Department of Cardiology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Department of Cardiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China.
Heart Lung. 2024 Sep-Oct;67:191-200. doi: 10.1016/j.hrtlng.2024.04.020. Epub 2024 May 11.
It is essential to assess the risk stratification of patients with aortic stenosis (AS).
To clarify the predictive value of red blood cell distribution width (RDW) in AS patients using a large cohort from the MIMIC-IV database.
Restricted cubic spline, the Kaplan-Meier method, and logistic and Cox regression analyses were used to explore the association between RDW and all-cause mortality in AS patients. Multivariate adjustments, propensity score matching and weighting, and subgroup analysis were conducted to exclude confounding factors. Receiver operating characteristic (ROC) and decision curve analysis (DCA) curves were drawn to evaluate the predictive performance of RDW.
1,148 patients with AS were included. Their death risks gradually increased with the elevation of RDW. Multivariate-adjusted 90-day (OR: 2.12; HR: 1.90; p = 0.001) and 1-year (OR: 2.07; HR: 1.97; p < 0.001) all-cause mortalities were significantly higher in patients with RDW≥14.7 %, which remained robust after propensity score matching and subgroup analysis. For AS patients with high RDW, those < 75 years old had higher death risks than those ≥ 75 years old. The area under the ROC curve of RDW were 0.741 and 0.75 at 90-day and 1-year follow-ups, respectively, exhibiting comparable performance to acute physiology score III and outperforming other critical illness scores in predicting the prognosis of AS patients. DCA curves also illustrated that RDW had a wide range of net benefits.
High RDW was independently associated with increased 90-day and 1-year all-cause mortalities of AS patients, with strong predictive capability of prognosis.
评估主动脉瓣狭窄（AS）患者的风险分层至关重要。
利用 MIMIC-IV 数据库中的大样本队列，阐明红细胞分布宽度（RDW）在 AS 患者中的预测价值。
采用限制性立方样条、Kaplan-Meier 方法、logistic 和 Cox 回归分析探讨 RDW 与 AS 患者全因死亡率之间的关系。进行多变量调整、倾向评分匹配和加权以及亚组分析，以排除混杂因素。绘制受试者工作特征（ROC）和决策曲线分析（DCA）曲线评估 RDW 的预测性能。
纳入 1148 例 AS 患者。随着 RDW 的升高，其死亡风险逐渐增加。多变量校正后 90 天（OR：2.12；HR：1.90；p = 0.001）和 1 年（OR：2.07；HR：1.97；p < 0.001）全因死亡率在 RDW≥14.7%的患者中显著升高，这一结果在倾向评分匹配和亚组分析后仍然稳健。对于 RDW 较高的 AS 患者，年龄<75 岁者的死亡风险高于年龄≥75 岁者。RDW 的 ROC 曲线下面积在 90 天和 1 年随访时分别为 0.741 和 0.75，其预测性能与急性生理评分 III 相当，优于其他危重病评分，可预测 AS 患者的预后。DCA 曲线也表明 RDW 具有广泛的净收益。
RDW 与 AS 患者 90 天和 1 年全因死亡率的增加独立相关，对预后有较强的预测能力。
