Refining the prognostic role of red cell distribution width in TAVR patients
Keywords
Red cell distribution width
Aortic stenosis
Frailty
Prognosis
Risk stratification
I read with interest the systematic review and meta-analysis by Pingili et al. [1] evaluating the impact of pre-procedural red cell distribution width (RDW) on one-year all-cause mortality following transcatheter aortic valve replacement (TAVR). The authors should be congratulated for synthesizing data from seven studies, concluding that elevated baseline RDW independently predicts one-year all-cause mortality (adjusted OR 1.60), particularly in patients over 80 years old. This work reinforces the potential utility of this simple, widely available biomarker for risk stratification in TAVR candidates. However, this study raises important questions that deserve further exploration. RDW is a non-specific marker reflecting various underlying pathophysiological processes - inflammation, malnutrition, ineffective erythropoiesis, and renal dysfunction [2] - all common in the elderly TAVR population characterized by significant frailty and multimorbidity [3,
4]. While Pingili et al. used adjusted odds ratios, the substantial heterogeneity (I
2 = 83 %) and acknowledged publication bias (Luis Furuya-Kanamori index 5.41) highlight the challenge of isolating RDW's independent contribution. Is high RDW simply a surrogate for overall patient vulnerability and accumulated comorbidities, or does it signify specific pathways directly influencing post-TAVR outcomes?