96 (1.48–2.60); p<0.0001). A similar association was observed for key secondary outcomes of prolonged low-output state, acute kidney injury and new renal failure at 28 days post-operatively. Strikingly, following multivariate adjustment, elevated RDW was strongly associated with all-cause death at 28-days and 6-months following surgery (highest vs. lowest RDW quartile at 28-days: HR 2.12 (1.24–3.61); p<0.01 and 6 months: HR 2.42 (1.60–3.05); p<0.0001) (table 1), (figure 1). In this large trial of patients undergoing cardiac surgery, elevated RDW was associated with an increase in cardiorenal events, and short- and long-term mortality risk after multivariate adjustment. RDW may be a simple, inexpensive and highly predictive biomarker for adverse perioperative outcomes in cardiac surgery.

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