Skip to main content

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

Abstract

Background

This study aims to investigate the association between preoperative Red blood cell Distribution Width (RDW) and postoperative outcomes, including myocardial infarction (MI), and mortality.

Methods

A prospective cohort including all patients submitted to elective vascular arterial surgery at a university hospital. The primary and secondary outcomes were 30-day mortality and 30-day MI, respectively.

Results

Atrial fibrillation, chronic kidney disease (CKD), and dependent functional status were more prevalent in deceased patients. After multivariable analysis, age (adjusted OR 1.08, 95% Confidence Interval [1.01–1.15], p = 0.027) and RDW-standard deviation (RDW-SD) (1.08 [1.01–1.16], p = 0.032) remained independent predictors of mortality. Patients with MI had higher rates of diabetes, CKD, dependent functional status, ASA physical status IV, and insulin medication. After multivariable analysis, dependent functional status (4.8 [1.6–15.0], p = 0.007), insulin medication (4.4 [1.5–12.6], p = 0.007) and RDW-SD (1.10 [1.02–1.19], p = 0.020) were independent predictors of MI.

Conclusion

RDW-SD independently predicted postoperative MI and mortality, and may provide valuable information for prevention and early management of adverse outcomes.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. Afari ME, Bhat T (2016) Neutrophil to lymphocyte ratio (NLR) and cardiovascular diseases: an update. Expert Rev Cardiovasc Ther 14:573–577

    CAS  Article  Google Scholar 

  2. Kofink D, Muller SA, Patel RS et al (2018) Routinely measured hematological parameters and prediction of recurrent vascular events in patients with clinically manifest vascular disease. PloS One 13:e0202682

    Article  Google Scholar 

  3. Satilmis S, Karabulut A (2019) Correlation between red cell distribution width and peripheral vascular disease severity and complexity. Med Sci (Basel) 7(7):77

    CAS  Google Scholar 

  4. Isik T, Ayhan E, Kurt M et al (2012) Is red cell distribution width a marker for the presence and poor prognosis of cardiovascular disease? Eurasian J Med 44:169–171

    CAS  Article  Google Scholar 

  5. Li N, Zhou H, Tang Q (2017) Red blood cell distribution width: a novel predictive Indicator for cardiovascular and cerebrovascular diseases. Dis Markers 2017:7089493

    PubMed  PubMed Central  Google Scholar 

  6. Duarte-Gamas L, Pereira-Neves A, Jacome F et al (2020) Red blood cell distribution width as a 5-year prognostic marker in patients submitted to carotid endarterectomy. Cerebrovasc Dis Extra 10:181–192

    Article  Google Scholar 

  7. Salvagno GL, Sanchis-Gomar F, Picanza A et al (2015) Red blood cell distribution width: a simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci 52:86–105

    Article  Google Scholar 

  8. Pereira-Neves A, Rocha-Neves J, Fragao-Marques M et al (2021) Red blood cell distribution width is associated with hypoperfusion in carotid endarterectomy under regional anesthesia. Surgery 169(6):1536–1543

    Article  Google Scholar 

  9. Veraldi GF, Mezzetto L, Scorsone L et al (2019) Red blood cell distribution width predicts 1-month complications after percutaneous transluminal angioplasty. J Med Biochem 38:468–474

    CAS  Article  Google Scholar 

  10. Arbel Y, Finkelstein A, Halkin A et al (2012) Neutrophil/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients undergoing angiography. Atherosclerosis 225:456–460

    CAS  Article  Google Scholar 

  11. Reis P, Lopes AI, Leite D et al (2020) Incidence, predictors and validation of risk scores to predict postoperative mortality after noncardiac vascular surgery, a prospective cohort study. Int J Surg 73:89–93

    Article  Google Scholar 

  12. Reis P, Lopes AI, Leite D et al (2019) Predicting mortality in patients admitted to the intensive care unit after open vascular surgery. Surg Today 49:836–842

    CAS  Article  Google Scholar 

  13. Reis PV, Lopes AI, Leite D et al (2019) Major cardiac events in patients admitted to intensive care after vascular noncardiac surgery: a retrospective cohort. Semin Cardiothorac Vasc Anesth 23:293–299

    Article  Google Scholar 

  14. von Elm E, Altman DG, Egger M et al (2014) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg 12:1495–1499

    Article  Google Scholar 

  15. Agha R, Abdall-Razak A, Crossley E et al (2019) STROCSS 2019 guideline: strengthening the reporting of cohort studies in surgery. Int J Surg 72:156–165

