Red cell distribution width at hospital discharge and out-of hospital outcomes in critically ill non-cardiac vascular surgery patients

Meijenfeldt, Gerdine C.I. von; Laan, Maarten J. van der; Zeebregts, Clark J.; Christopher, Kenneth B.

doi:10.1371/journal.pone.0199654

Cited by 7 publications

(5 citation statements)

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“…Red cell distribution width (RDW) is increased in response to inflammatory stimuli ( 9 ), and increased RDW is reported to be associated with unfavorable outcomes in many inflammatory diseases, such as pneumonia ( 32 ), sepsis ( 33 ), and ARDS ( 34 ). Previous studies have reported a positive association between RDW and all-cause mortality of many critically ill conditions ( 35–37 ). The elaborated mechanisms of RDW increase in critically ill patients remain to be determined; inflammation is induced to generate premature erythrocytes of premature erythrocytes from the bone marrow ( 38 ).…”

Section: Discussionmentioning

confidence: 95%

Association and prediction of red blood cell distribution width to albumin ratio in all-cause mortality of acute kidney injury in critically ill patients

Gao

Peng²

2023

Front. Med.

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AimThe progression of acute kidney injury (AKI) might be associated with systemic inflammation. Our study aims to explore the association and predictive value of the red blood cell distribution width (RDW) to human serum albumin (ALB) ratio (RDW/ALB ratio), an inflammation-related indicator, in the risk of all-cause mortality and renal replacement therapy (RRT) in AKI patients admitted in intensive care units (ICU).MethodsA retrospective cohort study was designed, and data were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III). The primary outcome was the risk of all-cause mortality (1-month, 3-month, and 12-month), and the secondary outcome was the risk of RRT. The association between the RDW/ALB ratio and the risk of all-cause mortality and RRT was assessed using the Cox regression analysis, with results shown as hazard ratio (HR) and 95% confidence intervals (CIs). The relationship between the RDW/ALB ratio and crude probability of all-cause mortality or RRT was assessed using restricted cubic splines (RCS). The concordance index (C-index) was used to assess the discrimination of the prediction model.ResultsA total of 13,856 patients were included in our study. In the fully adjusted Cox regression model, we found that a high RDW/ALB ratio was associated with an increased risk of 1-month, 3-month, and 12-month all-cause mortality and RRT (all p < 0.05). Moreover, RCS curves showed the linear relationship between the RDW/ALB ratio and the probability of all-cause mortality and RRT, and the probability was elevated with the increase of the ratio. In addition, the RDW/ALB ratio showed a good predictive performance in the risk of 1-month all-cause mortality, 3-month all-cause mortality, 12-month all-cause mortality, and RRT, with a C-index of 0.728 (95%CI: 0.719–0.737), 0.728 (95%CI: 0.721–0.735), 0.719 (95%CI: 0.713–0.725), and 0.883 (95%CI: 0.876–0.890), respectively.ConclusionThe RDW/ALB ratio performed well to predict the risk of all-cause mortality and RRT in critically ill patients with AKI, indicating that this combined inflammatory indicator might be effective in clinical practice.

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Section: Discussionmentioning

confidence: 95%

Association and prediction of red blood cell distribution width to albumin ratio in all-cause mortality of acute kidney injury in critically ill patients

Gao

Peng²

2023

Front. Med.

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“…DRG type was defined as medical or surgical and incorporates the Diagnostic Related Grouping (DRG) methodology, devised by the Centres for Medicare & Medicaid Services and is reflective of case mix and resource utilization [ 21 – 23 , 30 ]. Ethnicity was either self-determined or designated by a patient representative/healthcare proxy.…”

Section: Methodsmentioning

confidence: 99%

“…Patients eligible for inclusion were hospitalized adults aged ≥18 years who were admitted to intensive care unit (ICU) or in-patient care ward and who underwent non-cardiac vascular surgery during their hospitalization and survived to hospital discharge. All patients were assigned at least one Current Procedural Terminology (CPT) code for vascular surgery [ 23 ] ( S1 File ), and were assigned a Diagnostic Related Group (DRG) code. Patients treated with open vascular surgery as well as endovascular procedures were included.…”

Section: Methodsmentioning

confidence: 99%

“…Secondary outcomes were unplanned 30-day hospital readmission to the BWH or MGH, discharge to a care facility and 365-day mortality. Thirty-day hospital readmission was determined from RPDR hospital admission data as previously described [ 39 ] and defined as a subsequent or unscheduled admission to BWH or MGH within 30 days of discharge following the hospitalization associated with the vascular surgery or intervention [ 23 , 40 , 41 ]. We excluded 73 readmissions with DRG codes that are commonly associated with planned readmissions in addition to DRGs for transplantation, procedures related to pregnancy, and psychiatric issues [ 39 , 40 ].…”

Section: Methodsmentioning

confidence: 99%

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Nutritional status and out-of-hospital mortality in vascular surgery patients

et al. 2022

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Background Malnutrition is often present in vascular surgery patient during hospital admission. The present evidence of the consequence malnutrition has on morbidity and mortality is limited. Aim The purpose of this study was to determine the effect of nutritional status on out-of-hospital mortality in vascular surgery patients. Methods An observational cohort study was performed, studying non-cardiac vascular surgery patients surviving hospital admission 18 years or older treated in Boston, Massachusetts, USA. The exposure of interest was nutritional status categorized as well nourished, at-risk for malnutrition, nonspecific malnutrition or protein-energy malnutrition. The all cause 90-day mortality following hospital discharge was the primary outcome. Adjusted odds ratios were estimated by multivariable logistic regression models. Results This cohort included 4432 patients comprised of 48% women and a mean age 61.7 years. After evaluation by a registered dietitian, 3819 patients were determined to be well nourished, 215 patients were at-risk for malnutrition, 351 had non-specific malnutrition and 47 patients had protein-energy malnutrition. After adjustment for age, sex, ethnicity, medical versus surgical Diagnosis Related Group type, Deyo-Charlson index, length of stay, and vascular Current Procedural Terminology code category, the 90-day post-discharge mortality odds ratio for patients with non-specific malnutrition OR 1.96 (95%CI 1.21, 3.17) and for protein-energy malnutrition OR 3.58 (95%CI 1.59, 8.06), all relative to patients without malnutrition. Discussion Nutritional status is a strong predictor of out-of-hospital mortality. This suggests that patient with vascular disease suffering from malnutrition could benefit from more intensified In-hospital and out-of-hospital dietary guidance and interventions.

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“…In a previous cohort of critically ill vascular surgery patients (n = 4715), the post-discharge mortality in ICU survivors was studied 37 . From these data it was assumed that 90-day post-discharge mortality was 7.5%.…”

Section: Power Calculations and Statistical Analysismentioning

confidence: 99%

Functional Status and Out-of-Hospital Outcomes in Different Types of Vascular Surgery Patients

Meijenfeldt

Rydingsward

Laan

et al. 2021

Annals of Vascular Surgery

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Red cell distribution width at hospital discharge and out-of hospital outcomes in critically ill non-cardiac vascular surgery patients

Cited by 7 publications

References 54 publications

Association and prediction of red blood cell distribution width to albumin ratio in all-cause mortality of acute kidney injury in critically ill patients

Association and prediction of red blood cell distribution width to albumin ratio in all-cause mortality of acute kidney injury in critically ill patients

Nutritional status and out-of-hospital mortality in vascular surgery patients

Functional Status and Out-of-Hospital Outcomes in Different Types of Vascular Surgery Patients

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