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Title: The Prognostic Significance of Red Cell Distribution Width in Cardiac Surgery: A Systematic Review and Meta-Analysis.
Austin Authors: Frentiu, Angela A;Mao, Kevin;Caruana, Carla Borg;Raveendran, Dev;Perry, Luke A;Penny-Dimri, Jahan C;Ramson, Dhruvesh M;Segal, Reny;Bellomo, Rinaldo ;Smith, Julian A;Liu, Zhengyang
Affiliation: Department of Cardiothoracic Surgery, Monash Health, Clayton, Australia.
Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Clayton, Australia.
Department of Critical Care, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia
Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Australia.
Intensive Care
Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia
Monash University School and Public Health and Preventive Medicine, Monash University, Clayton, Australia
Data Analytics Research and Evaluation (DARE) Centre
Issue Date: Mar-2023
Date: 2022-11
Publication information: Journal of Cardiothoracic and Vascular Anesthesia 2023
Abstract: Red cell distribution width (RDW) is a routinely available biomarker of likely erythropoietic dysfunction, which may be associated with adverse outcomes after cardiac surgery. This systematic review and meta-analysis aimed to clarify the prognostic value of RDW in patients undergoing cardiac surgery.┬áThe authors searched MEDLINE, Embase, and the Cochrane Library from inception to May 10, 2022 for studies investigating the association between elevated RDW (as defined by the authors of included studies) and adverse outcomes after cardiac surgery. Herein, the authors extracted maximally adjusted hazard ratios (HRs) and odds ratios (ORs) with associated CIs, and pooled them using random-effects inverse- variance modeling. The authors explored interstudy heterogeneity using metaregression. The authors included 26 studies involving 48,092 patients who had undergone cardiac surgery. Elevated preoperative RDW was associated with long-term mortality (pooled HR 1.63, 95% CI 1.05-2.52), short-term mortality (pooled OR 2.16, 95% CI 1.21-3.87), acute kidney injury (AKI; pooled OR 1.30, 95% CI 1.19-1.41) and postoperative atrial fibrillation (POAF; pooled OR 1.44, 95% CI 1.05-1.96). Some studies suggested a significant association between preoperative RDW elevation and neurologic complications; however, their number was insufficient for meta-analysis. The postoperative RDW levels were less consistently reported and could not be meta-analyzed. In conclusion, the authors found that elevated preoperative RDW was associated with increased short- and long-term mortality, POAF, and AKI after cardiac surgery. Further research is needed to investigate its role in the risk stratification of patients undergoing cardiac surgery.
DOI: 10.1053/j.jvca.2022.11.015
Journal: Journal of Cardiothoracic and Vascular Anesthesia
PubMed URL: 36635145
PubMed URL:
ISSN: 1532-8422
Type: Journal Article
Subjects: Red cell distribution width (RDW)
Acute kidney injury
Cardiac surgery
Post-operative atrial fibrillation
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