AHJ：红细胞分布宽度与PCI术后大出血独立线性相关

　　美国一项研究表明，红细胞分布宽度（RDW）与经皮冠状动脉介入治疗（PCI）术后大出血呈独立线性相关。论文5月20日在线发表于《美国心脏杂志》（American Heart Journal）。

　　研究纳入6689例倾向行PCI的患者，获取患者PCI术前的全血细胞计数中的RDW数据。以血细胞比容减少≥12%，血红蛋白降低≥4，压缩红细胞输注≥2单位，腹膜后或胃肠道或颅内出血定义为院内大出血。利用Logistic回归模型多变量分析院内大出血。

　　结果显示，基线RDW水平较高的患者的大出血（P＜0.001）、血管并发症（P=0.005）和输血事件（P＜0.001）明显较高.校正已知出血相关因素后，RDW仍为大出血的明显预测因子（P＜0.001）。

Red cell distribution width as a bleeding predictor after percutaneous coronary intervention
Background
Red cell distribution width (RDW), a measure of variability in the size of circulating erythrocytes, is an independent predictor of mortality in cardiovascular disease and in patients undergoing percutaneous coronary intervention (PCI). We set out to determine if RDW is a prognostic marker of major bleeding post-PCI.
Methods
The study population included 6,689 patients who were subjected to PCI. The RDW was derived from a complete blood count drawn before PCI. Major inhospital bleeding was defined as a hematocrit decrease ≥12%, hemoglobin drop of ≥4, transfusion of ≥2 units of packed red blood cells, retroperitoneal, or gastrointestinal or intracranial bleeding. Multivariable logistic analysis of major inhospital bleeding was performed using a logistic regression model that comprised the National Cardiovascular Data Registry (NCDR) risk score model as a single variable.
Results
Major bleeding (P < .001), vascular complications (P = .005), and transfusions (P < .001) were significantly higher in patients with higher baseline RDW values. After adjustment for known bleeding correlates, RDW was a significant predictor for major bleeding (odds ratio 1.12, 95% CI 1.06-1.19, P < .001). Although the c statistic of the NCDR risk prediction model changed from 0.730 to 0.737 (P = .032), the net reclassification improvement increased significantly after the addition of RDW as a continuous variable (17.3% CI 6.7%-28%, P = .002).
Conclusions
Red cell distribution width, an easily obtainable marker, has an independent, linear relationship with major bleeding post-PCI and incrementally improves the well-validated NCDR risk prediction model. These data suggest that further investigation is necessary to determine the relationship of RDW and post-PCI bleeding.