open access

Vol 50, No 4 (2018)
Original and clinical articles
Published online: 2018-10-14
Submitted: 2018-03-02
Accepted: 2018-08-22
Get Citation

Diagnostic accuracy of red blood cell distribution width in predicting in-hospital mortality in patients undergoing high-risk gastrointestinal surgery

Michał Pluta, Tomasz Klocek, Łukasz J. Krzych
DOI: 10.5603/AIT.a2018.0037
·
Pubmed: 30317537
·
Anaesthesiol Intensive Ther 2018;50(4):277-282.

open access

Vol 50, No 4 (2018)
Original and clinical articles
Published online: 2018-10-14
Submitted: 2018-03-02
Accepted: 2018-08-22

Abstract

Background: The red blood cell distribution width index (RDW) is one of several parameters routinely analysed in
peripheral blood counts. The aim of the study was to assess the usefulness of RDW in the prediction of in-hospital
mortality in patients undergoing high-risk gastroenterological surgery.

Methods: Prospective observation covered 229 patients who underwent surgery, for whom the risk of cardiovascular
complications was high due to the type of procedure. The patient’s individual risk was assessed using the criteria of
the American Society of Anesthesiologists (ASA-PS). Peripheral blood for morphological examination was collected
preoperatively. The following parameters of the red blood cell system were evaluated: red blood cell count (RBC),
haemoglobin (Hgb), haematocrit (Hct), mean corpuscular volume (MCV), RDW expressed as a standard deviation (SD)
and a coefficient of variation (CV). The occurrence of hospital death was the main endpoint.

Results: Patients who died had had statistically significantly lower RBC, Hgb and Hct values, as well as higher RDW-SD
and RDW-CV values. Both the preoperative RDW-SD and RDW-CV values predicted the outcome, respectively: AUC
RDW-SD = 0.744 (95% CI: 0.683–0.799; P < 0.001), AUC RDW-CV = 0.762 (95% CI: 0.702–0.816; P < 0.001). In logistic
regression, it was confirmed that RDW predicted mortality (OR RDW-SD = 1.21; P < 0.001, OR RDW-CV = 1.62;
P = 0.01), even after adjustment for individual risk and other erythrocyte parameters.

Conclusion: RDW is a valuable screening predictor of in-hospital mortality in patients undergoing high-risk
gastroenterological surgery, regardless of the estimated individual risk and the value of other erythrocyte parameters.
Evaluation of the RDW may be helpful in the identification of patients requiring correction of haematological disorders
in the pre-operative period, as well as, in particular, surveillance in the perioperative period.

Abstract

Background: The red blood cell distribution width index (RDW) is one of several parameters routinely analysed in
peripheral blood counts. The aim of the study was to assess the usefulness of RDW in the prediction of in-hospital
mortality in patients undergoing high-risk gastroenterological surgery.

Methods: Prospective observation covered 229 patients who underwent surgery, for whom the risk of cardiovascular
complications was high due to the type of procedure. The patient’s individual risk was assessed using the criteria of
the American Society of Anesthesiologists (ASA-PS). Peripheral blood for morphological examination was collected
preoperatively. The following parameters of the red blood cell system were evaluated: red blood cell count (RBC),
haemoglobin (Hgb), haematocrit (Hct), mean corpuscular volume (MCV), RDW expressed as a standard deviation (SD)
and a coefficient of variation (CV). The occurrence of hospital death was the main endpoint.

Results: Patients who died had had statistically significantly lower RBC, Hgb and Hct values, as well as higher RDW-SD
and RDW-CV values. Both the preoperative RDW-SD and RDW-CV values predicted the outcome, respectively: AUC
RDW-SD = 0.744 (95% CI: 0.683–0.799; P < 0.001), AUC RDW-CV = 0.762 (95% CI: 0.702–0.816; P < 0.001). In logistic
regression, it was confirmed that RDW predicted mortality (OR RDW-SD = 1.21; P < 0.001, OR RDW-CV = 1.62;
P = 0.01), even after adjustment for individual risk and other erythrocyte parameters.

Conclusion: RDW is a valuable screening predictor of in-hospital mortality in patients undergoing high-risk
gastroenterological surgery, regardless of the estimated individual risk and the value of other erythrocyte parameters.
Evaluation of the RDW may be helpful in the identification of patients requiring correction of haematological disorders
in the pre-operative period, as well as, in particular, surveillance in the perioperative period.

Get Citation

Keywords

peripheral blood morphology; anaemia; risk; perioperative medicine

About this article
Title

Diagnostic accuracy of red blood cell distribution width in predicting in-hospital mortality in patients undergoing high-risk gastrointestinal surgery

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 50, No 4 (2018)

Pages

277-282

Published online

2018-10-14

DOI

10.5603/AIT.a2018.0037

Pubmed

30317537

Bibliographic record

Anaesthesiol Intensive Ther 2018;50(4):277-282.

