Hematological predictors and clinical outcomes in cardiac surgery

Aydınlı, Bahar; Demir, Aslı; Güçlü, Çiğdem Yıldırım; Bölükbaşı, Demet; Ünal, Ertekin Utku; Koçulu, Rabia; Selçuk, Gökçe

doi:10.1007/s00540-016-2197-y

Cited by 27 publications

(30 citation statements)

References 39 publications

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“…[152122] It is considered as a sensitive and low-cost prognostication marker, which may combine with other hematological parameters (such as mean platelet volume or neutrophil-to-lymphocyte ratio) to provide better outcome predictive value. [23] However, the use of RDW among noncardiac surgical condition is less common. [1824] This study evaluated the value of preoperative RDW for prediction of 30-day mortality in patients who received major- or ultra-major noncardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

“…For example, a combination of RDW with mean platelet volume and neutrophil-to-lymphocyte ratio might offer better adverse events (defined as myocardial infarction, cardiac reoperation, prolonged mechanical ventilation, prolonged hospital stay, rehospitalization, and mortality) predictions among patients who received cardiac surgery. [23] Mizuno et al . also illustrated the potential benefit of RDW combined with Mehran Risk Score for the prediction of contrast-induced acute kidney injury in patients with ST-elevated myocardial infarction.…”

Section: Discussionmentioning

confidence: 99%

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Preoperative red cell distribution width: Not a useful prognostic indicator for 30-day mortality in patients who undergo major- or ultra-major noncardiac surgery

Cheung

Shum

Chan

et al. 2016

Indian Journal of Critical Care Medicine

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Background:Red cell distribution width (RDW) has been shown to be associated with mortality in cardiac surgical patients. This study investigates the association of RDW with the 30-day mortality for those patients who undergo major- or ultra-major noncardiac surgery.Methods:Patients who received major- or ultra-major noncardiac surgery between July 2012 and May 2013 were included in the study and patients those with preoperative hemoglobin <10 g/day were excluded from the study. Patients were followed till day 30 from the date of surgery or death, whichever occurred earlier.Results:The overall 30-day mortality for major- and ultra-major surgery was 11.4%. The mean RDW of the 30-day survivors was 13.6 ± 1.6 and that of nonsurvivors was 14.2 ± 2.1 (P < 0.001). Other factors that were significantly different (P < 0.05) between survivors and nonsurvivors included age, sex, preoperative pulse rate, current or ex-alcoholic, the American Society of Anesthesiologists score, diabetes mellitus, use of antihypertensives, sepsis with 48 h before surgery, preoperative hemoglobin, white cell count, sodium, urea, creatinine, albumin, international normalized ratio (INR), pH, base excess, estimated blood loss, and emergency surgery. Logistic regression revealed that preoperative RDW > 13.35% (P = 0.025, odds ratio [OR]: 1.52), INR (P = 0.008, OR: 4.49), albumin level (P < 0.001, OR: 1.10), use of antihypertensives (P = 0.001, OR: 1.82), and preoperative pulse rate (P = 0.006, OR: 1.02) independently predicted the 30-day mortality. However, the area under receiver operating characteristic curve for the prediction of 30-day mortality using RDW was only 0.614.Conclusions:Although preoperative RDW independently predicted 30-day mortality in patients who underwent major- or ultra-major noncardiac surgery, it may not serve as an influential prognostic indicator in view of its low sensitivity and specificity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Preoperative red cell distribution width: Not a useful prognostic indicator for 30-day mortality in patients who undergo major- or ultra-major noncardiac surgery

Cheung

Shum

Chan

et al. 2016

Indian Journal of Critical Care Medicine

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“…6 In addition, patients with high RDW are 1.8 times more likely to develop adverse events after cardiac surgery (OR 0.55, 95% CI [0.365-0.852], p=0.007). 7 In another cohort (n=16,631), after non-cardiac surgery, the area under the curve was 0.761 (95% CI [0.736-0.787]) using a cut-off value of RDW 15.7% with a specificity of 89.3% and a negative predictive value of 99% for predicting 30-day mortality. 8 In contrast, in another cohort (n=217,567) RDW >14% was associated with metabolic syndrome (OR 1.14; 95% CI [1.07-1.21]; p<0.0001).…”

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confidence: 97%

“…10 Moreover, RDW >14.9% is associated with increased major bleeding risk (HR 2.41, 95% [CI 1.15-5.02], p=0.02) in non-STsegment elevation MI (NSTEMI). The addition of RDW to the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) bleeding score had a significant integrated reclassification improvement of 10% (95% CI [6][7][8][9][10][11][12][13][14][15][16][17][18][19]; p=0.02). 11 Similarly, another study showed that RDW was a predictor of major bleeding and that with the addition of RDW as a continuous variable to the National Cardiovascular Data Registry risk model, net reclassification improvement increased by 17.3% (95% CI [6.7-28]; p=0.02).…”

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confidence: 99%

Red Cell Volume Distribution Width as Another Biomarker

García-Escobar

Ingelmo

2019

Card Fail Rev

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“…The mortality rate increases when the need for a transfusion increases [17]. In a number of similar studies in recent years, preoperative low hematocrit levels in cardiac surgery have been shown to trigger postoperative complications [18,19]. Ranucci et al examined 3,003 patients who underwent isolated CABG surgery.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Preoperative Hematocrit Level on Early Outcomes After Coronary Artery Bypass Surgery

Pala¹,

Taner²,

Tatli³

et al. 2020

Cureus

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Introduction: Low hematocrit level is a hematological problem that is frequently encountered in the preoperative evaluation of patients undergoing coronary artery bypass grafting (CABG) surgery. The aim of this study was to investigate the effect of preoperative hematocrit level on the first 30-day outcomes in patients undergoing CABG surgery. Methods: Ninety-four patients undergoing isolated CABG were included in the study. The patients were divided into two groups as patients with preoperative low hematocrit levels (<36%) in Group 1 and patients with preoperative normal hematocrit levels (≥36%) in Group 2. Results: Forty-six patients in Group 1 (mean age: 63.6 ± 7.9 years) and 48 patients in Group 2 (mean age: 56.5 ± 8.8 years) were enrolled. European System for Cardiac Operative Risk Evaluation (EuroSCORE) scoring was statistically significantly higher in Group 1 (p = 0.011). In the postoperative period, the amount of drainage, transfusion of blood, and blood products were significantly higher in Group 1 (p < 0.001). The mortality rate of Group 1 was statistically higher in the first 30 days postoperatively (p = 0.020). Conclusion: Low preoperative hematocrit levels are associated with increased mortality after CABG surgery. We suggest that patients' preoperative hematocrit levels must be added to the risk scoring systems as an assessment parameter.

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Hematological predictors and clinical outcomes in cardiac surgery

Cited by 27 publications

References 39 publications

Preoperative red cell distribution width: Not a useful prognostic indicator for 30-day mortality in patients who undergo major- or ultra-major noncardiac surgery

Preoperative red cell distribution width: Not a useful prognostic indicator for 30-day mortality in patients who undergo major- or ultra-major noncardiac surgery

Red Cell Volume Distribution Width as Another Biomarker

The Effect of Preoperative Hematocrit Level on Early Outcomes After Coronary Artery Bypass Surgery

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