Anesth Pain Med.  2023 Oct;18(4):357-366. 10.17085/apm.23046.

Feasibility of using red cell distribution width for prediction of postoperative mortality in severe burn patients: an association with acute kidney injury after surgery

• Park JH
• Cho SS
• Jung J
• Choi SS

• KMID: 2550915
• DOI: http://doi.org/10.17085/apm.23046

Abstract

Background
Severe burns cause pathophysiological processes that result in mortality. A laboratory biomarker, red cell distribution width (RDW), is known as a predictor of mortality in critically-ill patients. We examined the association between RDW and postoperative mortality in severe burn patients. Methods: We retrospectively analyzed medical data of 731 severely burned patients who underwent surgery under general anesthesia. We evaluated whether preoperative RDW value can predict 3-month mortality after burn surgery using receiver operating characteristic (ROC) curve analysis, logistic regression, and Cox proportional-hazards regression analysis. Mortality was also analyzed according to preoperative RDW values and incidence of postoperative acute kidney injury (AKI). Results: The 3-month mortality rate after burn surgery was 27.1% (198/731). The area under the ROC curve of preoperative RDW to predict mortality after burn surgery was 0.701 (95% confidence interval [CI], 0.667–0.734; P < 0.001) with a cut-off point of 12.9. The adjusted hazard ratio in patients with RDW > 12.9 was 1.238 (95% CI, 1.138–1.347; P < 0.001). Subgroup analysis showed that the survival rate was 88.8% for the non-AKI group with RDW ≤ 12.9 and 17.6% for the AKI group with RDW > 12.9. Preoperative RDW was considered an independent risk factor for mortality (odds ratio, 1.679; 95% CI, 1.378– 2.046; P < 0.001). Conclusions: Preoperative RDW may predict 3-month postoperative mortality in patients with severe burns, while preoperative RDW > 12.9 and postoperative AKI may further increase mortality after burn surgery.

Keyword

Acute kidney injury; Burn; General anesthesia; Mortality; Red cell distribution width

Figure

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  Fig. 1. Flow diagram outlining the participant selection process for survivor and non-survivor groups. ICU: intensive care unit, TBSA: total body surface area.

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  Fig. 2. Receiver operating characteristics (ROC) curve analysis of preoperative red cell distribution width (RDW) for prediction of 3-month mortality after burn surgery. The ROC curve was used to determine the cut-off point of preoperative RDW which was 12.9. The area under the ROC curve (AUC) was 0.701.

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  Fig. 3. Kaplan-Meier curve of 3-month survival of the patients after burn surgery. (A) Survival probability according to preoperative cut-off value of RDW. The green line (solid) indicates the group with preoperative RDW ≤ 12.9 and the orange line (dotted) indicates the group with preoperative RDW > 12.9. (B) Subgroup analysis of survival probability according to postoperative AKI. The green solid line indicates the group with no postoperative AKI and preoperative RDW ≤ 12.9, which had the best survival probability among the other groups. AKI: acute kidney injury, RDW: red cell distribution width.

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