Red blood cell distribution width is associated with mortality after acute ischemic stroke: a cohort study and systematic review

Assessing red blood cell distribution width in Vietnamese heart failure patients: A cross-sectional study

BACKGROUND

Heart failure (HF) is becoming a growing public health concern. Diagnostic tests for determining the severity of HF often come with high costs and require specialized expertise, which makes it difficult to assess HF severity, especially in low-income countries or at primary healthcare facilities. Recently, red blood cell distribution width (RDW) has emerged as a promising, easily accessible marker associated with HF severity. The study aimed to assess changes in RDW levels in HF patients and the diagnostic value of RDW in detecting acute heart failure (AHF) among HF patients.

METHODS

We conducted a cross-sectional examination involving 351 participants divided into HF and non-HF cohorts. HF was defined and categorized according to the diagnostic and treatment guidelines for AHF and chronic heart failure (CHF) set forth by the European Society of Cardiology (2021). Univariate and multivariate analysis of factors associated with AHF was performed.

RESULTS

The study revealed that HF patients displayed higher median RDW levels (14.90% [13.70-17.00]) compared to non-HF individuals (13.00% [12.23-13.78]). RDW was notably elevated in HF patients with left ventricular ejection fraction < 50% compared to those with left ventricular ejection fraction ≥ 50%. ROC curve analysis of RDW for AHF detection identified a cutoff value of 13.85%, with a sensitivity of 86.05% and specificity of 47.18%, statistically significant at p < 0.001. RDW > 13.85% was identified as an independent risk factor for AHF in patients with HF, with odds ratios of 2.644 (95% CI, 1.190-5.875; p = 0.017).

CONCLUSION

The study revealed significant RDW variations in patients with CHF and AHF compared to the control group. These findings suggest that RDW could be a biomarker for detecting HF severity.

Prognostic value of combining 24-hour ASPECTS and hemoglobin to red cell distribution width ratio to the THRIVE score in predicting in-hospital mortality among ischemic stroke patients treated with intravenous thrombolysis

BACKGROUND

Acute ischemic stroke (AIS) is a significant global health issue, directly impacting mortality and disability. The Totaled Health Risks in Vascular Events (THRIVE) score is appreciated for its simplicity and ease of use to predict stroke clinical outcomes; however, it lacks laboratory and neuroimaging data, which limits its ability to predict outcomes precisely. Our study evaluates the impact of integrating the 24-hour Alberta Stroke Program Early CT Score (ASPECTS) and hemoglobin-to-red cell distribution width (HB/RDW) ratio into the THRIVE score using the multivariable fractional polynomial (MFP) method (combined THRIVE-MFP model) compared to the THRIVE-c model. We aim to assess their added value in predicting in-hospital mortality (IHM) prognosis.

MATERIALS AND METHODS

A retrospective study from January 2015 to July 2022 examined consecutive AIS patients receiving intravenous thrombolysis. Data on THRIVE scores, 24-hour ASPECTS, and HB/RDW levels were collected upon admission. The model was constructed using logistic regression and the MFP method. The prognostic value was determined using the area under the receiver operating characteristic curve (AuROC). Ischemic cerebral lesions within the middle cerebral artery territory were evaluated with non-contrast computed tomography (NCCT) after completing 24 hours of intravenous thrombolysis (24-hour ASPECTS).

RESULTS

Among a cohort of 345 patients diagnosed with AIS who received intravenous thrombolysis, 65 individuals (18.8%) experienced IHM. The combined THRIVE-MFP model was significantly superior to the THRIVE-c model in predicting IHM (AuROC 0.980 vs. 0.876, p<0.001), 3-month mortality (AuROC 0.947 vs. 0.892, p<0.001), and 3-month poor functional outcome (AuROC 0.910 vs. 0.853, p<0.001).

CONCLUSION

The combined THRIVE-MFP model showed excellent predictive performance, enhancing physicians' ability to stratify patient selection for intensive neurological monitoring and guiding treatment decisions. Incorporating 24-hour ASPECTS on NCCT and HB/RDW proved valuable in mortality prediction, particularly for hospitals with limited access to advanced neuroimaging resources.

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

BACKGROUND

This study aimed to review evidence on the ability of red cell distribution width (RDW) to predict mortality and poor functional outcomes after acute ischemic stroke (AIS).

