Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA.
Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA; Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan.
J Arthroplasty. 2021 Nov;36(11):3646-3649. doi: 10.1016/j.arth.2021.07.002. Epub 2021 Jul 14.
Mortality after total joint arthroplasty (TJA) has been thoroughly explored. Short and long-term mortality appear to be correlated with patient comorbidities. Red Cell Distribution Width (RDW) is a commonly performed test that reflects the variation in red blood cell size. This study investigated the utility of RDW, when combined with comorbidity indices, in predicting mortality after TJA.
Using a single institutional database, 30,437 primary TJA were identified. Patient demographics (age, gender, body mass index (BMI), pre-operative hemoglobin, RDW, and Charlson Comorbidity Index(CCI)) were queried. The primary outcome was 1-year mortality after TJA. Anemia was defined as hemoglobin <12g/dL for women and <13 g/dL for men. The normal range for RDW is 11.5-14.5%. A preliminary analysis assessed the bivariate association between demographics, preoperative anemia, RDW, CCI, and all-cause mortality within 1-year after TJA. A multivariate regression model was conducted to determine independent predictors of 1-year mortality. Finally, ROC curves were used to compare AUC of RDW, CCI and the combination of both in predicting 1-year mortality.
The mean RDW was 13.6% ± 1.2. Eighteen percent of patients had pre-operative anemia. The mean CCI was 0.4 ± 0.9. RDW, anemia, CCI, and age were significantly associated with a higher incidence of 1-year mortality. RDW, CCI, age, and male sex were found to be independent risk factors for 1-year mortality. RDW (AUC = 0.68) was a better predictor of mortality compared to CCI (AUC = 0.66). The combination of RDW and CCI (AUC = 0.76) predicted 1-year mortality more accurately than CCI or RDW alone.
RDW appears to be a useful parameter that, when combined with CCI, can predict the risk for 1-year mortality after TJA.
全关节置换术后（TJA）的死亡率已经得到了充分的研究。短期和长期死亡率似乎与患者合并症有关。红细胞分布宽度（RDW）是一种常用的检测方法，反映了红细胞大小的变化。本研究探讨了 RDW 与合并症指数相结合，在预测 TJA 后死亡率方面的作用。
使用单一机构数据库，确定了 30437 例原发性 TJA。查询了患者的人口统计学特征（年龄、性别、体重指数（BMI）、术前血红蛋白、RDW 和 Charlson 合并症指数（CCI））。主要结果是 TJA 后 1 年的死亡率。贫血定义为女性血红蛋白<12g/dL，男性血红蛋白<13g/dL。RDW 的正常范围为 11.5-14.5%。初步分析评估了人口统计学特征、术前贫血、RDW、CCI 与 TJA 后 1 年内全因死亡率之间的双变量相关性。进行了多变量回归模型以确定 1 年死亡率的独立预测因素。最后，使用 ROC 曲线比较了 RDW、CCI 及两者结合预测 1 年死亡率的 AUC。
平均 RDW 为 13.6%±1.2。18%的患者术前贫血。平均 CCI 为 0.4±0.9。RDW、贫血、CCI 和年龄与更高的 1 年死亡率显著相关。RDW、CCI、年龄和男性被认为是 1 年死亡率的独立危险因素。RDW（AUC=0.68）比 CCI（AUC=0.66）更能预测死亡率。RDW 和 CCI 的组合（AUC=0.76）比 CCI 或 RDW 单独预测 1 年死亡率更准确。
RDW 似乎是一个有用的参数，与 CCI 结合使用可以预测 TJA 后 1 年死亡率的风险。
