A single preoperative blood test predicts postoperative sepsis and pneumonia after coronary bypass or open aneurysm surgery

Ian D. van Koeverden, Hester M. den Ruijter, Vincent P. W. Scholtes, Marnix G. e. H. Lam, Saskia Haitjema, Marc P. Buijsrogge, Willem J. l. Suyker, Richard H. van Wijk, Mark C. H. de Groot, Joost A. van Herwaarden, Wouter W. van Solinge, Gert J. de Borst, Gerard Pasterkamp, Imo E. Hoefer

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Major surgery comes with a high risk for postoperative inflammatory complications. Preoperative risk scores predict mortality risk but fail to identify patients at risk for complications following cardiovascular surgery. We therefore assessed the value of preoperative red cell distribution width (RDW) as a predictor for pneumonia and sepsis after cardiovascular surgery and studied the relation of RDW with hematopoietic tissue activity. Methods: RDW is an easily accessible, yet seldomly used parameter from routine haematology measurements. RDW was extracted from the Utrecht Patient Orientated Database (UPOD) for preoperative measurements in patients undergoing open abdominal aortic anuerysm repair (AAA)(N = 136) or coronary artery bypass grafting (CABG)(N = 2193). The cohorts were stratified in tertiles to assess effects over the different groups. Generalized Linear Models were used to determine associations between RDW and postoperative inflammatory complications. Hematopoietic tissue activity was scored using fluor-18-(18F)-deoxyglucose positron emission tomography and associated with RDW using linear regression models. Results: In total, 43(31.6%) and 73 patients (3.3%) suffered from inflammatory complications after AAA-repair or CABG, respectively; the majority being pneumonia in both cohorts. Postoperative inflammatory outcome incidence increased from 19.6% in the lowest to 48.9% in the highest RDW tertile with a corresponding risk ratio (RR) of 2.35 ([95%CI:1.08-5.14] P = 0.032) in AAA patients. In the CABG cohort, the incidence of postoperative inflammatory outcomes increased from 1.8% to 5.3% with an adjusted RR of 1.95 ([95%CI:1.02-3.75] P = 0.044) for the highest RDW tertile compared with the lowest RDW tertile. FDG-PET scans showed associations of RDW with tissue activity in the spleen (B = 0.517 [P = 0.001]) and the lumbar bone marrow (B = 0.480 [P = 0.004]). Conclusion: Elevated RDW associates with increased risk for postoperative inflammatory complications and hematopoietic tissue activity. RDW likely reflects chronic low-grade inflammation and should be considered to identify patients at risk for postoperative inflammatory complications following cardiovascular surgery.
Original languageEnglish
Article numbere13055
JournalEuropean Journal of Clinical Investigation
Volume49
Issue number3
DOIs
Publication statusPublished - 1 Mar 2019

