A single preoperative blood test predicts postoperative sepsis and pneumonia after coronary bypass or open aneurysm surgery

• Published in: European journal of clinical investigation 2019-03, Vol.49 (3), p.e13055-n/a
• Main Authors: van Koeverden, Ian D., den Ruijter, Hester M., Scholtes, Vincent P. W., G. E. H. Lam, Marnix, Haitjema, Saskia, Buijsrogge, Marc P., J. L. Suyker, Willem, van Wijk, Richard H., de Groot, Mark C. H., van Herwaarden, Joost A., van Solinge, Wouter W., de Borst, Gert J., Pasterkamp, Gerard, Hoefer, Imo E.
• Format: Article
• Language: English
• Subjects: Aged; Aortic Aneurysm, Abdominal - blood; Aortic Aneurysm, Abdominal - surgery; Biomarkers - metabolism; Blood tests; Bone marrow; Cardiovascular diseases; chronic inflammation; Complications; Coronary artery; Coronary Artery Bypass - adverse effects; Deoxyglucose; Erythrocyte Indices - physiology; Female; Fluorodeoxyglucose F18; Generalized linear models; Health risks; Heart surgery; hematopoietic tissues; Humans; Incidence; Inflammation; Male; Patients; Pneumonia; Pneumonia - diagnosis; Positron emission; Positron emission tomography; Positron Emission Tomography Computed Tomography; Postoperative Complications - diagnosis; Predictive Value of Tests; Preoperative Care - methods; Radiopharmaceuticals; Red cell distribution width; Regression analysis; Regression models; Repair; Retrospective Studies; Risk; risk prediction; Sepsis; Sepsis - diagnosis; Spleen; Statistical models; Surgery; Tissues; Tomography
• ISSN: 0014-2972; 1365-2362
• DOI: 10.1111/eci.13055

Background Major surgery comes with a high risk for postoperative inflammatory complications. Preoperative risk scores predict mortality risk but fail to identify patients at risk for complications following cardiovascular surgery. We therefore assessed the value of preoperative red cell distribution width (RDW) as a predictor for pneumonia and sepsis after cardiovascular surgery and studied the relation of RDW with hematopoietic tissue activity. Methods RDW is an easily accessible, yet seldomly used parameter from routine haematology measurements. RDW was extracted from the Utrecht Patient Orientated Database (UPOD) for preoperative measurements in patients undergoing open abdominal aortic anuerysm repair (AAA)(N = 136) or coronary artery bypass grafting (CABG)(N = 2193). The cohorts were stratified in tertiles to assess effects over the different groups. Generalized Linear Models were used to determine associations between RDW and postoperative inflammatory complications. Hematopoietic tissue activity was scored using fluor‐18‐(18F)‐deoxyglucose positron emission tomography and associated with RDW using linear regression models. Results In total, 43(31.6%) and 73 patients (3.3%) suffered from inflammatory complications after AAA‐repair or CABG, respectively; the majority being pneumonia in both cohorts. Postoperative inflammatory outcome incidence increased from 19.6% in the lowest to 48.9% in the highest RDW tertile with a corresponding risk ratio (RR) of 2.35 ([95%CI:1.08‐5.14] P = 0.032) in AAA patients. In the CABG cohort, the incidence of postoperative inflammatory outcomes increased from 1.8% to 5.3% with an adjusted RR of 1.95 ([95%CI:1.02‐3.75] P = 0.044) for the highest RDW tertile compared with the lowest RDW tertile. FDG‐PET scans showed associations of RDW with tissue activity in the spleen (B = 0.517 [P = 0.001]) and the lumbar bone marrow (B = 0.480 [P = 0.004]). Conclusion Elevated RDW associates with increased risk for postoperative inflammatory complications and hematopoietic tissue activity. RDW likely reflects chronic low‐grade inflammation and should be considered to identify patients at risk for postoperative inflammatory complications following cardiovascular surgery.