Predicting the One-Year Prognosis and Mortality of Patients with Acute Ischemic Stroke Using Red Blood Cell Distribution Width Before Intravenous Thrombolysis

Overview

Journal Clin Interv Aging

Publisher Dove Medical Press

Specialty Geriatrics

Date 2020 Feb 29

PMID 32110004

Citations 11

Authors

Wei-Yi Ye

Jia Li

Xiang Li

Xue-Zhi Yang

Yi-Yun Weng

Wei-Wei Xiang

Ou Zhang

Bo-Xi Ke

Xu Zhang

Affiliations

Soon will be listed here.

Abstract

Purpose: Red blood cell (RBC) distribution width (RDW) is known to reflect the heterogeneity of RBC volume, which may be associated with cardiovascular events or mortality after myocardial infarction. However, the association between RDW and stroke, especially regarding endpoints such as death, remains ambiguous. This study aimed to explore the prognostic value of RDW and its effect on mortality among patients with acute ischemic stroke (AIS) undergoing intravenous thrombolysis (IVT) after one year.

Patients And Methods: We retrospectively reviewed patients with AIS treated with IVT between January 2016 and March 2018. We grouped the patients according to modified ranking scale (MRS) scores as follows:0-2, favorable functional outcome group; and 3-6, unfavorable functional outcome. Predictors were determined using multivariate logistic regression (MVLR). The area under receiver-operating characteristic curve (AUC) was used to evaluate the predictive capability of variables. Furthermore, the Cox proportional hazard model was used to assess the contribution of risk factors to the outcome of death at one year later.

Results: MVLR analysis showed that RDW (odds ratio [OR], 1.179; 95% confidence interval [CI], 0.900-1.545; p = 0.232) was not an independent predictor of unfavorable functional outcome, but it (OR 1.371; 95% CI 1.109-1.696; p = 0.004) was an independent biomarker for all-cause mortality. The optimal RDW cut-off value to predict mortality was 14.65% (sensitivity: 42%, specificity: 88.3%, AUC: 0.649, p < 0.001). Furthermore, higher RDW (hazard ratio, 2.860; 95% CI, 1.724-4.745; p < 0.001) indicated a greater risk of death.

Conclusion: The baseline RDW is a potential predictor of mortality in patients with AIS undergoing IVT, but RDW might not be associated with worse survival function among stroke survivors, which will help us to improve treatments and the management of patients with AIS.

Citing Articles

Red blood cell distribution width as a predictor of mortality and poor functional outcome after acute ischemic stroke: a meta-analysis and meta-regression.

Shen H, Shen L BMC Neurol. 2024; 24(1):122.

PMID: 38609862 PMC: 11010342. DOI: 10.1186/s12883-024-03610-6.

Hemoglobin to red cell distribution width ratio as a prognostic marker for ischemic stroke after mechanical thrombectomy.

Feng X, Zhang Y, Li Q, Wang B, Shen J Front Aging Neurosci. 2023; 15:1259668.

PMID: 38076531 PMC: 10710154. DOI: 10.3389/fnagi.2023.1259668.

Association between red blood cell distribution width-to-albumin ratio and prognosis of patients with acute myocardial infarction.

Li H, Xu Y BMC Cardiovasc Disord. 2023; 23(1):66.

PMID: 36737704 PMC: 9898980. DOI: 10.1186/s12872-023-03094-1.

RDW-to-ALB Ratio Is an Independent Predictor for 30-Day All-Cause Mortality in Patients with Acute Ischemic Stroke: A Retrospective Analysis from the MIMIC-IV Database.

Liu P, Luo S, Duan X, Chen X, Zhou Q, Jiang Y Behav Neurol. 2022; 2022:3979213.

PMID: 36567762 PMC: 9780005. DOI: 10.1155/2022/3979213.

Red cell distribution width is associated with stroke severity and unfavorable functional outcomes in ischemic stroke.

Xue J, Zhang D, Zhang X, Zhu X, Xu X, Yue Y Front Neurol. 2022; 13:938515.

PMID: 36438973 PMC: 9682065. DOI: 10.3389/fneur.2022.938515.

References

Tziakas D, Chalikias G, Stakos D, Tentes I, Papazoglou D, Thomaidi A . Independent and additive predictive value of total cholesterol content of erythrocyte membranes with regard to coronary artery disease clinical presentation. Int J Cardiol. 2010; 150(1):22-7. DOI: 10.1016/j.ijcard.2010.02.022. View

Rost N, Wolf P, Kase C, Silbershatz H, Massaro J, DAgostino R . Plasma concentration of C-reactive protein and risk of ischemic stroke and transient ischemic attack: the Framingham study. Stroke. 2001; 32(11):2575-9. DOI: 10.1161/hs1101.098151. View

Kara H, Degirmenci S, Bayir A, Ak A, Akinci M, Dogru A . Red cell distribution width and neurological scoring systems in acute stroke patients. Neuropsychiatr Dis Treat. 2015; 11:733-9. PMC: 4370912. DOI: 10.2147/NDT.S81525. View

