Associations of preoperative red cell distribution width with mortality and morbidity in patients underwent liver transplantation: a retrospectively observational study_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Siying ¹ , LIAO Xiaojun ¹ , YANG Jiayin ² , WEN Tianfu ² , WU Hong ² ,  YU Hai ¹

1. Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Department of Liver Surgery/Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

YU Hai, Email: yuhaishan117@yahoo.com

Keywords：

allogeneic liver transplantation; red cell distribution width; mortality; morbidity; propensity score matching

DOI：

10.7507/1007-9424.202112096

Video：

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Objective To investigate the associations of preoperative red cell distribution width (RDW) with mortality and morbidity in patients underwent liver transplantation. Methods This investigation was a retrospective study, the patients underwent liver transplantation met the inclusion criteria from June 2017 to May 2020 in the West China Hospital of Sichuan University were enrolled. The patients were divided into RDW≤14.5% group and RDW>14.5% group according to the normal RDW critical value (14.5%). The propensity score matching (PSM) was used to adjust the baseline characteristics. The primary outcome was 1-year mortality. The secondary outcomes included 1-year survival, 30-day mortality, incidence of early allograft dysfunction, acute kidney injury, renal replacement therapy, and pulmonary complications, as well as ICU stay and postoperative hospital stay. Results A total of 303 patients who met the analysis conditions were included. After PSM, 57 patients in each group were matched. There were no significant differences between the two groups in the baseline data such as the gender, age, body mass index (BMI), initial diagnosis, MELD score, Child-Pugh grade of the recipients, and the gender, age, and BMI of the donors (P>0.05). The 1-year [22.8% (13/57) versus 5.3% (3/57), χ²=7.27, P=0.007] and 30-day [15.8% (9/57) versus 3.5% (2/57), χ²=4.93, P=0.026] mortality of the patients with RDW >14.5% were higher than that of the patients with RDW ≤14.5% . The Kaplan-Meier survival curve showed that the 1-year survival of the patients with RDW ≤14.5% after liver transplantation was better than that of the patients with RDW >14.5% [hazard ratio=4.75, 95%CI (1.78, 12.67), P=0.007], but there were no significant differences between the two groups in the incidence of early graft dysfunction, acute renal injury, renal replacement therapy, and pulmonary complications, as well as postoperative hospital stay and ICU stay (P>0.05). Conclusion Preliminary results of this study indicate that preoperative RDW of patients underwent allogeneic liver transplantation is associated with1-year mortality, 30-day mortality, and 1-year survival.

Citation： WANG Siying, LIAO Xiaojun, YANG Jiayin, WEN Tianfu, WU Hong, YU Hai. Associations of preoperative red cell distribution width with mortality and morbidity in patients underwent liver transplantation: a retrospectively observational study. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(5): 594-598. doi: 10.7507/1007-9424.202112096 Copy

1.	Baganate F, Beal EW, Tumin D, et al. Early mortality after liver transplantation: defining the course and the cause. Surgery, 2018, 164(4): 694-704.
2.	Kwong AJ, Kim WR, Lake JR, et al. OPTN/SRTR 2019 annual data report: liver. Am J Transplant, 2021, 21 Suppl 2: 208-315.
3.	Brustia R, Monsel A, Skurzak S, et al. Guidelines for perioperative care for liver transplantation: enhanced recovery after surgery (ERAS) recommendations. Transplantation, 2022, 106(3): 552-561.
4.	Förhécz Z, Gombos T, Borgulya G, et al. Red cell distribution width in heart failure: prediction of clinical events and relationship with markers of ineffective erythropoiesis, inflammation, renal function, and nutritional state. Am Heart J, 2009, 158(4): 659-666.
5.	Lippi G, Targher G, Montagnana M, et al. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med, 2009, 133(4): 628-632.
6.	Joshi D, Chowdhury MAT, Alauddin M, et al. Role of pre-operative red cell distribution width estimation in the prediction of in-hospital mortality after off-pump coronary artery bypass grafting. J Cardiothorac Surg, 2021, 16(1): 232. doi: 10.1186/s13019-021-01612-w.
7.	Pluta M, Klocek T, Krzych ŁJ. Diagnostic accuracy of red blood cell distribution width in predicting in-hospital mortality in patients undergoing high-risk gastrointestinal surgery. Anaesthesiol Intensive Ther, 2018, 50(4): 277-282.
8.	Li N, Zhou H, Tang Q. Red blood cell distribution width: a novel predictive indicator for cardiovascular and cerebrovascular diseases. Dis Markers, 2017, 2017: 7089493. doi: 10.1155/2017/7089493.
9.	Abdullah HR, Sim YE, Sim YT, et al. Preoperative red cell distribution width and 30-day mortality in older patients undergoing non-cardiac surgery: a retrospective cohort observational study. Sci Rep, 2018, 8(1): 6226. doi: 10.1038/s41598-018-24556-z.
10.	Olafsson HB, Sigurdarson GA, Christopher KB, et al. A retrospective cohort study on the association between elevated preoperative red cell distribution width and all-cause mortality after noncardiac surgery. Br J Anaesth, 2020, 124(6): 718-725.
11.	Szygula-Jurkiewicz B, Szczurek W, Skrzypek M, et al. Red blood cell distribution width in end-stage heart failure patients is independently associated with all-cause mortality after orthotopic heart transplantation. Transplant Proc, 2018, 50(7): 2095-2099.
12.	Cuschieri S. The STROBE guidelines. Saudi J Anaesth, 2019, 13(Suppl 1): S31-S34. doi: 10.4103/sja.SJA_543_18.
13.	Kamath PS, Kim WR. The model for end-stage liver disease (MELD). Hepatology, 2007, 45(3): 797-805.
14.	Pugh RN, Murray-Lyon IM, Dawson JL, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg, 1973, 60(8): 646-649.
15.	Olthoff KM, Kulik L, Samstein B, et al. Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors. Liver Transpl, 2010, 16(8): 943-949.
16.	Kellum JA, Lameire N, Aspelin P, et al. Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Intern Suppl, 2012, 2(1): 1-138.
17.	O’Gara B, Talmor D. Perioperative lung protective ventilation. BMJ, 2018, 362: k3030. doi:10.1136/bmj.k3030.
18.	Caire MT, Kumar A, Stravitz RT, et al. Preliver transplant red cell distribution width predicts postliver transplant mortality. Clin Transplant, 2017, 31(3). doi: 10.1111/ctr.12908.
19.	Patel HH, Patel HR, Higgins JM. Modulation of red blood cell population dynamics is a fundamental homeostatic response to disease. Am J Hematol, 2015, 90(5): 422-428.
20.	Salvagno GL, Sanchis-Gomar F, Picanza A, et al. Red blood cell distribution width: a simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci, 2015, 52(2): 86-105.

