Duchnowski Piotr, Szymański Piotr, Orłowska-Baranowska Ewa, Kuśmierczyk Mariusz, Hryniewiecki Tomasz
Institute of Cardiology, Warsaw.
Kardiol Pol. 2016;74(6):547-52. doi: 10.5603/KP.a2015.0213. Epub 2015 Oct 27.
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.
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.
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%.
Elevated RDW is associated with a worse outcome following AVR, independent of RBC.
多项研究报告称，红细胞分布宽度（RDW）升高与冠状动脉疾病、慢性心力衰竭以及经导管主动脉瓣置换术后主动脉瓣狭窄患者的不良预后相关。其在接受主动脉瓣置换（AVR）手术患者中的预后价值尚不清楚。
我们前瞻性评估了RDW对一组191例连续接受AVR的重度有症状主动脉瓣狭窄患者的预后价值。30天随访时预先定义的主要终点包括：全因死亡率、围手术期心肌梗死、围手术期肾衰竭、机械通气时间延长、中风、心力衰竭、成功复苏的心脏骤停、多器官功能衰竭的发生以及因任何原因需要再次手术。次要终点是总死亡率。
54例患者出现复合终点。单因素分析中，RDW（p<0.0001）、血红蛋白水平（p = 0.005）、血细胞比容（p = 0.01）、红细胞计数（RBC；p = 0.002）、肾小球滤过率（p = 0.003）、纽约心脏协会分级（p = 0.02）、心房颤动（p = 0.0044）和肺动脉压（p = 0.004）与复合终点的发生相关。RDW（p = 0.0005）、血红蛋白水平（p = 0.004）、血细胞比容（p = 0.004）、RBC（p = 0.0009）和平均红细胞体积（p = 0.01）与死亡风险增加相关。多因素分析中，RDW（OR 3.274；95%CI 1.285 - 8.344；p = 0.0003）和RBC（OR 0.373；95%CI 0.176 - 0.787；p = 0.0097）仍然是复合终点的独立预测因素。受试者工作特征分析确定预测联合终点发生的RDW临界值为14.1%。
RDW升高与AVR术后较差的预后相关，独立于RBC。
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