title: Usefulness of elevated red cell distribution width for predicting systemic inflammatory response syndrome after extracorporeal circulation.
abstract: OBJECTIVE
  Cardiac surgical operations performed by using extracorporeal circulation (ECC) lead to a systemic inflammatory response (SIR). Sometimes SIR may turn into a severe state, the systemic inflammatory response syndrome (SIRS) that usually has a poor outcome with no specific clinical tools described for its prediction. Red cell distribution width (RDW) is a routine hematological parameter. It has been proposed as a marker of morbidity and mortality in various clinical conditions. We aimed to investigate the relationship between high RDW and SIRS which is triggered by ECC.
  
  
  METHODS
  Eleven hundred consecutive patients who underwent elective heart surgery with the use of ECC were retrospectively analyzed. A total of 19 patients fulfilled the described SIRS criteria and 20 consecutive patients were selected as the control group. RDW and other laboratory parameters, preoperative clinical status, operative data and postoperative data were compared between the SIRS and the control groups.
  
  
  RESULTS
  Baseline characteristics of the patient groups were similar. Significant mortality was found in the SIRS group; 18 (94.73%) patients and 2 (10%) patients in the control group (p < 0.002). RDW was found to be significantly higher in the SIRS group vs the control group (15.02 ± 2.03 vs 13.01 ± 1.93, respectively, p < 0.003). Multiple logistic regression analyses showed an association between high RDW levels and SIRS development (OR for RDW levels exceeding 13.5%; 95% confidence limits of 1.0-1.3; p < 0.04). Total operation time and the need for inotropic support were also found to be significant against the SIRS group (p = 0.049).
  
  
  CONCLUSIONS
  Increased RDW was significantly associated with increased risk of SIRS after ECC. The results of this study suggest that paying attention to RDW might provide valuable clinical information for predicting SIRS development among patients who are candidates for open heart surgery, without incurring additional costs.
authors.affiliation: Mersin University Medical Faculty, Department of Cardiovascular Surgery, Mersin, Turkey mozeren@yahoo.com.
authors.forename: M
authors.initials: M
authors.lastname: Özeren
authors.affiliation: Mersin University Medical Faculty, Department of Cardiovascular Surgery, Mersin, Turkey.
authors.forename: B
authors.initials: B
authors.lastname: Aytaçoğlu
authors.affiliation: Mersin University Medical Faculty, Department of Cardiovascular Surgery, Mersin, Turkey.
authors.forename: Ö
authors.initials: Ö
authors.lastname: Vezir
authors.affiliation: Mersin University Medical Faculty, Department of Cardiovascular Surgery, Mersin, Turkey.
authors.forename: K
authors.initials: K
authors.lastname: Karaca
authors.affiliation: Mersin University Medical Faculty, Department of Cardiovascular Surgery, Mersin, Turkey.
authors.forename: R
authors.initials: R
authors.lastname: Akın
authors.affiliation: Mersin University Medical Faculty, Department of Cardiovascular Surgery, Mersin, Turkey.
authors.forename: N
authors.initials: N
authors.lastname: Sucu
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures; D017558:Elective Surgical Procedures; D004909:Erythrocyte Indices; D004912:Erythrocytes / Q000378:metabolism* / Q000473:pathology; D005112:Extracorporeal Circulation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood* / Q000401:mortality
keywords: cardiopulmonary bypass; red cell distribution width; systemic inflammatory response syndrome