METHODS

Databases of PubMed, CENTRAL, Scopus, Embase, and Web of Science were searched online from inception to 25th Jul 2023 for all studies reporting the association between RDW and outcomes as adjusted ratios. A random-effects meta-analysis was done. Meta-regression was conducted using multiple moderators.

RESULTS

15 studies with 14,968 patients were included. Meta-analysis found that RDW, both as a categorical variable (OR: 2.10 95% CI: 1.74, 2.55 I2 = 42%) and continuous variable OR: 1.16 95% CI: 1.05, 1.28 I2 = 64%) was a significant predictor of mortality after AIS. Age and number of hypertensives were found to be significant moderators in the meta-regression. Also, high RDW, as a categorical variable (OR: 1.68 95% CI: 1.20, 2.35 I2 = 84%), was associated with significantly higher odds of poor functional outcomes after AIS, but not as a continuous variable (OR: 1.07 95% CI: 0.99, 1.16 I2 = 61%). Meta-regression showed that the association was stronger in small sample-sized studies.

CONCLUSION

RDW can be a useful, readily available, and cost-effective biomarker to rapidly stratify AIS patients at risk of poor outcomes. High RDW was consistently associated with an increased risk of mortality after AIS, however, its ability to predict poor functional outcomes needs to be verified by further studies.

Propensity score analysis of red cell distribution width to serum calcium ratio in acute myocardial infarction as a predictor of in-hospital mortality

Objective

Red cell distribution width (RDW) and serum calcium (Ca) levels are predictors of in-hospital mortality in acute myocardial infarction (AMI) patients. However, their sensitivity and specificity are limited. Therefore, this study aimed to determine whether the RDW to Ca ratio (RCR) acquired on admission can be used to predict the in-hospital mortality of AMI patients.

Methods

This retrospective cohort study extracted clinical information from the Medical Information Market for Intensive IV (MIMIC-IV) database on 2,910 AMI patients enrolled via propensity score matching (PSM). Prognostic values were assessed using a multivariate logistic model and three PSM approaches. Analysis was performed based on stratified variables and interactions among sex, age, ethnicity, anemia, renal disease, percutaneous transluminal coronary intervention (PCI), coronary artery bypass grafting (CABG), atrial fibrillation, congestive heart failure, dementia, diabetes, paraplegia, hypertension, cerebrovascular disease, and Sequential Organ Failure Assessment (SOFA) score.

Results

A total of 4,105 ICU-admitted AMI patients were analyzed. The optimal cut-off value of the RCR for in-hospital mortality was 1.685. The PSM was performed to identify 1,455 pairs (2,910) of score-matched patients, with balanced differences exhibited for nearly all variables.The patients' median age was 72 years (range, 63-82 years) and 60.9% were male. The risk of in-hospital mortality incidence increased with increasing RCR levels. After adjusting for confounders, the risk ratio for the incidence of in-hospital mortality for high RCR was 1.75 [95% confidence interval (CI): 1.60-1.94, P = 0.0113] compared to that associated with low RCR in the PSM cohort. High RCR was also substantially implicated in in-hospital mortality incidence in the weighted cohorts [odds ratio (OR) = 1.76, 95% CI: 1.62-1.94, P = 0.0129]. Assessment of RCR in three groups showed that patients with high RCR also had a higher risk of in-hospital mortality (OR = 3.04; 95% CI, 2.22-4.16; P < 0.0001) than in patients with RCR in the adjusted model. In the sensitivity analysis, both the original and weighted groups showed similar results.

Conclusion

The RCR at admission may be useful for predicting in-hospital mortality in ICU-admitted AMI patients.

Radiomics features on computed tomography reflect thrombus histological age prior to endovascular treatment of acute ischemic stroke

PURPOSE

To investigate the role of radiomics features in thrombus age identification and establish a CT-based radiomics model for predicting thrombus age of large vessel occlusion stroke patients.

METHODS

We retrospectively reviewed patients with middle cerebral artery occlusion receiving mechanical thrombectomy from July 2020 to March 2022 at our center. The retrieved clots were stained with Hematoxylin and Eosin (H&E) and determined as fresh or older thrombi based on coagulation age. Clot-derived radiomics features were selected by least absolute shrinkage and selection operator (LASSO) regression analysis, by which selected radiomics features were integrated into the Rad-score via the corresponding coefficients. The prediction performance of Rad-score in thrombus age was evaluated with the area under the curve (AUC) of receiver operating characteristic (ROC) curve analysis.

