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Xie X, He K, Zhang Y, Wu J. Association of hemoglobin-to-red cell distribution width ratio with the three-month outcomes in patients with acute ischemic stroke. Front Neurol 2024; 15:1425633. [PMID: 39188708 PMCID: PMC11345518 DOI: 10.3389/fneur.2024.1425633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 07/29/2024] [Indexed: 08/28/2024] Open
Abstract
Aim To explore the association of Hemoglobin-to-Red Cell Distribution Width Ratio (HRR) with the risk of three-month unfavorable outcomes in acute ischemic stroke (AIS). Methods A secondary analysis was conducted based on a prospective cohort study. A total of 1,889 patients with AIS treated in South Korea from January 2010 to December 2016 were enrolled. Multivariable logistic regression was conducted to investigated the independent relationship between HRR and risk of three-month unfavorable outcomes in AIS. Fitted smoothing curves were used to determine non-linear correlations. The recursive method was employed to explore the turning point and build a two-piece linear regression model. In addition, a set of subgroup analyses were carried out to evaluate the relationship between HRR and risk of three-month unfavorable outcomes. Results Multivariate analysis in which potential confounders were adjusted for indicated that the risk of unfavorable outcomes was reduced by 10% for each unit increased of HRR [OR = 0.90, 95% CI: 0.84-0.96, p = 0.0024]. In addition, a non-linear relationship was observed between HRR and risk of three-month unfavorable outcomes, which had an inflection point of HRR was 10.57. The effect sizes and the confidence intervals on the left side of the inflection point were 0.83 (0.75, 0.91), p = 0.0001. On the right side of the inflection point, no association was found between HRR and the risk of three-month unfavorable outcomes. Conclusion This study demonstrates a negative association between HRR and risk of three-month unfavorable outcomes. The relationship between HRR and risk of three-month unfavorable outcomes is non-linear. The correlation is negative for HRR values less than 10.57. For, HRR higher than 10.57, HRR is not associated with the risk of three-month unfavorable outcomes.
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Affiliation(s)
- Xiaorui Xie
- Department of Neurology, Xiangya Changde Hospital, Changde, Hunan, China
| | - Keli He
- Department of Clinical Laboratory, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), Changde, Hunan, China
| | - Yao Zhang
- Department of Clinical Laboratory, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), Changde, Hunan, China
| | - Jianhua Wu
- Department of Clinical Laboratory, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), Changde, Hunan, China
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Jiang M, Shen J, Muhammad B, Geng D. Red blood cell distribution width to platelet ratio predicts early neurological deterioration in acute ischemic stroke patients receiving intravenous thrombolysis. J Stroke Cerebrovasc Dis 2023; 32:107146. [PMID: 37148627 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/09/2023] [Accepted: 04/18/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Inflammation plays a prominent role in the pathogenesis and progression of acute ischemic stroke (AIS). The red blood cell distribution width to platelet ratio (RPR) has been demonstrated as a novel biomarker to indicate the severity of inflammatory reaction. This study aimed to explore the association between RPR before intravenous thrombolysis and early neurological deterioration (END) after thrombolysis in AIS patients. METHODS AIS patients accepting intravenous thrombolysis were recruited continuously. Postthrombolysis END was defined as death or an increase in the National Institute of Health Stroke Scale (NIHSS) score ≥4 points within 24 h after intravenous thrombolysis compared to the NIHSS score before intravenous thrombolysis. We constructed univariate and multivariate logistic regression analyses to investigate the relationship of RPR before intravenous thrombolysis to postthrombolysis END. Moreover, a receiver operating characteristic (ROC) curve was applied to examine the discriminative utility of RPR before intravenous thrombolysis in predicting postthrombolysis END. RESULTS A total of 235 AIS patients were included, and 31 (13.19%) subjects underwent postthrombolysis END. The univariate logistic regression analysis demonstrated that RPR before intravenous thrombolysis was significantly related to postthrombolysis END (odds ratio [OR], 2.162; 95% confidence interval [CI], 1.605-2.912; P < 0.001). After adjusting for potential confounding variables with P < 0.15 in the univariate logistic regression analysis, the difference remained statistically significant (OR, 2.031; 95% CI, 1.436-2.873; P < 0.001). Furthermore, an optimal cutoff value of 7.66 for RPR before intravenous thrombolysis in predicting postthrombolysis END was observed in the ROC curve analysis, and the sensitivity and specificity were calculated as 61.3% and 81.9%, respectively (area under the curve [AUC], 0.772; 95% CI, 0.684-0.860; P < 0.001). CONCLUSIONS RPR before intravenous thrombolysis might be an independent risk factor for postthrombolysis END in AIS patients. Elevated levels of RPR before intravenous thrombolysis may predict postthrombolysis END.