Cite this

van Koeverden, Ian D. ; den Ruijter, Hester M. ; Scholtes, Vincent P. W. ; G. e. H. Lam, Marnix ; Haitjema, Saskia ; Buijsrogge, Marc P. ; J. l. Suyker, Willem ; van Wijk, Richard H. ; de Groot, Mark C. H. ; van Herwaarden, Joost A. ; van Solinge, Wouter W. ; de Borst, Gert J. ; Pasterkamp, Gerard ; Hoefer, Imo E. / A single preoperative blood test predicts postoperative sepsis and pneumonia after coronary bypass or open aneurysm surgery. In: European Journal of Clinical Investigation. 2019 ; Vol. 49, No. 3.
@article{6c61af9ee1784ecba298fd091533b4f3,
title = "A single preoperative blood test predicts postoperative sepsis and pneumonia after coronary bypass or open aneurysm surgery",
abstract = "Background: Major surgery comes with a high risk for postoperative inflammatory complications. Preoperative risk scores predict mortality risk but fail to identify patients at risk for complications following cardiovascular surgery. We therefore assessed the value of preoperative red cell distribution width (RDW) as a predictor for pneumonia and sepsis after cardiovascular surgery and studied the relation of RDW with hematopoietic tissue activity. Methods: RDW is an easily accessible, yet seldomly used parameter from routine haematology measurements. RDW was extracted from the Utrecht Patient Orientated Database (UPOD) for preoperative measurements in patients undergoing open abdominal aortic anuerysm repair (AAA)(N = 136) or coronary artery bypass grafting (CABG)(N = 2193). The cohorts were stratified in tertiles to assess effects over the different groups. Generalized Linear Models were used to determine associations between RDW and postoperative inflammatory complications. Hematopoietic tissue activity was scored using fluor-18-(18F)-deoxyglucose positron emission tomography and associated with RDW using linear regression models. Results: In total, 43(31.6{\%}) and 73 patients (3.3{\%}) suffered from inflammatory complications after AAA-repair or CABG, respectively; the majority being pneumonia in both cohorts. Postoperative inflammatory outcome incidence increased from 19.6{\%} in the lowest to 48.9{\%} in the highest RDW tertile with a corresponding risk ratio (RR) of 2.35 ([95{\%}CI:1.08-5.14] P = 0.032) in AAA patients. In the CABG cohort, the incidence of postoperative inflammatory outcomes increased from 1.8{\%} to 5.3{\%} with an adjusted RR of 1.95 ([95{\%}CI:1.02-3.75] P = 0.044) for the highest RDW tertile compared with the lowest RDW tertile. FDG-PET scans showed associations of RDW with tissue activity in the spleen (B = 0.517 [P = 0.001]) and the lumbar bone marrow (B = 0.480 [P = 0.004]). Conclusion: Elevated RDW associates with increased risk for postoperative inflammatory complications and hematopoietic tissue activity. RDW likely reflects chronic low-grade inflammation and should be considered to identify patients at risk for postoperative inflammatory complications following cardiovascular surgery.",
author = "{van Koeverden}, {Ian D.} and {den Ruijter}, {Hester M.} and Scholtes, {Vincent P. W.} and {G. e. H. Lam}, Marnix and Saskia Haitjema and Buijsrogge, {Marc P.} and {J. l. Suyker}, Willem and {van Wijk}, {Richard H.} and {de Groot}, {Mark C. H.} and {van Herwaarden}, {Joost A.} and {van Solinge}, {Wouter W.} and {de Borst}, {Gert J.} and Gerard Pasterkamp and Hoefer, {Imo E.}",
year = "2019",
month = "3",
day = "1",
doi = "10.1111/eci.13055",
language = "English",
volume = "49",
journal = "European Journal of Clinical Investigation",
issn = "0014-2972",
number = "3",

}

van Koeverden, ID, den Ruijter, HM, Scholtes, VPW, G. e. H. Lam, M, Haitjema, S, Buijsrogge, MP, J. l. Suyker, W, van Wijk, RH, de Groot, MCH, van Herwaarden, JA, van Solinge, WW, de Borst, GJ, Pasterkamp, G & Hoefer, IE 2019, 'A single preoperative blood test predicts postoperative sepsis and pneumonia after coronary bypass or open aneurysm surgery' European Journal of Clinical Investigation, vol. 49, no. 3, e13055. https://doi.org/10.1111/eci.13055

A single preoperative blood test predicts postoperative sepsis and pneumonia after coronary bypass or open aneurysm surgery. / van Koeverden, Ian D.; den Ruijter, Hester M.; Scholtes, Vincent P. W.; G. e. H. Lam, Marnix; Haitjema, Saskia; Buijsrogge, Marc P.; J. l. Suyker, Willem; van Wijk, Richard H.; de Groot, Mark C. H.; van Herwaarden, Joost A.; van Solinge, Wouter W.; de Borst, Gert J.; Pasterkamp, Gerard; Hoefer, Imo E.

In: European Journal of Clinical Investigation, Vol. 49, No. 3, e13055, 01.03.2019.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - A single preoperative blood test predicts postoperative sepsis and pneumonia after coronary bypass or open aneurysm surgery

AU - van Koeverden, Ian D.

AU - den Ruijter, Hester M.

AU - Scholtes, Vincent P. W.

AU - G. e. H. Lam, Marnix

AU - Haitjema, Saskia

AU - Buijsrogge, Marc P.

AU - J. l. Suyker, Willem

AU - van Wijk, Richard H.

AU - de Groot, Mark C. H.

AU - van Herwaarden, Joost A.

AU - van Solinge, Wouter W.

AU - de Borst, Gert J.

AU - Pasterkamp, Gerard

AU - Hoefer, Imo E.