RESULTS

A total of 104 patients were included in our analysis, with 52 in training and 52 in validation cohort. Older thrombi were characterized with delayed procedure time, worse functional outcome and marginally associated with more attempts of device. We extracted 982 features from NCCT images. Following T test and LASSO analysis in training cohort, six radiomics features were selected, based on which the Rad-score was generated by the linear combination of features. The Rad-score showed satisfactory performance in distinguishing fresh with older thrombi, with the AUC of 0.873 (95 %CI: 0.777-0.956) and 0.773 (95 %CI: 0.636-0.910) in training and validation cohort, respectively.

CONCLUSION

This study established and validated a CT-based radiomics model that could accurately differentiate fresh with older thrombi for stroke patients receiving mechanical thrombectomy.

Relationship between the Ratio of Red Cell Distribution Width to Albumin and 28-Day Mortality among Chinese Patients over 80 Years with Atrial Fibrillation

INTRODUCTION

Atrial fibrillation (AF) is a prevalent heart arrhythmia in elderly adults aged 80 years or older. The red cell distribution width (RDW) to albumin ratio has been acknowledged as a reliable prognostic marker for poor outcomes in a variety of disorders. However, there exists limited scientific evidence on the association of RDW to albumin (RAR) with mortality in geriatric individuals with AF.

METHODS

From January 2015 to June 2020, a retrospective study was conducted in a tertiary academic institution that diagnosed 1,141 elderly adults with AF. The RAR value was calculated as the ratio of RDW (%) to albumin (g/dL). The potential association between RAR and cardiovascular mortality and the risk of all-cause mortality within 28 days was evaluated by means of multivariable Cox regression analysis.

RESULTS

The 28-day all-cause and cardiovascular mortality rates were 8.7% and 3.3%, respectively. Increased RAR tertiles were found to be significantly associated with greater all-cause mortality (T1: 1.6%; T2: 6.2%; T3: 18.1%, p < 0.001) and cardiovascular mortality (T1: 0.8%; T2: 2.9%; T3: 6.3%, p < 0.001) using Kaplan-Meier analysis. Continuous RAR had a positive association with all-cause mortality (hazard ratios [HR] = 1.42, 95% confidence interval [CI] 1.23-1.65) and cardiovascular mortality (HR = 1.31, 95% CI: 1.05-1.64), even after accounting for numerous confounding variables. In comparison to the T1 group, individuals with the highest RAR levels displayed a greater risk of all-cause mortality (HR = 2.73, 95% CI: 1.11-6.74) and cardiovascular mortality (HR = 2.59, 95% CI: 0.69-9.78). Increased RAR levels were related to higher rates of cardiovascular and all-cause mortality across almost all subgroups.

CONCLUSION

RAR is independently correlated with 28-day all-cause mortality and cardiovascular mortality in AF-affected individuals aged ≥80.

Association between red blood cell distribution width and the prognosis of brain death in patients with a Glasgow Coma Scale < 6

Red blood cell distribution width (RDW) has been reported as a meaningful prognostic factor in various diseases. Our study compared patients' RDW levels and prognosis at admission and discharge time. A total of 128 patients 77 patients who suffered brain death (subject group), and 51 patients who were discharged from the hospital (control group) with GCS ≤ 6 were recruited from 60 hospitals for this study. Demographical data and RDW measurements in these patients at admission time and brain death/discharge time were extracted into two groups. 46 (35.9%) patients were females and 82 patients (64.1%) were males with a median age of 36 years old. A significant difference in baseline characteristics of GCS (P < 0.001), RDW at admission time (P < 0.001), and RDW at discharge or brain death time (P < 0.001) were noted between the two groups. In the overall population, RDW at admission time had a median value of 13.75% and was positively correlated with gender (P < 0.04, rs = 0.582) and age (P < 0.023, rs = - 0.201). Initially, there were no significant differences in RDW upon admission. However, upon discharge, although the RDW in the control group was not significant (P < 0. 1), the RDW level at the time of brain death was notably 0.45 fold higher (P = 0.001) compared to the time of admission. The standardized residuals at the two-time points showed an approximately normal distribution. The most effective RDW cut-off in Brain death was determined as 14.55. Based on the findings, using RDW as a prognostic factor has a sensitivity of 0.468 and a specificity of 0.137 in diagnosing brain death. RDW biomarker is a simple and inexpensive laboratory test that may be seen as a valuable perspective for initial patient evaluation. RDW is a powerful marker for the prognosis of brain death in patients with a GCS ≤ 6 at admission time, in order to identify a subset of patients who may require more aggressive management in the trauma center.

