Title : Association of red blood cell distribution width with mortality in type A aortic dissection after surgery
Abstract:
Objective: Aortic dissection is closely associated with inflammation. Currently, red blood cell distribution width (RDW) has been regarded as a novel inflammatory biomarker. The role of RDW on the prognosis of patients with Type A aortic dissection after surgery still remains unclear. This study aims to explore the association between preoperative RDW with 30-day mortality in acute Type-A aortic dissection after surgery.
Methods: Retrospective analyses have been performed on patients with acute Type-A aortic dissection from January 1, 2016, to Sep 30, 2023. The locally weighted scatter plot smoothing (Lowess) method was utilized to display the crude association between RDW and 30-day mortality. The area under the receiver operating characteristic curve (AUC) was used to assess the discrimination. The cut-off value (14.55) of RDW was calculated using the Youden index method. The primary outcome was 30-day mortality.
Results: A total of 358 patients were collected. The Lowess curve showed an approximate positive linear relationship between RDW and 30-day mortality. In the multivariable logistic regression model, RDW was an independent risk factor (odds ratio [OR] = 1.55, 95% confidence interval [CI] 1.24-1.93, p < 0.001) for 30-day mortality. Besides, RDW (AUC 0.69, 95% CI 0.59-0.79) demonstrated great discrimination for 30-day mortality. High RDW (≥ 14.55) consistently had a higher risk of 30-day mortality (OR = 4.27, 95% CI 1.53-11.96, p = 0.006) after adjusting for all included covariates, compared with low RDW(< 14.55). The Kaplan-Meier survival curve showed patients with low RDW show better 30-day survival rates than those with high RDW (p < 0.001).
Conclusions: Preoperative high RDW could serve as an independent risk predictor for 30-day mortality. The cut-off value of RDW can be utilized for risk stratification, assessment of the prognosis and further provide guidance for the treatment among patients with acute Type-A aortic dissection following surgery.
