The Prognostic Significance of Red Cell Distribution Width in Cardiac Surgery: A Systematic Review and Meta-Analysis

Published:November 19, 2022DOI:


      Red cell Distribution Width (RDW) is a routinely available biomarker of likely erythropoietic dysfunction, which may be associated with adverse outcomes following cardiac surgery. This systematic review and meta-analysis aimed to clarify the prognostic value of RDW in patients undergoing cardiac surgery. We searched MEDLINE, Embase, and the Cochrane Library from inception to 10 May 2022 for studies investigating the association between elevated RDW (as defined by authors of included studies) and adverse outcomes after cardiac surgery. We extracted maximally adjusted hazard ratios (HRs) and odds ratios (ORs) with associated confidence intervals and pooled them using random-effects inverse variance modelling. We explored inter-study heterogeneity using meta-regression. We included 26 studies involving 48,092 cardiac surgery patients. 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 neurological complications; however, their number was insufficient for meta-analysis. Postoperative RDW levels were less consistently reported and could not be meta-analyzed. In conclusion, we found elevated preoperative RDW is associated with increased short and long-term mortality, POAF and AKI after cardiac surgery. Further research is needed to investigate its role in risk stratification of cardiac surgery patients.

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