1. Baganate F, Beal EW, Tumin D, et al. Early mortality after liver transplantation: defining the course and the cause. Surgery, 2018, 164(4): 694-704.
2. Kwong AJ, Kim WR, Lake JR, et al. OPTN/SRTR 2019 annual data report: liver. Am J Transplant, 2021, 21 Suppl 2: 208-315.
3. Brustia R, Monsel A, Skurzak S, et al. Guidelines for perioperative care for liver transplantation: enhanced recovery after surgery (ERAS) recommendations. Transplantation, 2022, 106(3): 552-561.
4. Förhécz Z, Gombos T, Borgulya G, et al. Red cell distribution width in heart failure: prediction of clinical events and relationship with markers of ineffective erythropoiesis, inflammation, renal function, and nutritional state. Am Heart J, 2009, 158(4): 659-666.
5. Lippi G, Targher G, Montagnana M, et al. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med, 2009, 133(4): 628-632.
6. Joshi D, Chowdhury MAT, Alauddin M, et al. Role of pre-operative red cell distribution width estimation in the prediction of in-hospital mortality after off-pump coronary artery bypass grafting. J Cardiothorac Surg, 2021, 16(1): 232. doi: 10.1186/s13019-021-01612-w.
7. Pluta M, Klocek T, Krzych ŁJ. Diagnostic accuracy of red blood cell distribution width in predicting in-hospital mortality in patients undergoing high-risk gastrointestinal surgery. Anaesthesiol Intensive Ther, 2018, 50(4): 277-282.
8. Li N, Zhou H, Tang Q. Red blood cell distribution width: a novel predictive indicator for cardiovascular and cerebrovascular diseases. Dis Markers, 2017, 2017: 7089493. doi: 10.1155/2017/7089493.
9. Abdullah HR, Sim YE, Sim YT, et al. Preoperative red cell distribution width and 30-day mortality in older patients undergoing non-cardiac surgery: a retrospective cohort observational study. Sci Rep, 2018, 8(1): 6226. doi: 10.1038/s41598-018-24556-z.
10. Olafsson HB, Sigurdarson GA, Christopher KB, et al. A retrospective cohort study on the association between elevated preoperative red cell distribution width and all-cause mortality after noncardiac surgery. Br J Anaesth, 2020, 124(6): 718-725.
11. Szygula-Jurkiewicz B, Szczurek W, Skrzypek M, et al. Red blood cell distribution width in end-stage heart failure patients is independently associated with all-cause mortality after orthotopic heart transplantation. Transplant Proc, 2018, 50(7): 2095-2099.
12. Cuschieri S. The STROBE guidelines. Saudi J Anaesth, 2019, 13(Suppl 1): S31-S34. doi: 10.4103/sja.SJA_543_18.
13. Kamath PS, Kim WR. The model for end-stage liver disease (MELD). Hepatology, 2007, 45(3): 797-805.
14. Pugh RN, Murray-Lyon IM, Dawson JL, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg, 1973, 60(8): 646-649.
15. Olthoff KM, Kulik L, Samstein B, et al. Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors. Liver Transpl, 2010, 16(8): 943-949.
16. Kellum JA, Lameire N, Aspelin P, et al. Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Intern Suppl, 2012, 2(1): 1-138.
17. O’Gara B, Talmor D. Perioperative lung protective ventilation. BMJ, 2018, 362: k3030. doi:10.1136/bmj.k3030.
18. Caire MT, Kumar A, Stravitz RT, et al. Preliver transplant red cell distribution width predicts postliver transplant mortality. Clin Transplant, 2017, 31(3). doi: 10.1111/ctr.12908.
19. Patel HH, Patel HR, Higgins JM. Modulation of red blood cell population dynamics is a fundamental homeostatic response to disease. Am J Hematol, 2015, 90(5): 422-428.
20. Salvagno GL, Sanchis-Gomar F, Picanza A, et al. Red blood cell distribution width: a simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci, 2015, 52(2): 86-105.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Associations of preoperative red cell distribution width with mortality and morbidity in patients underwent liver transplantation: a retrospectively observational study

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