Olafsson Halldór B, Karason Sigurbergur, Magnusson Magnus K, Indridason Olafur S, Long Thorir E, Sigurðsson Martin I
Faculty of Medicine, University of Iceland, Reykjavík, Iceland.
Division of Anaesthesiology and Critical Care Medicine, Landspitali University Hospital, Reykjavík, Iceland.
BJA Open. 2025 Feb 27;13:100380. doi: 10.1016/j.bjao.2025.100380. eCollection 2025 Mar.
Elevated red cell distribution width (RDW) is associated with increased postoperative mortality, but less is known about kidney outcomes. This study investigated the association between elevated preoperative RDW and postoperative worsening of long-term kidney function and incidence of acute kidney injury.
This retrospective cohort study included patients ≥18 yr undergoing noncardiac operation at Landspitali-The National University Hospital of Iceland between 2005 and 2018. Outcomes were compared between groups with elevated preoperative RDW (13.3-14.0%, 14.0-14.7%, 14.7-15.8%) and a propensity score-matched cohort (RDW ≤13.3%) using Fine-Gray competing risk regression analysis, with death as a competing event. The primary outcome was time to worsening of at least one estimated glomerular filtration rate (eGFR) category sustained for 3 months. Secondary outcomes were acute kidney injury, length of hospital stay, and 30-day readmission rate.
Out of 63 056 operations included in this study, 55 724 were available for propensity score-matched analysis. The hazard of long-term eGFR worsening was higher for patients with RDW between 14.0% and 14.7%: hazard ratio (HR) 1.23 (95% confidence interval [CI] 1.13-1.35), 14.7% and 15.8%: HR 1.20 (95% CI 1.07-1.34), and >15.8%: HR 1.16 (95% CI 1.00-1.34) compared with matched controls (RDW <13.3%), adjusted for death as a competing event. For secondary outcomes there was no difference in acute kidney injury, but increased risk of readmission for patients with RDW of 14.0-14.7% (9.8% 8.5%, =0.01), 14.7-15.8% (12.2% 10.1%, =0.001), and >15.8% (14.9% 11.4%, <0.001).
Elevated preoperative RDW was associated with long-term worsening of eGFR category after operation.
红细胞分布宽度（RDW）升高与术后死亡率增加相关，但关于肾脏预后的了解较少。本研究调查了术前RDW升高与术后长期肾功能恶化及急性肾损伤发生率之间的关联。
这项回顾性队列研究纳入了2005年至2018年间在冰岛国家大学医院Landspitali接受非心脏手术的18岁及以上患者。使用Fine-Gray竞争风险回归分析，以死亡作为竞争事件，比较术前RDW升高组（13.3%-14.0%、14.0%-14.7%、14.7%-15.8%）和倾向评分匹配队列（RDW≤13.3%）之间的预后。主要结局是至少一个估计肾小球滤过率（eGFR）类别持续恶化3个月的时间。次要结局包括急性肾损伤、住院时间和30天再入院率。
本研究纳入的63056例手术中，55724例可用于倾向评分匹配分析。RDW在14.0%至14.7%之间的患者长期eGFR恶化的风险更高：风险比（HR）为1.23（95%置信区间[CI]为1.13-1.35），14.7%至15.8%：HR为1.20（95%CI为1.07-1.34），>15.8%：HR为1.16（95%CI为1.00-1.34），与匹配对照组（RDW<13.3%）相比，并对死亡作为竞争事件进行了调整。对于次要结局，急性肾损伤方面无差异，但RDW为14.0%-14.7%（9.8%对8.5%，P=0.01）、14.7%-15.8%（12.2%对10.1%，P=0.001）和>15.8%（14.9%对11.4%，P<0.001）的患者再入院风险增加。
术前RDW升高与术后eGFR类别长期恶化相关。
