Association Between Red Cell Distribution Width and Prognosis in Critically Ill Patients With Aortic Valve Disease:A Retrospective Study Based on MIMIC-IV

Objective To analyze the relationship between red cell distribution width(RDW)and 1-year all-cause mortality in critically ill patients with aortic stenosis(AS)and aortic regurgitation(AR),aiming to evaluate the potential of RDW as an independent prognostic indicator. Methods Patients were divided into four groups based on the quartiles of their RDW levels:Q1,Q2,Q3,and Q4.The impact of different RDW levels on 1-year all-cause mortality in patients with AS and AR was analyzed using Cox regression analysis,Kaplan-Meier survival curves,Log-Rank tests,and restricted cubic spline（RCS）analysis.The predictive performance of RDW and various clinical scores was compared using Receiver Operating Characteristic(ROC)and Decision Curve Analysis(DCA).Subgroup analyses were conducted to ensure the robustness of the results. Results A total of 2,820 patients were included in the study.Patients in the high RDW group were older,had more comorbidities,and exhibited significantly higher 1-year all-cause mortality.After adjusting for confounding factors in the multivariate Cox regression analysis,elevated RDW was significantly associated with 1-year all-cause mortality(95%CI:1.13–1.29,P<0.01).Kaplan-Meier and RCS analyses revealed that the high RDW group had the lowest survival rates,with a nonlinear relationship observed between RDW and mortality risk.RDW outperformed most traditional scoring systems in predicting 1-year mortality.Subgroup analyses showed that RDW was significantly associated with 1-year all-cause mortality across all subgroups. Conclusion RDW is an independent predictor of 1-year all-cause mortality in critically ill patients with AS and AR.