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Published online: 2020-05-15
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Erythrocyte transfusion limits the role of elevated red cell distribution width on predicting cardiac surgery associated acute kidney injury

Wuhua Jiang, Zhouping Zou, Shuan Zhao, Yi Fang, Jiarui Xu, Yimei Wang, Bo Shen, Zhe Luo, Chunsheng Wang, Xiaoqiang Ding, Jie Teng
DOI: 10.5603/CJ.a2020.0070
·
Pubmed: 32419126

open access

Ahead of print
Original articles
Published online: 2020-05-15

Abstract

Background: Acute kidney injury (AKI) is one of the more serious complications after cardiac surgery. Elevated red cell distribution width (RDW) was reported as a predictor for cardiac surgery associated acute kidney injury (CSAKI). However, the increment of RDW by erythrocyte transfusion makes its prognostic role doubtful. The aim of this study is to elucidate the impact of erythrocyte transfusion on the prognostic role of elevated red cell distribution width (RDW) for predicting CSAKI.

Methods: A total of 3207 eligible patients who underwent cardiac surgery during 2016–2017 were enrolled. Changes of RDW was defined as the difference between preoperative RDW and RDW measured 24 h after cardiac surgery. The primary outcome was CSAKI which was defined by the Kidney Disease: Improving Global Outcomes Definition and Staging (KDIGO) criteria. Univariate and multivariate analysis were performed to identify predictors for CSAKI.

Results: The incidence of CSAKI was 38.07% and the mortality was 1.18%. CSAKI patients had higher elevated RDW than those without CSAKI (0.65 vs. 0.39%, p < 0.001). Multivariate regression showed that male, age, New York Heat Association Classification 3–4, elevated RDW, estimated glomerular filtration rate < 60 mL/min/1.73 m2, CPB time > 120 min and erythrocyte transfusion were associated with CSAKI. Subgroup analysis showed elevated RDW was an independent predictor for CSAKI in the non-transfused subset (adjusted odds ratio: 1.616, p < 0.001) whereas no significant association between elevated RDW and CSAKI was found in the transfused patients (odds ratio: 1.040, p = 0.497).

Conclusions: Elevated RDW is one of the independent predictors of CSAKI in the absence of erythrocyte transfusion, which limits the prognostic role of the former on predicting CSAKI.

Abstract

Background: Acute kidney injury (AKI) is one of the more serious complications after cardiac surgery. Elevated red cell distribution width (RDW) was reported as a predictor for cardiac surgery associated acute kidney injury (CSAKI). However, the increment of RDW by erythrocyte transfusion makes its prognostic role doubtful. The aim of this study is to elucidate the impact of erythrocyte transfusion on the prognostic role of elevated red cell distribution width (RDW) for predicting CSAKI.

Methods: A total of 3207 eligible patients who underwent cardiac surgery during 2016–2017 were enrolled. Changes of RDW was defined as the difference between preoperative RDW and RDW measured 24 h after cardiac surgery. The primary outcome was CSAKI which was defined by the Kidney Disease: Improving Global Outcomes Definition and Staging (KDIGO) criteria. Univariate and multivariate analysis were performed to identify predictors for CSAKI.

Results: The incidence of CSAKI was 38.07% and the mortality was 1.18%. CSAKI patients had higher elevated RDW than those without CSAKI (0.65 vs. 0.39%, p < 0.001). Multivariate regression showed that male, age, New York Heat Association Classification 3–4, elevated RDW, estimated glomerular filtration rate < 60 mL/min/1.73 m2, CPB time > 120 min and erythrocyte transfusion were associated with CSAKI. Subgroup analysis showed elevated RDW was an independent predictor for CSAKI in the non-transfused subset (adjusted odds ratio: 1.616, p < 0.001) whereas no significant association between elevated RDW and CSAKI was found in the transfused patients (odds ratio: 1.040, p = 0.497).

Conclusions: Elevated RDW is one of the independent predictors of CSAKI in the absence of erythrocyte transfusion, which limits the prognostic role of the former on predicting CSAKI.

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Keywords

red cell distribution width, erythrocyte transfusion, cardiac surgery, acute kidney injury

About this article
Title

Erythrocyte transfusion limits the role of elevated red cell distribution width on predicting cardiac surgery associated acute kidney injury

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2020-05-15

DOI

10.5603/CJ.a2020.0070

Pubmed

32419126

Keywords

red cell distribution width
erythrocyte transfusion
cardiac surgery
acute kidney injury

Authors

Wuhua Jiang
Zhouping Zou
Shuan Zhao
Yi Fang
Jiarui Xu
Yimei Wang
Bo Shen
Zhe Luo
Chunsheng Wang
Xiaoqiang Ding
Jie Teng

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