Association between red cell distribution width-to-platelet ratio and short-term and long-term mortality risk in patients with acute ischemic stroke

BACKGROUND

The objective of this study was to evaluate the association between red cell distribution width/platelet ratio (RPR) and 30-day and 1-year mortality in acute ischemic stroke (AIS).

METHODS

Data for the retrospective cohort study were collected from the Medical Information Mart for Intensive Care (MIMIC) III database. RPR was divided into two groups: RPR ≤ 0.11 and RPR > 0.11. The study outcomes were 30-day mortality and 1-year mortality from AIS. Cox proportional hazard models were utilized to assess the association between RPR and mortality. Subgroup analyses were applied based on age, tissue-type plasminogen activator (IV-tPA), endovascular treatment, and myocardial infarction.

RESULTS

A total of 1,358 patients were included in the study. Short- and long-term mortality occurred in 375 (27.61%) and 560 (41.24%) AIS patients, respectively. A high RPR was significantly associated with increased 30-day [hazard ratio (HR): 1.45, 95% confidence interval (CI): 1.10 to 1.92, P = 0.009] and 1-year mortality (HR: 1.54, 95%CI: 1.23 to 1.93, P < 0.001) in AIS patients. Meanwhile, RPR was found to be significantly related to 30-day mortality in AIS patients aged < 65 years (HR: 2.19, 95% CI: 1.17 to 4.10, P = 0.014), without IV-tPA use (HR: 1.42, 95% CI: 1.05 to 1.90, P = 0.021), without using endovascular treatment (HR: 1.45, 95% CI: 1.08 to 1.94, P = 0.012), and without myocardial infarction (HR: 1.54, 95% CI: 1.13 to 2.10, P = 0.006). Additionally, RPR was associated with 1-year mortality in AIS patients aged < 65 years (HR: 2.54, 95% CI: 1.56 to 4.14, P < 0.001), aged ≥ 65 years (HR: 1.38, 95% CI: 1.06 to 1.19, P = 0.015), with (HR: 1.46, 95% CI: 1.15 to 1.85, P = 0.002) and without using IV-tPA (HR: 2.30, 95% CI: 1.03 to 5.11, P = 0.041), without using endovascular treatment (HR: 1.56, 95% CI: 1.23 to 1.96, P < 0.001), and without myocardial infarction (HR: 1.68, 95% CI: 1.31 to 2.15, P < 0.001).

CONCLUSION

Elevated RPR is associated with a high risk of short-term and long-term mortality in AIS.

Red blood cell distribution width to platelet ratio predicts early neurological deterioration in acute ischemic stroke patients receiving intravenous thrombolysis

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.

Red Cell Distribution Width-to-Platelet Count Ratio: A Promising Predictor of In-Hospital All-Cause Mortality in Critically Ill Patients with Acute Ischemic Stroke

INTRODUCTION

The red blood cell distribution width-to-platelet ratio (RPR), a novel inflammatory index, has already been proven as a prognostic factor in some other diseases, but its prognostic effect on critically ill patients with acute ischemic stroke (AIS) has been rarely investigated. This study aimed to investigate the association between RPR and in-hospital mortality in these patients.

METHODS

We extracted clinical data from the Medical Information Mart for Intensive Care IV 1.0 database. The primary outcome was in-hospital all-cause mortality of patients with critical AIS. The main independent variable was RPR. To investigate the association between RPR and in-hospital all-cause mortality in patients with critical AIS, multivariable logistic analyses, smooth curve fitting, and stratified analyses were conducted.

