23 Increased red blood cell distribution width is a marker of adverse cardiorenal outcomes following cardiac surgery
Bibliographic record
Abstract
There is a paucity of biomarkers for risk stratification following cardiac surgery. The red blood cell distribution width (RDW) – a standard component of routine CBC – quantifies the variation of RBC volumes during their lifespan. Elevated RDW is independently associated with morbidity and mortality across various metabolic and infectious conditions, and is a surrogate measure of fragility. Whether RDW can aid in risk stratification following cardiac surgery is unknown, and was the subject of this investigation. We evaluated the association of RDW with outcomes in patients enrolled in the global TRICS III randomized trial which compared restrictive to liberal blood transfusion in adult patients undergoing cardiac surgery. The primary composite outcome included death from any cause, myocardial infarction, stroke, or new-onset severe renal failure by hospital discharge at 28-days post-operatively. Secondary outcomes included all-cause death at 28 days and 6-months respectively. This analysis included 3658 patients for whom RDW was available (mean age 72±10; 63% male; EuroScore II 7.9±2.0; 26% CABG; 19% CABG+valve; 28% valve; 27% other). Elevated RDW was significantly and independently associated with incident primary adverse cardiorenal events at 28-days (highest RDW quartile vs. lowest RDW quartile, HR 1.96 (1.48–2.60); p<0.0001). A similar association was observed for key secondary outcomes of prolonged low-output state, acute kidney injury and new renal failure at 28 days post-operatively. Strikingly, following multivariate adjustment, elevated RDW was strongly associated with all-cause death at 28-days and 6-months following surgery (highest vs. lowest RDW quartile at 28-days: HR 2.12 (1.24–3.61); p<0.01 and 6 months: HR 2.42 (1.60–3.05); p<0.0001) (table 1), (figure 1). In this large trial of patients undergoing cardiac surgery, elevated RDW was associated with an increase in cardiorenal events, and short- and long-term mortality risk after multivariate adjustment. RDW may be a simple, inexpensive and highly predictive biomarker for adverse perioperative outcomes in cardiac surgery.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".