Red Blood Cell Distribution Width: A Prognostic Marker in Patients With Type B Aortic Dissection Undergoing Endovascular Aortic Repair

Predictive ability of red blood cell distribution width for negative remodeling of type B aortic dissection

OBJECTIVE

To investigate the correlation between red blood cell distribution width (RDW) and negative remodeling (NR) in type B aortic dissection (TBAD).

METHODS

This study involved the retrospective analysis of clinical data of 264 patients with nonsurgical TBAD admitted to our hospital between September 2015 and September 2022. Patients underwent regular follow-up after discharge, including periodic chest and abdominal aortic computed tomography angiography. Aortic dissection false lumen expansion was evaluated based on computed tomography angiography images taken at the final follow-up. Patients were divided into two groups based on the occurrence of NR in aortic dissection: NR and non-NR groups.

RESULTS

A total of 264 patients with an average age of 60 years (63.6% male), with a mean follow-up duration of 53.5 months and a survival rate of 87.9% (232/264 patients), were enrolled. During the follow-up period, 87 patients (33.0%) developed NR of the aortic dissection (NR group). Twenty-four patients in the NR group underwent surgery, which was significantly higher than the number of patients in the non-NR group (27.6% vs 16.9%). One patient in each group died of aortic rupture. RDW levels were significantly higher in the NR than the non-NR group (13.7 ± 1.2 vs 12.7 ± 1.0; P < .001). Spearman's correlation analysis identified a positive correlation between RDW and NR (r = 0.368; P < .001). Multivariate logistic regression analysis identified elevated RDW (odds ratio, 3.910; P < .001) as an independent risk factor for NR. The receiver operating characteristic curve indicated that a cutoff point of RDW >13.7% achieved an area under the curve for prediction of 0.770, sensitivity of 75.1%, and specificity of 93.2% (95% confidence interval, 0.722-0.818; P < .001).

CONCLUSIONS

RDW is a simple, inexpensive, and effective predictive marker of NR in TBAD. Herein, we identified that an RDW of >13.7% is a risk factor for NR in patients with nonsurgical TBAD during follow-up. This limit may provide a reliable basis for assessing the need for surgical intervention, optimizing prognosis evaluation, and making clinical decisions, ultimately improving the long-term survival and quality of life of patients.

The correlation and predictive value of Hb, RDW and their association for short-term and long-term mortality in patients with acute aortic dissection

Background

This study examines the relationship between Hb, RDW and their association and both short-term and long-term mortality in patients with acute aortic dissection (AAD), aiming to establish combined effect between Hb and RDW as a potential prognostic biomarker for AAD outcomes.

Methods

We extracted clinical data from the Medical Information Mart for Intensive Care (MIMIC) databases for this analysis. Using adjusted Cox regression and Kaplan-Meier survival curve analyses, we assessed the relationship between Hb, RDW and their association at admission and mortality at multiple post-discharge intervals (30 days, 90 days, 1 year, and 5 years) among patients with AAD. Additionally, subgroup analyses and receiver operating characteristic (ROC) curve analyses were conducted to evaluate the predictive accuracy of Hb, RDW and their association for mortality in this patient population.

Results

High RDW combined with low Hb (RDW ≥ 13.60 and Hb < 7.9) significantly predicted increased mortality at 30 days, 90 days, 1 year, and 5 years post-diagnosis, with hazard ratios (HRs) as follows: 4.33 (95% CI: 1.82-10.33, P < 0.001), 4.48 (95% CI: 2.06-9.77, P < 0.001), 3.38 (95% CI: 1.70-6.70, P < 0.001), and 3.07 (95% CI: 1.66-5.66, P < 0.001), respectively.

Conclusion

Hb and RDW are both abnormal (Hb with low level, RDW with high level) is positively correlated with 30 days, 90 days, 1 year, and 5 years mortality risk in patients with AAD. This suggests that combined effect between Hb and RDW is a significant predictor of short-term to long-term mortality risk in this patient population, highlighting its potential utility as a prognostic marker in clinical settings.

Is Red Cell Distribution Width a Reliable Marker for Cardiovascular Diseases? A Narrative Review

Red cell distribution width (RDW) is an easy-to-access marker which is routinely measured in complete blood count (CBC) test. Besides the classic use of RDW as a marker for discriminating different types of anemia, recent studies had indicated the relationship between high RDW and cardiovascular diseases. High RDW is not only useful in the diagnosis and prognostication of various cardiovascular conditions but also could be used as a valuable tool for predicting the incidence of cardiovascular diseases. population-based studies have indicated that higher RDW could effectively predict the incidence of heart failure (HF), atherosclerotic diseases, and atrial fibrillation (AF). It has been also demonstrated that higher RDW is associated with worse outcomes in these diseases. Recent studies have shown that high RDW is also associated with other cardiovascular conditions including cardiomyopathies, and pulmonary hypertension. The predictive role of RDW in endovascular interventions has also been demonstrated by many recent studies. Here in this review, we attempt to compile the most recent findings with older reports regarding the relation between high RDW and HF, cardiomyopathies, pulmonary hypertension, AF, atherosclerotic disorders, primary hypertension, and the outcomes of endovascular interventions. we also discussed the role of RDW in the prognostication of different cardiovascular conditions when combined with classic classification criteria.