RESULTS

In total, 2,673 patients with AIS who were admitted to the intensive care unit were included in the study. In the multivariable analysis, in-hospital mortality was positively related to RPR (odds ratio [OR] 1.28, 95% confidence interval [CI] 1.02-1.59). According to the two-piecewise logistic regression model, we found that the inflection point of RPR was 1.89%. To the left of the inflection point (RPR ≤1.89%), we did not detect any relationship between RPR and in-hospital all-cause mortality (OR [95% CI]: 0.73 [0.41, 1.31], p = 0.2884). In contrast, to the right of the inflection point (RPR >1.89%), RPR was positively related to in-hospital all-cause mortality (OR [95% CI]: 1.61 [1.18, 2.19], p = 0.0027).

CONCLUSIONS

RPR showed a nonlinear relationship with in-hospital all-cause mortality in patients with critical AIS.

Higher serum homocysteine levels are associated with an increased risk of hemorrhagic transformation in patients with acute ischemic stroke

BACKGROUND

Hemorrhagic transformation (HT) is a common complication of acute ischemic stroke (AIS), and may develop into parenchyma hemorrhage (PH). We aimed to investigate the association between serum homocysteine levels and HT as well as PH in all AIS patients, and in those with and without thrombolysis by subgroup analysis.

METHODS

AIS patients who were admitted within 24 h after onset were enrolled and categorized into the higher homocysteine level group (≥ 15.5 µmol/L) and the lower homocysteine level group (< 15.5 µmol/L). HT was determined by a second round of brain imaging within 7 days during hospitalization, and PH was defined as hematoma in the ischemic parenchyma. Multivariate logistic regression was used to investigate the associations between serum homocysteine levels and HT and PH, respectively.

RESULTS

Of the 427 included patients (mean age 67.35 years, 60.0% males), 56 (13.11%) developed HT and 28 (6.56%) had PH. Serum homocysteine levels were significantly associated with HT (adjusted OR 1.029, 95%CI 1.003-1.055) and PH (adjusted OR 1.041, 95%CI 1.013-1.070). The higher homocysteine group was more likely to have HT (adjusted OR 1.902, 95% CI 1.022-3.539) and PH (adjusted OR 3.073, 95% CI 1.327-7.120) than the lower homocysteine group. Subgroup analysis of patients without thrombolysis also showed the significant differences in HT (adjusted OR 2.064, 95% CI 1.043-4.082) and PH (adjusted OR 2.926, 95% CI 1.196-7.156) between the two groups.

CONCLUSION

Higher serum homocysteine levels are associated with an increased risk of HT and PH in AIS patients, especially in those without thrombolysis. Monitoring the serum homocysteine may be conducive to determining individuals at a high risk of HT.

Postoperative red blood cell distribution width predicts functional outcome in aneurysmal subarachnoid hemorrhage after surgical clipping: A single-center retrospective study

Objective

Red blood cell (RBC) parameters are associated with outcomes following aneurysmal subarachnoid hemorrhage (aSAH), but their predictive value remains uncertain. This study aimed to detect the association between RBC parameters and functional outcome in aSAH patients undergoing surgical clipping.

Methods

This retrospective observational study included aSAH patients who underwent surgical clipping at Affiliated Hospital of North Sichuan Medical College between August 2016 and September 2019. The functional outcome following aSAH was assessed by modified Rankin Scale (mRS), and mRS 3-6 was defined as poor functional outcome.

Results

Out of 187 aSAH patients included (62% female, 51-66 years old), 73 patients had poor functional outcome. Multivariate logistic regression of admission parameters showed that World Federation of Neurosurgical Societies (WFNS) grade (odds ratio [95% CI]: 1.322 [1.023-1.707], p = 0.033) and white blood cell (WBC) (odds ratio [95% CI]: 1.136 [1.044-1.236], p = 0.003) were independently associated with poor functional outcome. In postoperative parameters, RBC distribution width (RDW) (odds ratio [95% CI]: 1.411 [1.095-1.818], p = 0.008), mean platelet volume (MPV, odds ratio [95% CI]: 1.253 [1.012-1.552], p = 0.039) and admission WFNS grade (odds ratio [95% CI]: 1.439 [1.119-1.850], p = 0.005) were independently associated with poor functional outcome. The predictive model including WFNS grade, admission WBC, and postoperative RDW and MPV had significantly higher predictive power compared to WFNS grade alone (0.787 [0.722-0.852] vs. 0.707 [0.630-0.784], p = 0.024). The combination of WFNS grade and WBC on admission showed the highest positive predictive value (75.5%) and postoperative RDW and MPV combined with admission WFNS grade and WBC showed the highest negative predictive value (83.7%).

