The Prognostic Significance of Red Cell Distribution Width in Cardiac Surgery: A Systematic Review and Meta-Analysis

Angela A. Frentiu, Kevin Mao, Carla Borg Caruana, Dev Raveendran, Luke A. Perry, Jahan C. Penny-Dimri, Dhruvesh M. Ramson, Reny Segal, Rinaldo Bellomo, Julian A. Smith, Zhengyang Liu

Research output: Contribution to journalReview ArticleResearchpeer-review

3 Citations (Scopus)


RED CELL DISTRIBUTION WIDTH (RDW) is a routinely available biomarker of likely erythropoietic dysfunction, which may be associated with adverse outcomes after cardiac surgery. This systematic review and meta-analysis aimed to clarify the prognostic value of RDW in patients undergoing cardiac surgery. The authors searched MEDLINE, Embase, and the Cochrane Library from inception to May 10, 2022 for studies investigating the association between elevated RDW (as defined by the authors of included studies) and adverse outcomes after cardiac surgery. Herein, the authors extracted maximally adjusted hazard ratios (HRs) and odds ratios (ORs) with associated CIs, and pooled them using random-effects inverse- variance modeling. The authors explored interstudy heterogeneity using metaregression. The authors included 26 studies involving 48,092 patients who had undergone cardiac surgery. Elevated preoperative RDW was associated with long-term mortality (pooled HR 1.63, 95% CI 1.05-2.52), short-term mortality (pooled OR 2.16, 95% CI 1.21-3.87), acute kidney injury (AKI; pooled OR 1.30, 95% CI 1.19-1.41) and postoperative atrial fibrillation (POAF; pooled OR 1.44, 95% CI 1.05-1.96). Some studies suggested a significant association between preoperative RDW elevation and neurologic complications; however, their number was insufficient for meta-analysis. The postoperative RDW levels were less consistently reported and could not be meta-analyzed. In conclusion, the authors found that elevated preoperative RDW was associated with increased short- and long-term mortality, POAF, and AKI after cardiac surgery. Further research is needed to investigate its role in the risk stratification of patients undergoing cardiac surgery.

Original languageEnglish
Pages (from-to)471-479
Number of pages9
JournalJournal of Cardiothoracic and Vascular Anesthesia
Issue number3
Publication statusPublished - Mar 2023


  • acute kidney injury
  • cardiac surgery
  • mortality
  • post-operative atrial fibrillation
  • prognosis
  • Red cell distribution width (RDW)

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