Red Blood Cell Distribution Width as a 5-Year Prognostic Marker in Patients Submitted to Carotid Endarterectomy

Abstract

<b><i>Objective:</i></b> Patients submitted to carotid artery endarterectomy (CEA) have a long-term risk of major adverse cardiovascular events (MACE) of 6–9% at 2 years. Hematological parameters have been shown to have a predictive function in atherosclerotic diseases, namely the red blood cell distribution width-coefficient of variation (RDW-CV). This parameter has been associated with worse outcomes such as myocardial infarction (MI), stroke, and all-cause mortality. This study aims to evaluate the potential role of preoperative hematologic parameters such as RDW-CV in predicting perioperative and long-term cardiovascular adverse events and mortality in patients submitted to CEA. <b><i>Methods:</i></b> From January 2012 to January 2019, 180 patients who underwent CEA with regional anesthesia in a tertiary care and referral center were selected from a prospective cohort database. Blood samples were collected preoperatively 2 weeks before admission, including a full blood count. The primary outcome included long-term MACE. Secondary outcomes included all-cause mortality, stroke, MI, acute heart failure, and major adverse limb events (MALE). <b><i>Results:</i></b> At baseline, 27.2% of patients had increased RDW-CV. Increased RDW-CV was independently associated with baseline hemoglobin (adjusted odds ratio [aOR] 0.715, 95% CI 0.588–0.869, <i>p</i> = 0.001) and atrial fibrillation (aOR 4.028, 95% CI 1.037–15.639, <i>p</i> = 0.001). After a median follow-up of 50 months, log-rank univariate analysis of RDW-CV demonstrated a significant association between increased RDW-CV and long-term all-cause mortality (log-rank <0.001), MACE (log-rank <0.001), and MI (log-rank = 0.017). After multivariate Cox regression analysis, increased RDW-CV was associated with increased long-term mortality (adjusted hazard ratio [aHR] 2.455, 95% CI 1.231–4.894, <i>p</i> = 0.011) and MACE (aHR 2.047, 95% CI 1.202–3.487, <i>p</i> = 0.008). A decreased hemoglobin to platelet ratio (aHR 2.650e–8, 95% CI 9.049e–15 to 0.078, <i>p</i> = 0.019) was also associated with all-cause mortality. <b><i>Conclusion:</i></b> RDW is a widely available and low-cost marker that independently predicts long-term mortality, MACE, and MI after CEA. This biomarker could prove useful in assessing which patients would likely benefit from CEA in the long term.

Red Blood Cell Distribution Width Predicts Myocardial Infarction and Mortality After Vascular Surgery–A Prospective Cohort Study

“…The present findings support previous evidence that these readily available hematological parameters exhibit a good predictive capacity for all-cause mortality and adverse cardiovascular events 1,4,6 . Despite the existence of several studies that prove the association between RDW or NLR and cardiovascular diseases, the present study has further evidenced that these parameters are significant predictors of adverse outcomes following vascular surgery.…”

“…It measures the difference in size between the largest and the smallest cells, reflecting the heterogeneity amongst these cells’ dimensions. In most automated laboratory blood counters, it is expressed as a coefficient of variation (RDW‐CV), defined by the ratio between RDW standard deviation (RDW‐SD) and the mean corpuscular volume [6, 7]. The term anisocytosis corresponds to an increase in the RDW, meaning that the size distribution of red blood cells has a greater variation when compared to normal RDW values.…”

Acute Myocardial Infarction (AMI) as the Effect Modifiers to Modify the Association Between Red Blood Cell Distribution Width (RDW) and Mortality in Critically Ill Patients With Stroke

“…It is worth noting that RDW was measured, on average, 7.4 years prior to the cerebrovascular event in the study; therefore, the timing between RDW measurement, stroke, and death could have influenced the findings. A retrospective cohort study of 180 patients who underwent CEA reported that increased RDW-CV was associated with increased long-term mortality (adjusted hazard ratio [aHR] 2.455, 95% CI, 1.231–4.894, p = 0.011) ( 27 ). A secondary analysis of the Medical Information Mart for Intensive Care III (MIMIC-III) database study showed RDW as an independent risk factor of all-cause mortality of patients with AKI (HR, 1.219, 95% CI, 1.211 to 1.228); RDW is positively correlated with survival time of a 4-year follow-up in critically ill patients with AKI ( 28 ).…”

Elevated Red Blood Cell Distribution Width Is Associated with Poor Prognosis in Fractured Patients Admitted to Intensive Care Units

“…[15][16][17] The red blood cell distribution width (RDW), which is the indication of size diversity among circulating red blood cells, has been as a biomarker reflecting systemic inflammation and malnutrition among elderly people. 18 Nevertheless, its association with prognosis in various infectious diseases 19,20 and cancers [21][22][23][24][25][26] has been recently noted. Recent studies have investigated the potential relationship between vertebral body fracture, hip fracture, and RDW.…”