Keywords

peripheral blood morphology
anaemia
risk
perioperative medicine

Authors

Michał Pluta
Tomasz Klocek
Łukasz J. Krzych

References (20)
  1. Feely MA, Collins CS, Daniels PR, et al. Preoperative testing before noncardiac surgery: guidelines and recommendations. Am Fam Physician. 2013; 87(6): 414–418.
  2. Biomarkers Definitions Working Group.. Biomarkers and surrogate endpoints: preferred definitions and conceptual framework. Clin Pharmacol Ther. 2001; 69(3): 89–95.
  3. Cha MJ, Lee HS, Kim HM, et al. Association between red cell distribution width and thromboembolic events in patients with atrial fibrillation. Eur J Intern Med. 2017; 46: 41–44.
  4. Huang YL, Hu ZD, Liu SJ, et al. Prognostic value of red blood cell distribution width for patients with heart failure: a systematic review and meta-analysis of cohort studies. PLoS One. 2014; 9(8): e104861.
  5. Akboga MK, Yayla C, Yilmaz S, et al. Increased red cell distribution width predicts occlusion of the infarct-related artery in STEMI. Scand Cardiovasc J. 2016; 50(2): 114–118.
  6. Sen HS, Abakay O, Tanrikulu AC, et al. Is a complete blood cell count useful in determining the prognosis of pulmonary embolism? Wien Klin Wochenschr. 2014; 126(11-12): 347–354.
  7. Kristensen SD, Knuuti J, Saraste A, et al. Authors/Task Force Members. 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 Heart J. 2014; 35(35): 2383–2431.
  8. ASA Physical Status Classification System. American Society of An¬esthesiologists. http://www.asahq.org/quality-and-practice-management/standards-guidelines-and-related-resources/asa-physical-status-classification-system (15.02.2018).
  9. Kucewicz-Czech E, Krzych ŁJ, Ligowski M. Perioperative haemodynamic optimisation in patients undergoing non-cardiac surgery - a position statement from the Cardiac and Thoracic Anaesthesia Section of the Polish Society of Anaesthesiology and Intensive Therapy. Part 2. Anaesthesiol Intensive Ther. 2017; 49(1): 16–27.
  10. Caporal F, Comar S. Evaluation of RDW-CV, RDW-SD, and MATH-1SD for the detection of erythrocyte anisocytosis observed by optical microscopy. Jornal Brasileiro de Patologia e Medicina Laboratorial. 2013; 49(5): 324–331.
  11. Ustawa z dnia 5 grudnia 1996 r. o zawodzie lekarza; Rozdz.4 (tekst jedn. Dz.U. 1997 nr 28 poz. 152). http://isap.sejm.gov.pl/ (15.02.2018).
  12. Jo YH, Kim K, Lee JH, et al. Red cell distribution width is a prognostic factor in severe sepsis and septic shock. Am J Emerg Med. 2013; 31(3): 545–548.
  13. Mucsi I, Ujszaszi A, Czira ME, et al. Red cell distribution width is associated with mortality in kidney transplant recipients. Int Urol Nephrol. 2014; 46(3): 641–651.
  14. Majercik S, Fox J, Knight S, et al. Red cell distribution width is predictive of mortality in trauma patients. J Trauma Acute Care Surg. 2013; 74(4): 1021–1026.
  15. Engström G, Smith JG, Persson M, et al. Red cell distribution width, haemoglobin A1c and incidence of diabetes mellitus. J Intern Med. 2014; 276(2): 174–183.
  16. Sadaka F, O'Brien J, Prakash S. Red cell distribution width and outcome in patients with septic shock. J Intensive Care Med. 2013; 28(5): 307–313.
  17. Rozporządzenie Ministra Zdrowia z dn. 16.12.2016 w sprawie standardu organizacyjnego opieki zdrowotnej w dziedzinie anestezjologii i intensywnej terapii. Dz.U. 2016, poz.2218. http://prawo.sejm.gov.pl/ (15.02.2018).
  18. Jiang L, Feng X, Ma Y, et al. Red cell distribution width: a novel predictor of mortality in critically ill patients. J Thorac Dis. 2014; 6(9): E194–E195.
  19. Nada AM. Red cell distribution width in type 2 diabetic patients. Diabetes Metab Syndr Obes. 2015; 8: 525–533.
  20. Jaksz-Recmanik E, Bobiński R. Pre-analytical errors in nurse practice. Problemy Pielęgniarstwa. 2011; 19(3): 386–390.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

VM Media sp. z o.o. VM Group sp.k., Grupa Via Medica, Świętokrzyska 73 St., 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl