Seth Harsh Sateesh, Mishra Prashant, Khandekar Jayant V, Raut Chaitanya, Mohapatra Chandan Kumar Ray, Ammannaya Ganesh Kumar K, Saini Jaskaran Singh, Shah Vaibhav
Department of Cardiovascular and Thoracic Surgery Lokmanya Tilak Municipal Medical College and General Hospital.
Braz J Cardiovasc Surg. 2017 Jul-Aug;32(4):288-294. doi: 10.21470/1678-9741-2017-0023.
Cardiac surgical operations involving extracorporeal circulation may develop severe inflammatory response. This severe inflammatory response syndrome (SIRS) is usually associated with poor outcome with no predictive marker. Red cell distribution width (RDW) is a routine hematological marker with a role in inflammation. We aim to determine the relationship between RDW and SIRS through our study.
A total of 1250 patients who underwent cardiac surgery with extracorporeal circulation were retrospectively analyzed out of which 26 fell into the SIRS criteria and 26 consecutive control patients were taken. RDW, preoperative clinical data, operative time and postoperative data were compared between SIRS and control groups.
The demographic profile of the patients was similar. RDW was significantly higher in the SIRS versus control group (15.5±2.0 vs. 13.03±1.90), respectively with P value <0.0001. There was significant mortality in the SIRS group, 20 (76.92%) as compared to 2 (7.6%) in control group with a P value of <0.005. Multiple logistic regression analysis revealed that there was significant association with high RDW and development of SIRS after extracorporeal circulation (OR for RDW levels exceeding 13.5%; 95% CI 1.0-1.2; P<0.05).
Increased RDW was significantly associated with increased risk of SIRS after extracorporeal circulation. Thus, RDW can act as a useful tool to predict SIRS in patients undergoing cardiac surgery with extracorporeal circulation. Hence, more aggressive measures can be taken in patients with high RDW to prevent postoperative morbidity and mortality.
涉及体外循环的心脏外科手术可能会引发严重的炎症反应。这种严重炎症反应综合征（SIRS）通常与不良预后相关，且没有预测指标。红细胞分布宽度（RDW）是一种常规血液学指标，在炎症中发挥作用。我们旨在通过本研究确定RDW与SIRS之间的关系。
回顾性分析了1250例行体外循环心脏手术的患者，其中26例符合SIRS标准，并选取了26例连续的对照患者。比较了SIRS组和对照组之间的RDW、术前临床资料、手术时间和术后资料。
两组患者的人口统计学特征相似。SIRS组的RDW显著高于对照组（分别为15.5±2.0与13.03±1.90），P值<0.0001。SIRS组的死亡率显著高于对照组，分别为20例（76.92%）和2例（7.6%），P值<0.005。多因素逻辑回归分析显示，体外循环后高RDW与SIRS的发生显著相关（RDW水平超过13.5%时的比值比；95%置信区间1.0 - 1.2；P<0.05）。
体外循环后RDW升高与SIRS风险增加显著相关。因此，RDW可作为预测行体外循环心脏手术患者发生SIRS的有用工具。因此，对于RDW高的患者可采取更积极的措施以预防术后发病和死亡。