Comment on, "Systematic literature review and critical analysis of RDW in patients with aortic pathologies"

Recent medical research has explored Red Cell Distribution Width (RDW) as a potential biomarker for predicting adverse clinical outcomes in patients with aortic pathologies. The study "Systematic literature review and critical analysis of RDW in patients with aortic pathologies" conducted a pooled analysis of 704 patients, revealing a consistent association between elevated RDW levels and adverse clinical progression. While the study provides valuable insights into RDW's diagnostic and prognostic potential, limitations include the inclusion of a limited number of articles and the lack of direct comparison with established biomarkers or imaging techniques. Further research is needed to validate RDW's clinical utility and elucidate underlying biological mechanisms. RDW shows promise as a cost-effective marker for risk stratification and monitoring in clinical practice, but further validation and refinement are necessary for its full clinical impact in aortic diseases.

Systematic literature review and critical analysis of RDW in patients with aortic pathologies

Diseases of the aorta, such as aortic aneurysm, dissection, and rupture, account for a large proportion of acute clinical emergencies. The red blood cell distribution width (RDW), which directly reflects anisocytosis (i.e., the heterogeneity of erythrocyte volumes), has emerged as a promising biomarker for many cardiovascular pathologies. Thus, we aimed to explore the implication of RDW in aortic pathologies. We searched Scopus and PubMed using the keywords "RDW" OR "red blood cell distribution width" AND "aortic aneurysm" OR "aortic dilatation" OR "aortic dissection" for identifying studies in which RDW values were measured in patients with these aortic diseases. Ten observational studies were finally included. In all studies, RDW value was increased in patients with aortic diseases. In the four studies in which sufficient RDW data were available for pooling, the weighted mean difference (WMD) of RDW in patients with or without complicated aortic pathologies was 0.575 (95 %CI, 0.254-0.896). RDW may be a valuable diagnostic and prognostic biomarker in patients with aortic pathologies.

Develop ment and validation of a prognostic dynamic nomogram for in-hospital mortality in patients with Stanford type B aortic dissection

Background

This study aimed to identify the risk factors for in-hospital mortality in patients with Stanford type B aortic dissection (TBAD) and develop and validate a prognostic dynamic nomogram for in-hospital mortality in these patients.

Methods

This retrospective study involved patients with TBAD treated from April 2002 to December 2020 at the General Hospital of Northern Theater Command. The patients with TBAD were divided into survival and non-survival groups. The data were analyzed by univariate and multivariate logistic regression analyses. To identify independent risk factors for in-hospital mortality, multivariate logistic regression analysis, least absolute shrinkage, and selection operator regression were used. A prediction model was constructed using a nomogram based on these factors and validated using the original data set. To assess its discriminative ability, the area under the receiver operating characteristic curve (AUC) was calculated, and the calibration ability was tested using a calibration curve and the Hosmer-Lemeshow test. Clinical utility was evaluated using decision curve analysis (DCA) and clinical impact curves (CIC).

Results

Of the 978 included patients, 52 (5.3%) died in hospital. The following variables helped predict in-hospital mortality: pleural effusion, systolic blood pressure ≥160 mmHg, heart rate >100 bpm, anemia, ischemic cerebrovascular disease, abnormal cTnT level, and estimated glomerular filtration rate <60 ml/min. The prediction model demonstrated good discrimination [AUC = 0.894; 95% confidence interval (CI), 0.850-0.938]. The predicted probabilities of in-hospital death corresponded well to the actual prevalence rate [calibration curve: via 1,000 bootstrap resamples, a bootstrap-corrected Harrell's concordance index of 0.905 (95% CI, 0.865-0.945), and the Hosmer-Lemeshow test (χ² = 8.3334, P = 0.4016)]. DCA indicated that when the risk threshold was set between 0.04 and 0.88, the predictive model could achieve larger clinical net benefits than "no intervention" or "intervention for all" options. Moreover, CIC showed good predictive ability and clinical utility for the model.

Conclusion

We developed and validated prediction nomograms, including a simple bed nomogram and online dynamic nomogram, that could be used to identify patients with TBAD at higher risk of in-hospital mortality, thereby better enabling clinicians to provide individualized patient management and timely and effective interventions.

Association of lymphopenia and RDW elevation with risk of mortality in acute aortic dissection

OBJECTIVE

The study aimed to investigate whether lymphopenia and red blood cell distribution width (RDW) elevation are associated with an increased risk of mortality in acute aortic dissection (AAD).

METHODS

This multicenter retrospective cohort study enrolled patients diagnosed with AAD by aortic computed tomographic angiography (CTA) from 2010 to 2021 in five teaching hospitals in central-western China. Cox proportional hazards regression and Kaplan-Meier curves were used in univariable and multivariable models. Clinical outcomes were defined as all-cause in-hospital mortality, while associations were evaluated between lymphopenia, accompanied by an elevated RDW, and risk of mortality.

RESULTS

Of 1903 participants, the median age was 53 (interquartile range [IQR], 46-62) years, and females accounted for 21.9%. Adjusted increased risk of mortality was linearly related to the decreasing lymphocyte percentage (P-non-linearity = 0.942) and increasing RDW (P-non-linearity = 0.612), and per standard deviation (SD) of increment lymphocyte percentage and RDW was associated with the 26% (0.74, 0.64-0.84) decrement and 5% (1.05, 0.95-1.15) increment in hazard ratios (HRs) and 95% confidence intervals (CIs) of mortality, respectively. Importantly, lymphopenia and elevation of RDW exhibited a significant interaction with increasing the risk of AAD mortality (P-value for interaction = 0.037).

CONCLUSIONS

Lymphopenia accompanied by the elevation of RDW, which may reflect the immune dysregulation of AAD patients, is associated with an increased risk of mortality. Assessment of immunological biomarkers derived from routine tests may provide novel perspectives for identifying the risk of mortality.