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Exploring red cell distribution width as a potential risk factor in emergency bowel surgery—A retrospective cohort study

Increased preoperative red cell distribution width (RDW) is associated with higher mortality following non-cardiac surgery in patients older than 65 years. Little is known if this association holds for all adult emergency laparotomy patients and whether it affects 30-day or long-term mortality. Thus...

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Autores principales: Berry, Michael, Gosling, Jennifer Louise, Bartlett, Rachel Elizabeth, Brett, Stephen James
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9071152/
https://www.ncbi.nlm.nih.gov/pubmed/35511937
http://dx.doi.org/10.1371/journal.pone.0266041
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author Berry, Michael
Gosling, Jennifer Louise
Bartlett, Rachel Elizabeth
Brett, Stephen James
author_facet Berry, Michael
Gosling, Jennifer Louise
Bartlett, Rachel Elizabeth
Brett, Stephen James
author_sort Berry, Michael
collection PubMed
description Increased preoperative red cell distribution width (RDW) is associated with higher mortality following non-cardiac surgery in patients older than 65 years. Little is known if this association holds for all adult emergency laparotomy patients and whether it affects 30-day or long-term mortality. Thus, we examined the relationship between increased RDW and postoperative mortality. Furthermore, we investigated the prognostic worth of anisocytosis and explored a possible association between increased RDW and frailty in this cohort. We conducted a retrospective, single centre National Emergency Laparotomy Audit (NELA) database study at St Mary’s Hospital Imperial NHS Trust between January 2014 and April 2018. A total of 356 patients were included. Survival models were developed using Cox regression analysis, whereas RDW and frailty were analysed using multivariable logistic regression. Underlying model assumptions were checked, including discrimination and calibration. We internally validated our models using bootstrap resampling. There were 33 (9.3%) deaths within 30-days and 72 (20.2%) overall. Median RDW values for 30-day mortality were 13.8% (IQR 13.1%-15%) in survivors and 14.9% (IQR 13.7%-16.1%) in non-survivors, p = 0.007. Similarly, median RDW values were lower in overall survivors (13.7% (IQR 13%-14.7%) versus 14.9% (IQR 13.9%-15.9%) (p<0.001)). Mortality increased across quartiles of RDW, as did the proportion of frail patients. Anisocytosis was not associated with 30-day mortality but demonstrated a link with overall death rates. Increasing RDW was associated with a higher probability of frailty for 30-day (Odds ratio (OR) 4.3, 95% CI 1.22–14.43, (p = 0.01)) and overall mortality (OR 4.9, 95% CI 1.68–14.09, (p = 0.001)). We were able to show that preoperative anisocytosis is associated with greater long-term mortality after emergency laparotomy. Increasing RDW demonstrates a relationship with frailty. Given that RDW is readily available at no additional cost, future studies should prospectively validate the role of RDW in the NELA cohort nationally.
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spelling pubmed-90711522022-05-06 Exploring red cell distribution width as a potential risk factor in emergency bowel surgery—A retrospective cohort study Berry, Michael Gosling, Jennifer Louise Bartlett, Rachel Elizabeth Brett, Stephen James PLoS One Research Article Increased preoperative red cell distribution width (RDW) is associated with higher mortality following non-cardiac surgery in patients older than 65 years. Little is known if this association holds for all adult emergency laparotomy patients and whether it affects 30-day or long-term mortality. Thus, we examined the relationship between increased RDW and postoperative mortality. Furthermore, we investigated the prognostic worth of anisocytosis and explored a possible association between increased RDW and frailty in this cohort. We conducted a retrospective, single centre National Emergency Laparotomy Audit (NELA) database study at St Mary’s Hospital Imperial NHS Trust between January 2014 and April 2018. A total of 356 patients were included. Survival models were developed using Cox regression analysis, whereas RDW and frailty were analysed using multivariable logistic regression. Underlying model assumptions were checked, including discrimination and calibration. We internally validated our models using bootstrap resampling. There were 33 (9.3%) deaths within 30-days and 72 (20.2%) overall. Median RDW values for 30-day mortality were 13.8% (IQR 13.1%-15%) in survivors and 14.9% (IQR 13.7%-16.1%) in non-survivors, p = 0.007. Similarly, median RDW values were lower in overall survivors (13.7% (IQR 13%-14.7%) versus 14.9% (IQR 13.9%-15.9%) (p<0.001)). Mortality increased across quartiles of RDW, as did the proportion of frail patients. Anisocytosis was not associated with 30-day mortality but demonstrated a link with overall death rates. Increasing RDW was associated with a higher probability of frailty for 30-day (Odds ratio (OR) 4.3, 95% CI 1.22–14.43, (p = 0.01)) and overall mortality (OR 4.9, 95% CI 1.68–14.09, (p = 0.001)). We were able to show that preoperative anisocytosis is associated with greater long-term mortality after emergency laparotomy. Increasing RDW demonstrates a relationship with frailty. Given that RDW is readily available at no additional cost, future studies should prospectively validate the role of RDW in the NELA cohort nationally. Public Library of Science 2022-05-05 /pmc/articles/PMC9071152/ /pubmed/35511937 http://dx.doi.org/10.1371/journal.pone.0266041 Text en © 2022 Berry et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Berry, Michael
Gosling, Jennifer Louise
Bartlett, Rachel Elizabeth
Brett, Stephen James
Exploring red cell distribution width as a potential risk factor in emergency bowel surgery—A retrospective cohort study
title Exploring red cell distribution width as a potential risk factor in emergency bowel surgery—A retrospective cohort study
title_full Exploring red cell distribution width as a potential risk factor in emergency bowel surgery—A retrospective cohort study
title_fullStr Exploring red cell distribution width as a potential risk factor in emergency bowel surgery—A retrospective cohort study
title_full_unstemmed Exploring red cell distribution width as a potential risk factor in emergency bowel surgery—A retrospective cohort study
title_short Exploring red cell distribution width as a potential risk factor in emergency bowel surgery—A retrospective cohort study
title_sort exploring red cell distribution width as a potential risk factor in emergency bowel surgery—a retrospective cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9071152/
https://www.ncbi.nlm.nih.gov/pubmed/35511937
http://dx.doi.org/10.1371/journal.pone.0266041
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