Red blood cell distribution width (RDW) is an independent predictor of post-implantation syndrome in patients undergoing endovascular aortic repair for abdominal aortic aneurysm

Abstract

Background: This observational, retrospective study aims establishing the role of red blood cell distribution width (RDW) for identifying abdominal aortic aneurism (AAA) patients at risk of developing post-implantation syndrome (PiS) after endovascular aneurysm repair (EVAR). Methods: The study population consisted of all patients undergoing EVAR for AAA at the University Hospital of Verona (Italy), between June 1, 2016 and May 31, 2018. Blood samples for measuring hemoglobin, mean corpuscular volume (MCV) and RDW were collected at hospital admission and the day after EVAR. The primary endpoint was PiS development. Delta variations were calculated as the ratio between values measured after and before EVAR. Results: The final study population consisted of 124 patients (10 women and 114 men; median age, 75 years), 55 of whom developed PiS. In patients with or without PiS hemoglobin significantly decreased after EVAR, whilst RDW significantly increased in patients with PiS and decreased in those without. Age, sex, hypertension, diabetes and renal failure were similar in patients who developed PiS or not, whilst a positive history of coronary artery disease was more frequent in PiS patients. Although hemoglobin and MCV changes after EVAR did not differ in patients with or without PiS, delta RDW was higher in those with PiS. The rate of patients with delta RDW >1 was significantly higher in patients with PiS that in those without (61.8% vs. 34.8%; P=0.002). In multivariate analysis, delta RDW remained independently associated with PiS (β coefficient, 2.023; P=0.001). A delta RDW >1 after EVAR was associated with ~3-fold enhanced risk of PiS (odds ratio, 3.04; P=0.003) and exhibited a good prognostic performance (area under the curve, 0.69; P<0.001). Conclusions: Calculation of delta RDW after EVAR seems an efficient prognostic tool for stratifying the risk of developing PiS, especially in the early postoperative period.

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

“…Oxidative stress is strongly related to the erythrocytes’ variability in size since it shortens these cells’ lifespan and impairs iron metabolism, leading to the production and release of immature forms into the systemic circulation [3, 5]. Elevated RDW values are associated with a decrease in erythrocyte deformability, which in turn leads to a higher propensity for developing thrombotic events as well as an impaired blood flow, leading to tissue ischemia [20]. The NLR has been broadly studied as a marker of systemic inflammation and hence, of cardiovascular risk [2, 21].…”

Association Between Red Blood Cell Distribution Width-to-Albumin Ratio and Prognosis of Patients with Aortic Aneurysms

“…2,11 Recently, the red blood cell distribution width (RDW) has been identified as a new prognostic factor under many pathophysiological conditions, including cardiovascular and cerebrovascular diseases and inflammation. 12,13 Recent studies 14,15 have also suggested that RDW is a predictor of adverse outcomes in aortic aneurysms. Recent recommendations suggest combining RDW with other biomarkers.…”

Factors Associated With Noninfectious Fever After Endovascular Aortic Aneurysm Repair

“…5,6 The postoperative inflammatory response consecutive to EVAR, which clinically manifests with fever, has been ascribed to a wide range of proinflammatory mediators, such as interleukin-6 (IL-6) and C-reactive protein (CRP). [7][8][9] Various characteristics have been associated with this reaction, such as mural thrombus formation and type of endograft material. [10][11][12][13] Subclinical colonic ischemia, following the occlusion of a patent inferior mesenteric artery (IMA) during aneurysm repair, may also be associated with postoperative inflammatory response and fever.…”