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Prognostic Value of Preoperative Red Cell Distribution Width: Fine-Tuning by Mean Corpuscular Volume
Lu Dai1, Stephanie L Mick1, Keith R McCrae2
1Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
The Annals of Thoracic Surgery
|June 15, 2019
Summary
Abnormal red cell size (RDW) and volume (MCV) impact cardiac surgery outcomes. RDW is a key predictor, but MCV offers additional value, especially with macrocytosis, for better perioperative risk assessment.
Area of Science:
- Cardiology
- Hematology
- Medical Informatics
Background:
- Abnormal red cell distribution width (RDW) is linked to cardiovascular disease.
- The prognostic value of mean corpuscular volume (MCV) in cardiac surgery outcomes remains unclear.
- Investigating RDW and MCV simultaneously is crucial for understanding cardiac surgery risks.
Purpose of the Study:
- To determine the prognostic value of RDW and MCV in patients undergoing cardiac surgery.
- To assess the combined impact of RDW and MCV on postoperative outcomes.
- To identify which parameter, RDW or MCV, is a stronger predictor of adverse events.
Main Methods:
- Analysis of complete blood count data from 16,097 cardiac surgery patients.
- Utilized random forest machine learning for risk-adjusted outcome prediction.
- Evaluated associations between RDW, MCV, and outcomes like transfusion, complications, and length of stay.
Main Results:
- Elevated RDW correlated with increased red blood cell (RBC) transfusions.
- Normal RDW (13-14%) was associated with minimal complications and shorter hospital stays.
- MCV showed a U-shaped risk association; both microcytosis and macrocytosis increased risk.
- RDW was a significant predictor for most outcomes, while MCV provided additional value, particularly in cases of macrocytosis.
Conclusions:
- Abnormal RDW and MCV increase the risk of transfusion and adverse postoperative outcomes in cardiac surgery.
- RDW is a primary predictor of outcomes, but MCV offers supplementary prognostic information.
- Both RDW and MCV should be considered for comprehensive perioperative risk assessment in cardiac surgery patients.
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