Red Blood Cell Distribution Width as a 5-Year Prognostic Marker in Patients Submitted to Carotid Endarterectomy

Luís Duarte-Gamas; António Pereira-Neves; Filipa Jácome; Mariana Fragão-Marques; Ricardo P Vaz; Jose Paulo Andrade; João P Rocha-Neves

doi:10.1159/000512587

Red Blood Cell Distribution Width as a 5-Year Prognostic Marker in Patients Submitted to Carotid Endarterectomy

Cerebrovasc Dis Extra. 2020 Dec 16;10(3):181-192. doi: 10.1159/000512587. Online ahead of print.

Authors

Luís Duarte-Gamas^{1

2}, António Pereira-Neves^{3

4

5}, Filipa Jácome^{3

4}, Mariana Fragão-Marques^{4

6

7}, Ricardo P Vaz^{4

8}, Jose Paulo Andrade^{4

8}, João P Rocha-Neves^{3

4

5}

Affiliations

¹ Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal, afonso_gamas@hotmail.com.
² Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal, afonso_gamas@hotmail.com.
³ Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal.
⁴ Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
⁵ Department of Biomedicine, Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
⁶ Department of Clinical Pathology, Centro Hospitalar Universitário de São João, Porto, Portugal.
⁷ Cardiovascular R&D Unit, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
⁸ Center for Health Technology and Services Research (CINTESIS), Porto, Portugal.

Abstract

Objective: Patients submitted to carotid artery endarterectomy (CEA) have a long-term risk of major adverse cardiovascular events (MACE) of 6-9% at 2 years. Hematological parameters have been shown to have a predictive function in atherosclerotic diseases, namely the red blood cell distribution width-coefficient of variation (RDW-CV). This parameter has been associated with worse outcomes such as myocardial infarction (MI), stroke, and all-cause mortality. This study aims to evaluate the potential role of preoperative hematologic parameters such as RDW-CV in predicting perioperative and long-term cardiovascular adverse events and mortality in patients submitted to CEA.

Methods: From January 2012 to January 2019, 180 patients who underwent CEA with regional anesthesia in a tertiary care and referral center were selected from a prospective cohort database. Blood samples were collected preoperatively 2 weeks before admission, including a full blood count. The primary outcome included long-term MACE. Secondary outcomes included all-cause mortality, stroke, MI, acute heart failure, and major adverse limb events (MALE).

Results: At baseline, 27.2% of patients had increased RDW-CV. Increased RDW-CV was independently associated with baseline hemoglobin (adjusted odds ratio [aOR] 0.715, 95% CI 0.588-0.869, p = 0.001) and atrial fibrillation (aOR 4.028, 95% CI 1.037-15.639, p = 0.001). After a median follow-up of 50 months, log-rank univariate analysis of RDW-CV demonstrated a significant association between increased RDW-CV and long-term all-cause mortality (log-rank <0.001), MACE (log-rank <0.001), and MI (log-rank = 0.017). After multivariate Cox regression analysis, increased RDW-CV was associated with increased long-term mortality (adjusted hazard ratio [aHR] 2.455, 95% CI 1.231-4.894, p = 0.011) and MACE (aHR 2.047, 95% CI 1.202-3.487, p = 0.008). A decreased hemoglobin to platelet ratio (aHR 2.650e-8, 95% CI 9.049e-15 to 0.078, p = 0.019) was also associated with all-cause mortality.

Conclusion: RDW is a widely available and low-cost marker that independently predicts long-term mortality, MACE, and MI after CEA. This biomarker could prove useful in assessing which patients would likely benefit from CEA in the long term.

Keywords: Carotid; Endarterectomy; Erythrocyte Indices; Major cardiovascular events; Mortality; Prognosis.