Red cell distribution width is a prognostic marker of perioperative stroke in patients undergoing cardiac valve surgery

Abstract

OBJECTIVES Numerous studies have shown that elevated red cell distribution width (RDW) is associated with poor outcomes in patients with cardiovascular diseases such as coronary artery disease, peripheral artery disease or stroke. The usefulness of the RDW as a predictor of perioperative stroke in patients with valve disease undergoing valve surgery is currently unknown. The aim of the study was to evaluate the prognostic value of RDW for stroke in the early postoperative period in patients undergoing valve replacement or repair surgery. METHODS A prospective study was conducted on a group of 500 consecutive patients with haemodynamically significant valvular heart disease who underwent elective valvular surgery. Preoperative complete blood count, data on risk factors, the course of operations and the postoperative period were assessed. The primary end-point at the 30-day follow-up was perioperative stroke or transient ischaemic attack. The secondary end-point was death from all causes in patients with perioperative stroke. Univariate analysis, followed by multivariate regression analysis, was performed. RESULTS The perioperative stroke occurred in 14 patients. At multivariate analysis: RDW [odds ratio (OR) 1.640, 95% confidence interval (CI) 1.132-2.377; P = 0.009] and haemoglobin (OR 0.655, 95% CI 0.447-0.961; P = 0.03) remained independent predictors of the primary end-point. Receiver operator characteristics analysis determined a cut-off value of RDW for the prediction of the occurrence of the perioperative stroke/transient ischaemic attack at 14.1%. Creatinine (OR 1.015, 95% CI 1.004-1.026; P = 0.0079) and RDW (OR 1.493, 95% CI 1.171-1.815; P = 0.04) were associated with an increased risk of death in patients with perioperative stroke. CONCLUSIONS Elevated RDW is associated with a higher risk of perioperative stroke/transient ischaemic attack and death in patients with perioperative stroke.