Smirne C, Grossi G, Pinato D, Burlone M, Mauri F, Januszewski A . Evaluation of the red cell distribution width as a biomarker of early mortality in hepatocellular carcinoma. Dig Liver Dis. 2015; 47(6):488-94. DOI: 10.1016/j.dld.2015.03.011. View

Turcato G, Cappellari M, Follador L, Dilda A, Bonora A, Zannoni M . Red Blood Cell Distribution Width Is an Independent Predictor of Outcome in Patients Undergoing Thrombolysis for Ischemic Stroke. Semin Thromb Hemost. 2016; 43(1):30-35. DOI: 10.1055/s-0036-1592165. View

Libby P, Loscalzo J, Ridker P, Farkouh M, Hsue P, Fuster V . Inflammation, Immunity, and Infection in Atherothrombosis: JACC Review Topic of the Week. J Am Coll Cardiol. 2018; 72(17):2071-2081. PMC: 6196735. DOI: 10.1016/j.jacc.2018.08.1043. View

Chamorro A, Dirnagl U, Urra X, Planas A . Neuroprotection in acute stroke: targeting excitotoxicity, oxidative and nitrosative stress, and inflammation. Lancet Neurol. 2016; 15(8):869-881. DOI: 10.1016/S1474-4422(16)00114-9. View

Soderholm M, Borne Y, Hedblad B, Persson M, Engstrom G . Red cell distribution width in relation to incidence of stroke and carotid atherosclerosis: a population-based cohort study. PLoS One. 2015; 10(5):e0124957. PMC: 4423855. DOI: 10.1371/journal.pone.0124957. View

Salvagno G, Sanchis-Gomar F, Picanza A, Lippi G . Red blood cell distribution width: A simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci. 2014; 52(2):86-105. DOI: 10.3109/10408363.2014.992064. View

10.

Ren D, Wang J, Li H, Li Y, Li Z . Red blood cell distribution width and carotid intima-media thickness in patients with metabolic syndrome. BMC Cardiovasc Disord. 2017; 17(1):44. PMC: 5273817. DOI: 10.1186/s12872-017-0481-x. View

11.

Menk M, Giebelhauser L, Vorderwulbecke G, Gassner M, Graw J, Weiss B . Nucleated red blood cells as predictors of mortality in patients with acute respiratory distress syndrome (ARDS): an observational study. Ann Intensive Care. 2018; 8(1):42. PMC: 5869325. DOI: 10.1186/s13613-018-0387-5. View

12.

Wohner N, Sotonyi P, Machovich R, Szabo L, Tenekedjiev K, Silva M . Lytic resistance of fibrin containing red blood cells. Arterioscler Thromb Vasc Biol. 2011; 31(10):2306-13. PMC: 3339800. DOI: 10.1161/ATVBAHA.111.229088. View

13.

Petrone A, Eisenman R, Steele K, Mosmiller L, Urhie O, Zdilla M . Temporal dynamics of peripheral neutrophil and lymphocytes following acute ischemic stroke. Neurol Sci. 2019; 40(9):1877-1885. PMC: 7898194. DOI: 10.1007/s10072-019-03919-y. View

14.

Patel K, Ferrucci L, Ershler W, Longo D, Guralnik J . Red blood cell distribution width and the risk of death in middle-aged and older adults. Arch Intern Med. 2009; 169(5):515-23. PMC: 2765040. DOI: 10.1001/archinternmed.2009.11. View

15.

Gao F, Chen C, Lyu J, Zheng J, Ma X, Yuan X . Association between platelet distribution width and poor outcome of acute ischemic stroke after intravenous thrombolysis. Neuropsychiatr Dis Treat. 2018; 14:2233-2239. PMC: 6126482. DOI: 10.2147/NDT.S170823. View

16.

Perlstein T, Weuve J, Pfeffer M, Beckman J . Red blood cell distribution width and mortality risk in a community-based prospective cohort. Arch Intern Med. 2009; 169(6):588-94. PMC: 3387573. DOI: 10.1001/archinternmed.2009.55. View

17.

Duchnowski P, Hryniewiecki T, Kusmierczyk M, Szymanski P . The usefulness of selected biomarkers in aortic regurgitation. Cardiol J. 2018; 26(5):477-482. PMC: 8084396. DOI: 10.5603/CJ.a2018.0108. View

18.

Felker G, Allen L, Pocock S, Shaw L, McMurray J, Pfeffer M . Red cell distribution width as a novel prognostic marker in heart failure: data from the CHARM Program and the Duke Databank. J Am Coll Cardiol. 2007; 50(1):40-7. DOI: 10.1016/j.jacc.2007.02.067. View

19.

Hampole C, Mehrotra A, Thenappan T, Gomberg-Maitland M, Shah S . Usefulness of red cell distribution width as a prognostic marker in pulmonary hypertension. Am J Cardiol. 2009; 104(6):868-72. DOI: 10.1016/j.amjcard.2009.05.016. View

20.

Oh H, Park J, Kim J, Yoo D, Kim S, Han S . Red blood cell distribution width is an independent predictor of mortality in acute kidney injury patients treated with continuous renal replacement therapy. Nephrol Dial Transplant. 2011; 27(2):589-94. DOI: 10.1093/ndt/gfr307. View