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Background: Major surgery comes with a high risk for postoperative inflammatory complications. Preoperative risk scores predict mortality risk but fail to identify patients at risk for complications following cardiovascular surgery. We therefore assessed the value of preoperative red cell distribution width (RDW) as a predictor for pneumonia and sepsis after cardiovascular surgery and studied the relation of RDW with hematopoietic tissue activity. Methods: RDW is an easily accessible, yet seldomly used parameter from routine haematology measurements. RDW was extracted from the Utrecht Patient Orientated Database (UPOD) for preoperative measurements in patients undergoing open abdominal aortic anuerysm repair (AAA)(N = 136) or coronary artery bypass grafting (CABG)(N = 2193). The cohorts were stratified in tertiles to assess effects over the different groups. Generalized Linear Models were used to determine associations between RDW and postoperative inflammatory complications. Hematopoietic tissue activity was scored using fluor-18-(18F)-deoxyglucose positron emission tomography and associated with RDW using linear regression models. Results: In total, 43(31.6%) and 73 patients (3.3%) suffered from inflammatory complications after AAA-repair or CABG, respectively; the majority being pneumonia in both cohorts. Postoperative inflammatory outcome incidence increased from 19.6% in the lowest to 48.9% in the highest RDW tertile with a corresponding risk ratio (RR) of 2.35 ([95%CI:1.08-5.14] P = 0.032) in AAA patients. In the CABG cohort, the incidence of postoperative inflammatory outcomes increased from 1.8% to 5.3% with an adjusted RR of 1.95 ([95%CI:1.02-3.75] P = 0.044) for the highest RDW tertile compared with the lowest RDW tertile. FDG-PET scans showed associations of RDW with tissue activity in the spleen (B = 0.517 [P = 0.001]) and the lumbar bone marrow (B = 0.480 [P = 0.004]). Conclusion: Elevated RDW associates with increased risk for postoperative inflammatory complications and hematopoietic tissue activity. RDW likely reflects chronic low-grade inflammation and should be considered to identify patients at risk for postoperative inflammatory complications following cardiovascular surgery.

AB - Background: Major surgery comes with a high risk for postoperative inflammatory complications. Preoperative risk scores predict mortality risk but fail to identify patients at risk for complications following cardiovascular surgery. We therefore assessed the value of preoperative red cell distribution width (RDW) as a predictor for pneumonia and sepsis after cardiovascular surgery and studied the relation of RDW with hematopoietic tissue activity. Methods: RDW is an easily accessible, yet seldomly used parameter from routine haematology measurements. RDW was extracted from the Utrecht Patient Orientated Database (UPOD) for preoperative measurements in patients undergoing open abdominal aortic anuerysm repair (AAA)(N = 136) or coronary artery bypass grafting (CABG)(N = 2193). The cohorts were stratified in tertiles to assess effects over the different groups. Generalized Linear Models were used to determine associations between RDW and postoperative inflammatory complications. Hematopoietic tissue activity was scored using fluor-18-(18F)-deoxyglucose positron emission tomography and associated with RDW using linear regression models. Results: In total, 43(31.6%) and 73 patients (3.3%) suffered from inflammatory complications after AAA-repair or CABG, respectively; the majority being pneumonia in both cohorts. Postoperative inflammatory outcome incidence increased from 19.6% in the lowest to 48.9% in the highest RDW tertile with a corresponding risk ratio (RR) of 2.35 ([95%CI:1.08-5.14] P = 0.032) in AAA patients. In the CABG cohort, the incidence of postoperative inflammatory outcomes increased from 1.8% to 5.3% with an adjusted RR of 1.95 ([95%CI:1.02-3.75] P = 0.044) for the highest RDW tertile compared with the lowest RDW tertile. FDG-PET scans showed associations of RDW with tissue activity in the spleen (B = 0.517 [P = 0.001]) and the lumbar bone marrow (B = 0.480 [P = 0.004]). Conclusion: Elevated RDW associates with increased risk for postoperative inflammatory complications and hematopoietic tissue activity. RDW likely reflects chronic low-grade inflammation and should be considered to identify patients at risk for postoperative inflammatory complications following cardiovascular surgery.

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UR - https://www.ncbi.nlm.nih.gov/pubmed/30475403

U2 - 10.1111/eci.13055

DO - 10.1111/eci.13055

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JO - European Journal of Clinical Investigation

JF - European Journal of Clinical Investigation

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