Department of Thoracic Surgery, The Second Affiliated Hospital of Jiangxi Medical College of Nanchang University, Nanchang, Jiangxi Province, China.
PLoS One. 2024 Jul 23;19(7):e0306258. doi: 10.1371/journal.pone.0306258. eCollection 2024.
Surgical aortic valve replacement (SAVR) currently stands as a primary surgical intervention for addressing aortic valve disease in patients. This retrospective study focused on the role of the red blood cell distribution width (RDW) in predicting adverse outcomes among SAVR patients.
The subjects for this study were exclusively derived from the Medical Information Mart for Intensive Care database (MIMIC IV 2.0). Kaplan‒Meier (K-M) curves and Cox proportional hazards regression models were employed to assess the correlation between RDW, one-year mortality, and postoperative atrial fibrillation (POAF). The smooth-fitting curves were used to observe the relative risk (RR) of RDW in one-year mortality and POAF. Furthermore, time-dependent receiver operating characteristic (ROC) curves, the continuous-net reclassification index (NRI), and integrated discrimination improvement (IDI) were employed for comprehensive assessment of the prognostic value of RDW.
Analysis of RDW revealed a distinctive inverted U-shaped relationship with one-year mortality, while its association with POAF appeared nearly linear. Cox multiple regression models showed that RDW > 14.35%, along with preoperative potassium concentration and perioperative red blood cell transfusion, were significantly linked to one-year mortality (K-M curves, log-rank P < 0.01). Additionally, RDW was associated with both POAF and prolonged hospital stays (P < 0.05). There was no significant difference in length of stay in ICU. Notably, the inclusion of RDW in the predictive models substantially enhanced its performance. This was evidenced by the time-dependent ROC curve (AUC = 0.829), NRI (P< 0.05), IDI (P< 0.05), and K-M curves (log-rank P< 0.01).
RDW serves as a robust prognostic indicator for SAVR patients, offering a novel means of anticipating adverse postoperative events.
外科主动脉瓣置换术（SAVR）目前是治疗主动脉瓣疾病患者的主要手术干预手段。本回顾性研究侧重于红细胞分布宽度（RDW）在预测 SAVR 患者不良结局中的作用。
本研究的对象仅来自医疗信息监护数据库（MIMIC IV 2.0）。采用 Kaplan-Meier（K-M）曲线和 Cox 比例风险回归模型评估 RDW 与一年死亡率和术后心房颤动（POAF）之间的相关性。使用平滑拟合曲线观察 RDW 与一年死亡率和 POAF 的相对风险（RR）。此外，时间依赖性接收者操作特征（ROC）曲线、连续净重新分类指数（NRI）和综合鉴别改善（IDI）用于全面评估 RDW 的预后价值。
RDW 分析显示与一年死亡率呈独特的倒 U 型关系，而与 POAF 的关系几乎呈线性。Cox 多变量回归模型显示，RDW > 14.35%，以及术前钾浓度和围手术期红细胞输血，与一年死亡率显著相关（K-M 曲线，对数秩 P < 0.01）。此外，RDW 与 POAF 和延长住院时间相关（P < 0.05）。ICU 住院时间无显著差异。值得注意的是，将 RDW 纳入预测模型显著提高了其性能。这可以通过时间依赖性 ROC 曲线（AUC = 0.829）、NRI（P < 0.05）、IDI（P < 0.05）和 K-M 曲线（对数秩 P < 0.01）得到证明。
RDW 是 SAVR 患者的强大预后指标，为预测不良术后事件提供了新方法。
