Can red blood cell distribution width predict long‐term cardiovascular event after off‐pump coronary artery bypass? A retrospective study

RDW-to-ALB Ratio Is an Independent Predictor for 30-Day All-Cause Mortality in Patients with Acute Ischemic Stroke: A Retrospective Analysis from the MIMIC-IV Database

Purpose

Previous studies have shown that the peripheral red blood cell distribution width (RDW) and human serum albumin (ALB) were both predictors of the risk and mortality of cerebrovascular diseases, and the ratio of RDW to ALB (RAR) was a combined new index that can predict the prognosis of the cardiovascular and respiration systemic diseases, but its role in cerebrovascular diseases had not been effectively evaluated. This study is aimed at exploring whether RAR can effectively predict the 30-day all-cause mortality of acute ischemic stroke (AIS) patients.

Methods

This retrospective cohort study was conducted on AIS patients (age > 18 years) in the intensive care database MIMIC-IV. The RAR was measured based on the red blood cell distribution width and albumin. The main result was 30-day all-cause mortality, and the secondary results were ICU mortality and hospital mortality. Obtain the odds ratio (OR) estimate from the logistic regression model of log-transformed RAR values and mortality. We had used another database for external validation.

Results

A total of 1412 patients were enrolled, with an average age of 68.8 ± 15.9, including 708 (50.1%) males. When log-transformed RAR values were used as a continuous variable, as the values increases, the risk of death increases (30-day all-cause mortality OR = 4.02 (2.21, 7.32) P < 0.0001, ICU mortality OR = 3.81 (1.92, 7.54) P = 0.0001, and hospital mortality OR = 3.31 (1.83, 6.00) P < 0.0001), when the values were used as three-category variables and as a trend variable was also positively correlated with each mortality rate. Especially as the categorical variables, a dose-response relationship was clearly observed, that was, as the category of RAR increased (Q1 to Q3), the HR value of the risk of death gradually steadily increased. Such a relationship can also be observed in the external validation database. In the subgroup analysis, we observed an increased risk of death in the patient with hyperlipidemia and low HAS-BLED scores; however, no significant interaction was found in other subgroup analyses (including the diagnostic sequence of AIS).

Conclusion

RAR was a predictor of mortality in AIS patients. However, more in-depth research is needed to further analyze and confirm the role of RAR in AIS patients.

Preoperative Combined Adiposity–Nutritional Index Predicts Major aDverse Cardiac and Cerebral Events following Off-pump coRonary Artery Revascularization (PANDORA): A Retrospective Single-Center Study

Background The metabolic–nutritional profile of coronary artery disease (CAD) patients can be an important outcome determinant. A high visceral adiposity index (VAI) and a low prognostic nutritional index (PNI) have been described to predict major adverse cardiac and cerebral events (MACCE) in nonoperative settings and poor cardiac-surgical outcomes, respectively. The present study evaluated the MACCE-predictive value of the two indices, in isolation and as a combined adiposity–nutritional index (CANI = VAI/PNI) in patients undergoing off-pump coronary artery bypass grafting (OPCABG).

Methods The retrospective study was conducted in 1207 OPCABG patients at a tertiary cardiac care center. Thirty-day postoperative data was evaluated for the development of MACCE, defined by any of the following: cardiac arrest, ST-segment elevation myocardial ischemia (STEMI), repeat coronary revascularization, or stroke. The perioperative characteristics of the MACCE and no-MACCE groups were analyzed for the predictors of postoperative MACCE.

Results One-hundred thirty-two patients (10.93%) developed MACCE postoperatively. On univariate analysis, age, EuroSCORE II, ejection fraction, diabetes mellitus, asymptomatic carotid artery disease, left main (LM) disease, PNI, and VAI predicted MACCE. Subsequent to multivariate analysis, age, EuroSCORE II, and CANI were the independent predictors. The MACCE predictive cutoffs of VAI, PNI, and CANI were 3.2, 38.46, and 0.075 (area under the curve [AUC]; sensitivity; specificity: 0.64; 77%; 81.3%, 0.77; 92.6%, 65%, 0.78; 64.5%; 80.2%, respectively). CANI correlated positively with duration of mechanical ventilation, length of intensive care unit (ICU) stay, and mean postoperative vasoactive inotropic scores (VIS). CANI ≥ 0.075 was also associated with a higher incidence of postoperative atrial fibrillation, low cardiac output syndrome, and acute kidney injury.

Conclusions CANI emerged as an independent predictor of MACCE following OPCABG.

Hemoglobin concentration, hematocrit and red blood cell count predict major adverse cardiovascular events in patients with familial hypercholesterolemia

BACKGROUND AND AIMS

Familial hypercholesterolemia (FH) is a genetic disease associated with an important risk of premature and recurrent atherosclerotic cardiovascular disease (ASCVD). Red blood cell (RBC) parameters such as cell count and hematocrit (HCT) have previously been associated with ASCVD risk in the general population. However, little is known concerning their effect in FH. The aim of the present study is to investigate the effect of the different RBC parameters on the incidence of major adverse cardiovascular events (MACE) in FH patients.

METHODS

In this prospective cohort study, genetically-confirmed FH patients aged between 18 and 65 years and without history of a prior ASCVD event were included. MACE included myocardial infarction, stroke, coronary revascularization, unstable angina or cardiovascular death.

RESULTS

A total of 482 subjects (6217 person-years of follow-up) were included in the analysis. Hemoglobin (HB), RBC count, and HCT were significant predictors of MACE risk (HR 1.04 (95% CI 1.01-1.06) p = 0.001, HR 2.69 (95% CI 1.49-4.86) p = 0.001, and HR 1.16 (95% CI 1.08-1.26) p < 0.0001, respectively) and these associations remained significant when adjusted for traditional cardiovascular risk factors. In addition, the frequency of recurrent MACE was 4-fold and 7-fold higher in the group above vs below the median for HB (p = 0.002) and RBC count (p = 0.001), respectively.

CONCLUSIONS

HB, RBC count and HCT were significant predictors of incident and recurring MACE in FH patients. These parameters could therefore be used to further refine the ASCVD risk prediction in this vulnerable population.