Ann Lab Med.  2024 Sep;44(5):401-409. 10.3343/alm.2023.0345.

Association Between the Red Blood Cell Distribution Width and 30-Day Mortality in Intensive Care Patients Undergoing Cardiac Surgery: A Retrospective Observational Study Based on the Medical Information Mart for Intensive Care-IV Database

• Chen W
• Yu P
• Chen C
• Cai S
• Chen J
• Zheng C
• Chen C
• Zheng L
• Guo C

• KMID: 2559146
• DOI: http://doi.org/10.3343/alm.2023.0345

Abstract

Background
Millions of patients undergo cardiac surgery each year. The red blood cell distribution width (RDW) could help predict the prognosis of patients who undergo percutaneous coronary intervention or coronary artery bypass surgery. We investigated whether the RDW has robust predictive value for the 30-day mortality among patients in an intensive care unit (ICU) after undergoing cardiac surgery.
Methods
Using the Medical Information Mart for Intensive Care-IV Database, we retrieved data for 11,634 patients who underwent cardiac surgery in an ICU. We performed multivariate Cox regression analysis to model the association between the RDW and 30-day mortality and plotted Kaplan–Meier curves. Subgroup analyses were stratified using relevant covariates. Receiver operating characteristic (ROC) curves were used to determine the predictive value of the RDWs.
Results
The total 30-day mortality rate was 4.2% (485/11,502). The elevated-RDW group had a higher 30-day mortality rate than the normal-RDW group (P < 0.001). The robustness of our data analysis was confirmed by performing subgroup analyses. Each unit increase in the RDW was associated with a 17% increase in 30-day mortality when the RDW was used as a continuous variable (adjusted hazard ratio = 1.17, 95% confidence interval, 1.10–1.25). Our ROC results showed the predictive value of the RDW.
Conclusions
An elevated RDW was associated with a higher 30-day mortality in patients after undergoing cardiac surgery in an ICU setting. The RDW can serve as an efficient and accessible method for predicting the mortality of patients in ICUs following cardiac surgery.

Keyword

Cardiac surgery; Intensive care unit; Medical Information Mart for Intensive Care-IV (MIMIC-IV); Mortality; Multivariate Cox regression; Red blood cell distribution width

Figure

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  Fig. 1 Study flow chart showing the inclusion and exclusion criteria. Abbreviations: ICU, intensive care unit; ICD, International Classification of Diseases; MIMIC-IV, Medical Information Mart for Intensive Care-IV; RDW, red blood cell distribution width.

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  Fig. 2 Kaplan–Meier curves showing the association between the red blood cell distribution width (RDW) and the 30-day mortality of patients after undergoing cardiac surgery.

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  Fig. 3 Forest plot showing subgroup analysis of the association between red blood cell distribution width (RDW) and 30-day mortality. Abbreviations: HR, hazard ratio; CI, confidence interval; Sepsis 3.0, the third international consensus definitions for sepsis and septic shock; SOFA, sequential organ failure assessment; AKI, acute kidney injury; MI, myocardial infarction; CHF, congestive heart failure; CVD, cerebrovascular disease; CPD, chronic pulmonary disease; DM, diabetes mellitus.

Reference

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