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Affiliation(s)
- Min Jiang
- The First School of Clinical Medicine, Nanjing Medical University, Nanjing, Jiangsu 210029, China; Department of Neurology, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, Jiangsu 223002, China
| | - Jun Shen
- Department of Neurology, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, Jiangsu 223002, China
| | - Bilal Muhammad
- School of Graduate, Xuzhou Medical University, Xuzhou, Jiangsu 221002, China
| | - Deqin Geng
- The First School of Clinical Medicine, Nanjing Medical University, Nanjing, Jiangsu 210029, China; Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, China.
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Shen Z, Huang Y, Zhou Y, Jia J, Zhang X, Shen T, Li S, Wang S, Song Y, Cheng J. Association between red blood cell distribution width and ischemic stroke recurrence in patients with acute ischemic stroke: a 10-years retrospective cohort analysis. Aging (Albany NY) 2023; 15:3052-3063. [PMID: 37053005 DOI: 10.18632/aging.204657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/24/2023] [Indexed: 04/14/2023]
Abstract
Numerous studies have reported that a higher red blood cell distribution width (RDW) level was associated with adverse outcomes in patients with the first stroke. However, no studies have examined the association between RDW and recurrent ischemic stroke. We performed a population-based cohort data analysis from 2007 to 2017. Baseline RDW was measured in 6402 first ischemic stroke participants, who were followed for about five years on average. During 62 months of median follow-up, 205 participants (3.20%) reported a recurrence (self-reported). RDW showed a nonlinear relationship with the risk of ischemic stroke recurrence. When RDW was assessed as quartiles (quartile 1, RDW<12.4; quartile 2, 12.4 to 12.8; quartile 3,12.8 to 13.3, quartile4, RDW>13.3), compared with the reference group (quartile 1), the hazard ratios (HRs) of ischemic stroke recurrence were 1.372 (95% confidence interval [CI]=0.671-2.805, P=0.386) in quartile 2, 1.835 (95% CI=1.222-2.755, P=0.003) in quartile 3, and 1.732 (95% CI=1.114-2.561, P<0.001) in quartile 4. The trend test was significant (P<0.001). When quartiles 3 and 4 were combined, the adjusted HR of ischemic stroke recurrence was 1.439 (95% CI=1.330-1.556, P<0.001) compared with the combined quartiles 1 and 2 subgroups. This study demonstrated that elevated RDW levels were positively associated with an increased risk of recurrent ischemic stroke. RDW can provide a new perspective for initial risk assessment and identify high-risk patients early. Further research is required to confirm our results.
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Affiliation(s)
- Zhan Shen
- Department of Geratology, Shanghai Xuhui Central Hospital, Fudan University, Shanghai, People’s Republic of China
- Department of Neurology, Shanghai Xuhui Central Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Ying Huang
- Department of Neurology, Shanghai Xuhui Central Hospital, Fudan University, Shanghai, People’s Republic of China
- Department of General Medicine, Shanghai Xuhui Central Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Ying Zhou
- Department of Neurology, Shanghai Xuhui Central Hospital, Fudan University, Shanghai, People’s Republic of China
- Department of General Medicine, Shanghai Xuhui Central Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Jingying Jia
- Department of Central Laboratory, Shanghai Xuhui Central Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Xian Zhang
- Department of Geratology, Shanghai Xuhui Central Hospital, Fudan University, Shanghai, People’s Republic of China
- Department of Neurology, Shanghai Xuhui Central Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Tingting Shen
- Department of Neurology, Shanghai Xuhui Central Hospital, Fudan University, Shanghai, People’s Republic of China
- Department of General Medicine, Shanghai Xuhui Central Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Shengjie Li
- Shanghai Internet Hospital Engineering Technology Research Center, Shanghai Xuhui Central Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Siyang Wang
- Department of Geratology, Shanghai Xuhui Central Hospital, Fudan University, Shanghai, People’s Republic of China
- Department of Neurology, Shanghai Xuhui Central Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Yunxiao Song
- Department of Clinical Laboratory, Shanghai Xuhui Central Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Jie Cheng
- Department of Geratology, Shanghai Xuhui Central Hospital, Fudan University, Shanghai, People’s Republic of China
- Department of Neurology, Shanghai Xuhui Central Hospital, Fudan University, Shanghai, People’s Republic of China
- Department of Urinary Surgery, Shanghai Xuhui Central Hospital, Fudan University, Shanghai, People’s Republic of China
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Zhou X, Li Y, Sun Z, Mu L, Ma Y. Elevated red blood cell distribution width levels predict depression after intracerebral hemorrhage: A 3-month follow-up study. Front Neurol 2023; 14:1077518. [PMID: 37090985 PMCID: PMC10113641 DOI: 10.3389/fneur.2023.1077518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/08/2023] [Indexed: 04/08/2023] Open
Abstract
