红细胞分布宽度是心脏瓣膜手术患者围手术期卒中的一个预后指标。
Red cell distribution width is a prognostic marker of perioperative stroke in patients undergoing cardiac valve surgery.
作者信息
Duchnowski Piotr, Hryniewiecki Tomasz, Kusmierczyk Mariusz, Szymanski Piotr
机构信息
Department of Acquired Cardiac Defects, Institute of Cardiology, Warsaw, Poland.
Department of Cardiac Surgery and Transplantology, Institute of Cardiology, Warsaw, Poland.
出版信息
Interact Cardiovasc Thorac Surg. 2017 Dec 1;25(6):925-929. doi: 10.1093/icvts/ivx216.
OBJECTIVES
Numerous studies have shown that elevated red cell distribution width (RDW) is associated with poor outcomes in patients with cardiovascular diseases such as coronary artery disease, peripheral artery disease or stroke. The usefulness of the RDW as a predictor of perioperative stroke in patients with valve disease undergoing valve surgery is currently unknown. The aim of the study was to evaluate the prognostic value of RDW for stroke in the early postoperative period in patients undergoing valve replacement or repair surgery.
METHODS
A prospective study was conducted on a group of 500 consecutive patients with haemodynamically significant valvular heart disease who underwent elective valvular surgery. Preoperative complete blood count, data on risk factors, the course of operations and the postoperative period were assessed. The primary end-point at the 30-day follow-up was perioperative stroke or transient ischaemic attack. The secondary end-point was death from all causes in patients with perioperative stroke. Univariate analysis, followed by multivariate regression analysis, was performed.
RESULTS
The perioperative stroke occurred in 14 patients. At multivariate analysis: RDW [odds ratio (OR) 1.640, 95% confidence interval (CI) 1.132-2.377; P = 0.009] and haemoglobin (OR 0.655, 95% CI 0.447-0.961; P = 0.03) 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 stroke/transient ischaemic attack at 14.1%. Creatinine (OR 1.015, 95% CI 1.004-1.026; P = 0.0079) and RDW (OR 1.493, 95% CI 1.171-1.815; P = 0.04) were associated with an increased risk of death in patients with perioperative stroke.
CONCLUSIONS
Elevated RDW is associated with a higher risk of perioperative stroke/transient ischaemic attack and death in patients with perioperative stroke.
目的
大量研究表明，红细胞分布宽度（RDW）升高与冠心病、外周动脉疾病或中风等心血管疾病患者的不良预后相关。目前尚不清楚RDW作为接受瓣膜手术的瓣膜病患者围手术期中风预测指标的效用。本研究的目的是评估RDW对接受瓣膜置换或修复手术患者术后早期中风的预后价值。
方法
对一组连续500例接受择期瓣膜手术、血流动力学显著的瓣膜性心脏病患者进行了一项前瞻性研究。评估术前全血细胞计数、危险因素数据、手术过程和术后情况。30天随访时的主要终点是围手术期中风或短暂性脑缺血发作。次要终点是围手术期中风患者的全因死亡。进行了单因素分析，随后进行多因素回归分析。
结果
14例患者发生围手术期中风。多因素分析显示：RDW[比值比（OR）1.640，95%置信区间（CI）1.132 - 2.377；P = 0.009]和血红蛋白（OR 0.655，95%CI 0.447 - 0.961；P = 0.03）仍然是主要终点的独立预测因素。受试者工作特征分析确定，预测围手术期中风/短暂性脑缺血发作发生的RDW截断值为14.1%。肌酐（OR 1.015，95%CI 1.004 - 1.026；P = 0.0079）和RDW（OR 1.493，95%CI 1.171 - 1.815；P = 0.04）与围手术期中风患者的死亡风险增加相关。
结论
RDW升高与围手术期中风患者围手术期中风/短暂性脑缺血发作及死亡风险较高相关。
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