Relation between red cell distribution width and clinical outcome after surgery for congenital heart disease in children.

Recent studies have reported a strong association between increased red cell distribution width (RDW) and the risk of adverse outcomes for adults with heart failure. This study investigated the association between preoperative RDW and postoperative clinical outcomes for children with cardiac disease. The relation between preoperative RDW and the length of postoperative stay was tested with 688 consecutive children undergoing surgery for congenital heart disease (CHD). The RDW was significantly higher in patients who died during the postoperative hospital stay (mean, 18.34 ± 4.69 vs 16.12 ± 2.84; p = 0.004). The risk of postoperative death was five times higher for patients with an RDW of 16% or more. In the general study population, RDW correlated with the intensive care unit (ICU) stay (p < 0.0001) and with the total hospital stay in the local population (p < 0.0001). The correlation between RDW and ICU stay was stronger for patients with acyanotic CHD (p < 0.0001) than for those with cyanotic CHD (p = 0.0007), and for the subpopulation of patients with acyanotic CHD and normal hemoglobin level (p < 0.0001) than for anemic patients with acyanotic CHD (p = 0.025). Preoperative RDW is a strong predictor of an adverse outcome in children undergoing surgery for CHD, especially in nonanemic patients, for whom it reflects an underlying inflammatory stress.