    Article  Google Scholar 

  16. Kristensen SD, Knuuti J, Saraste A et al (2014) 2014 ESC/ESA guidelines on non-cardiac surgery: cardiovascular assessment and management: the joint task force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur J Anaesthesiol 31:517–573

    Article  Google Scholar 

  17. Thygesen K, Alpert JS, Jaffe AS et al (2018) Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol 72:2231–2264

    Article  Google Scholar 

  18. Song SY, Hua C, Dornbors D 3rd et al (2019) Baseline red blood cell distribution width as a predictor of stroke occurrence and outcome: a comprehensive meta-analysis of 31 studies. Front Neurol 10:1237

    Article  Google Scholar 

  19. Al-Kindi SG, Refaat M, Jayyousi A et al (2017) Red cell distribution width is associated with all-cause and cardiovascular mortality in patients with diabetes. Biomed Res Int 2017:5843702

    Article  Google Scholar 

  20. Veraldi GF, Mezzetto L, Scorsone L et al (2018) Red blood cell distribution width (RDW) is an independent predictor of post-implantation syndrome in patients undergoing endovascular aortic repair for abdominal aortic aneurysm. Ann Transl Med 6:453

    CAS  Article  Google Scholar 

  21. Usman R, Jamil M, Naveed M (2017) High preoperative neutrophil-lymphocyte ratio (NLR) and red blood cell distribution width (RDW) as independent predictors of native arteriovenous fistula failure. Ann Vasc Dis 10(3):205–210

    Article  Google Scholar 

  22. Lee E, Choi EK, Han KD et al (2018) Mortality and causes of death in patients with atrial fibrillation: a nationwide population-based study. PLoS One 13:e0209687

    Article  Google Scholar 

  23. Malaisrie SC, McCarthy PM, Kruse J et al (2018) Burden of preoperative atrial fibrillation in patients undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg 155:2358–2367

    Article  Google Scholar 

  24. Banach M, Mariscalco G, Ugurlucan M et al (2008) The significance of preoperative atrial fibrillation in patients undergoing cardiac surgery: preoperative atrial fibrillation–still underestimated opponent. Europace 10:1266–1270

    Article  Google Scholar 

  25. Liu M, Li XC, Lu L et al (2014) Cardiovascular disease and its relationship with chronic kidney disease. Eur Rev Med Pharmacol Sci 18:2918–2926

    CAS  PubMed  Google Scholar 

  26. Scarborough JE, Bennett KM, Englum BR et al (2015) The impact of functional dependency on outcomes after complex general and vascular surgery. Ann Surg 261:432–437

    Article  Google Scholar 

  27. Araujo-Andrade L, Rocha-Neves JP, Duarte-Gamas L et al (2020) Prognostic effect of the new 5-factor modified frailty index in patients undergoing carotid endarterectomy with regional anesthesia–a prospective cohort study. Int J Surg 80:27–34

    Article  Google Scholar 

  28. Fronczek J, Polok K, Devereaux PJ et al (2019) External validation of the revised cardiac risk index and national surgical quality improvement program myocardial infarction and cardiac arrest calculator in noncardiac vascular surgery. Br J Anaesth 123:421–429

    CAS  Article  Google Scholar 

  29. Guthrie RA, Guthrie DW (2004) Pathophysiology of diabetes mellitus. Crit Care Nurs Q 27:113–125

    Article  Google Scholar 

  30. Mentias A, Shantha G, Adeola O et al (2019) Role of diabetes and insulin use in the risk of stroke and acute myocardial infarction in patients with atrial fibrillation: a medicare analysis. Am Heart J 214:158–166

    CAS  Article  Google Scholar 

  31. Dongerkery SP, Schroeder PR, Shomali ME (2017) Insulin and its cardiovascular effects: what is the current evidence? Curr Diab Rep 17:120

    Article  Google Scholar 

Download references

Acknowledgements

All authors made a substantial contribution to the concept and design, acquisition of data or analysis and interpretation of data; drafted the article or revised it critically for important intellectual content and approved the final version to be published.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Pedro José Vinhais Domingues Videira Reis.

Ethics declarations

Conflict of interest

The authors have no related conflicts of interest to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Caldeira de Albuquerque, F.V.S., Dias-Neto, M.F., Rocha-Neves, J.M.P. et al. Red Blood Cell Distribution Width Predicts Myocardial Infarction and Mortality After Vascular Surgery–A Prospective Cohort Study. World J Surg 46, 957–965 (2022). https://doi.org/10.1007/s00268-022-06441-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-022-06441-z