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Relation between red cell distribution width and clinical outcome after surgery for congenital heart disease in
1Division of Pediatric Cardiology, Queen Fabiola Children's University Hospital (HUDERF), Free University of Brussels (ULB), Avenue J. J. Crocq, 15, B-1020 Brussels, Belgium. martial.massin@huderf.be
Insights
Preoperative red cell distribution width (RDW) predicts poor outcomes in children undergoing heart surgery. Higher RDW levels are linked to increased mortality and longer hospital stays, especially in nonanemic patients.
Area of Science:
- Pediatric Cardiology
- Hematology
- Surgical Outcomes
Background:
- Increased red cell distribution width (RDW) is associated with adverse outcomes in adult heart failure patients.
- The prognostic value of RDW in pediatric cardiac surgery remains under-explored.
Purpose of the Study:
- To investigate the association between preoperative RDW and postoperative clinical outcomes in children undergoing surgery for congenital heart disease (CHD).
Main Methods:
- A study involving 688 children undergoing surgery for CHD.
- Analysis of the correlation between preoperative RDW and postoperative mortality, intensive care unit (ICU) stay, and total hospital stay.
Main Results:
- RDW was significantly higher in patients who died postoperatively (18.34 ± 4.69 vs 16.12 ± 2.84; p = 0.004).
- Patients with RDW ≥ 16% had a fivefold higher risk of postoperative death.
- RDW correlated with ICU and total hospital stay (p < 0.0001).
- The correlation between RDW and ICU stay was stronger in nonanemic patients with acyanotic CHD.
Conclusions:
- Preoperative RDW is a significant predictor of adverse outcomes in pediatric cardiac surgery for CHD.
- RDW may reflect underlying inflammatory stress, particularly in nonanemic patients.
Abstract:
Recent studies have reported a strong association between increased red cell distribution width (RDW) and the risk of adverse outcomes for adults with heart failure. This study investigated the association between preoperative RDW and postoperative clinical outcomes for children with cardiac disease. The relation between preoperative RDW and the length of postoperative stay was tested with 688 consecutive children undergoing surgery for congenital heart disease (CHD). The RDW was significantly higher in patients who died during the postoperative hospital stay (mean, 18.34 ± 4.69 vs 16.12 ± 2.84; p = 0.004). The risk of postoperative death was five times higher for patients with an RDW of 16% or more. In the general study population, RDW correlated with the intensive care unit (ICU) stay (p < 0.0001) and with the total hospital stay in the local population (p < 0.0001). The correlation between RDW and ICU stay was stronger for patients with acyanotic CHD (p < 0.0001) than for those with cyanotic CHD (p = 0.0007), and for the subpopulation of patients with acyanotic CHD and normal hemoglobin level (p < 0.0001) than for anemic patients with acyanotic CHD (p = 0.025). Preoperative RDW is a strong predictor of an adverse outcome in children undergoing surgery for CHD, especially in nonanemic patients, for whom it reflects an underlying inflammatory stress.