ObjectivesInflammation vitally impacts the progression of depression resulting from intracerebral hemorrhage (ICH), while red blood cell distribution width (RDW) marks inflammatory-related diseases. The present study aimed at evaluating how RDW affects depression after ICH.MethodsFrom prospective analyses of patients admitted to our department between January 2017 and September 2022, ICH patients with complete medical records were evaluated. The 17-item Hamilton Depression (HAMD-17) scale was used for measuring the depressive symptoms at 3 months after ICH. Diagnosis of post-ICH depression was conducted for patients based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria.ResultsA total of 438 patients were enrolled in the study, out of which 93 (21.23%) patients had PSD at the 3-month follow-up. Accordingly, patients with depression had higher RDW levels (13.70 [IQR: 13.56–13.89] vs.13.45 [IQR: 12.64–13.75], p < 0.001) at admission compared with those without depression. In multivariate analyses, RDW was used for independently predicting the depression after ICH at 3 months (OR: 2.832 [95% CI: 1.748–4.587], p < 0.001). After adjusting the underlying confounding factors, the odds ratio (OR) of depression after ICH was 4.225 (95% CI: 1.686–10.586, p = 0.002) for the highest tertile of RDW relative to the lowest tertile. With an AUC of 0.703 (95% CI: 0.649–0.757), RDW demonstrated a significantly better discriminatory ability relative to CRP and WBC. RDW as an indicator for predicting depression after ICH had an optimal cutoff value of 13.68, and the sensitivity and specificity were 63.4% and 64.6%, respectively.ConclusionsElevated RDW level predicted post-ICH depression at 3 months, confirming RDW as an effective inflammatory marker for predicting depression after ICH.
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Affiliation(s)
- Xianping Zhou
- Department of Laboratory, Bozhou Hospital Affiliated to Anhui Medical University, Bozhou, China
| | - Yaqiang Li
- Department of Neurology, People's Hospital of Lixin County, Bozhou, China
| | - Zhongbo Sun
- Department of Neurosurgery, First Affiliated Hospital of Anhui University of Science and Technology (First People's Hospital of Huainan), Huainan, China
- *Correspondence: Zhongbo Sun
| | - Li Mu
- Department of Laboratory, Bozhou Hospital Affiliated to Anhui Medical University, Bozhou, China
| | - Yaoyao Ma
- Department of Laboratory, Bozhou Hospital Affiliated to Anhui Medical University, Bozhou, China
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Jiang Y, Ren C, Alimujiang A, Wu Y, Huang D, Yang W. The difference in red blood cell distribution width from before to after thrombolysis as a prognostic factor in acute ischemic stroke patients: A 2-year follow-up. Front Neurol 2022; 13:1011946. [PMID: 36313517 PMCID: PMC9606336 DOI: 10.3389/fneur.2022.1011946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose The aim of our study was to determine whether delta red blood cell distribution (ΔRDW) improves neurological outcomes in acute ischemic stroke (AIS) patients 2 years after intravenous thrombolysis (IVT) therapy. Methods AIS patients who received IVT between January 2013 and December 2019 were retrospectively analyzed. In accordance with their mRS scores, the patients were divided into two groups. A binary logistic regression analysis was conducted to determine the influencing factors of adverse functional outcomes. It was decided to evaluate the variables' the predictive ability by using the area under the receiver operating characteristic. For the poor neurological recovery risk model, features were selected using the LASSO regression model. We also developed a predictive model based on logistic regression analysis, which combined the features selected in the minimum absolute contraction and selection operator regression models. An evaluation of the discrimination, calibration, and clinical applicability of the predictive model was conducted using the C index, calibration chart, and decision curve analysis. Internal validation was evaluated via bootstrapping. Results Binary logistic regression analysis showed that ΔRDW was an independent influencing factor for poor neurofunctional outcomes. The most appropriate ΔRDW cut-off value for predicting the recovery of poor neurological outcomes was 18.9% (sensitivity: 89.9%, specificity: 78.6%, p < 0.001). The predictive factors included in the nomogram were age, the occurrence of CHD, stroke, AF, ΔRDW, NIHSS score at onset, interval time from onset to IVT, and whether there were indwelling urine catheters and gastric tubes. The model has not only a good discrimination ability, which was indicated by an overall C index of 0.891 (95% confidence interval: 0.829–0.953), but also a considerable calibration ability. Decision curve analysis showed that the nomogram of adverse neurological outcomes recovery was useful in the clinical practice when intervention was implemented above the threshold of 1% possibility of adverse neurological outcomes recovery. Conclusion In patients with AIS after thrombolysis, the ΔRDW is a potential influencing factor that can be readily used to predict the likelihood of poor neurological function recovery.
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Affiliation(s)
- Yanyan Jiang
- Department of Neurology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chuancheng Ren
- Department of Neurology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Aydos Alimujiang
- Department of Neurology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuncheng Wu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Yuncheng Wu
| | - Dongya Huang
- Department of Neurology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Dongya Huang
| | - Weiting Yang
- Department of Neurology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Weiting Yang
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