Conclusion

Postoperative RDW is independently associated with poor functional outcome in aSAH patients undergoing surgical clipping. A combined model containing postoperative RDW may help predict good outcome in patients with aSAH after timely aneurysm clipping.

Red cell distribution width: a novel predictive biomarker for stroke risk after transient ischaemic attack

OBJECTIVE

Predicting the prognosis of transient ischaemic attack (TIA) is difficult for many frontline clinicians. The purpose of this study was to determine whether subsequent stroke in TIA patients can be predicted via red blood cell distribution width (RDW).

MATERIAL AND METHODS

A total of 360 consecutive patients with new-onset TIA in our stroke centre, were enrolled over the period studied. The patients were divided into three groups: 103 TIA patients, 206 ischaemic stroke (IS) patients and 51 patients with haemorrhagic stroke (HS) within 7 days after TIA. Complete blood count, biochemical parameters and brain imaging were performed on all patients.

RESULTS

The mean RDW values of patients with IS and HS after TIA were significantly higher than patients with TIA (13.35 ± 1.59 vs 12.84 ± 1.19, 13.32 ± 1.08 vs 12.84 ± 1.19, respectively, all p ≤ .001). In a multivariate model, RDW was independently associated with stroke after TIA (IS: odds ratio (OR) = 2.52, 95% confidence interval (CI) = 1.46-3.35, p = .002; HS: OR = 1.511, 95% CI = 1.101-2.074, p = .011). Compared to ABCD² scores, the diagnostic power of RDW in the differentiation of patients with IS after TIA was better (area under curve (AUC): 0.731 vs 0.613, p = .015). When an RDW cut-off value of 13.95% was accepted for differentiating patients with IS from TIA, the sensitivity and specificity were 73.7% and 74.3%, respectively. However, the AUC for the ability of the RDW to predict HS was 0.653 (95% CI = 0.589-0.716; p < .001).

CONCLUSIONS

The early determination of RDW is a promising, rapid, easy and inexpensive biomarker to predict the subsequent stroke in TIA patients, especially for IS. KEY MESSAGESThe most important result of our study is to show that (1) the higher RDW, the earlier the stroke onset and (2) RDW ≥13.95% has a 2.52-fold risk of ischaemic stroke in TIA patients, and RDW ≥12.85% has a 1.51-fold risk of haemorrhagic stroke.As an economic and accessible hematological marker, baseline RDW may serve as a useful biomarker for risk stratification in TIA patients.

Relationship between the Hemoglobin-to-Red Cell Distribution Width Ratio and All-Cause Mortality in Septic Patients with Atrial Fibrillation: Based on Propensity Score Matching Method

(1) Objective: To reveal the correlation between the hemoglobin-to-red cell distribution width ratio (HRR) and all-cause mortality (ACM) among the septic patients with atrial fibrillation. (2) Methods: Specific clinical information was collected from the Medical Information Mart for Intensive IV (MIMIC-IV) database. The optimal cut-off value of HRR was calculated through ROC curve analysis conducted by using the maximum Youden index for the prediction of survival status. In addition, univariable and multivariable Cox regressive analyses were carried out to assess the prognostic significance of HRR and the Kaplan-Meier (K-M) analysis was conducted to draw the survival curves. Then, the 1:1 propensity score matching (PSM) method was adopted to improve the reliability of research result while balancing the unintended influence of underlying confounders. (3) Results: There were 9228 patients participating in this retrospective cohort study. The optimal cut-off value of the HRR was determined as 5.877 for in-hospital mortality. The PSM was performed to identify 2931 pairs of score-matched patients, with balanced differences exhibited by nearly all variables. According to the K-M analysis, those patients with a lower HRR than 5.877 showed a significantly higher level of in-hospital mortality, 28-day mortality, and 90-day mortality, compared to the patients with HRR ≥ 5.877 (p < 0.001). After the adjustment of possible confounders, those patients whose HRR was below 5.877 had a significantly higher level of in-hospital mortality than the patients with HRR ≥ 5.877, as revealed by the multivariable Cox regression analysis (HR = 1.142, 95%CI: 1.210−1.648, p < 0.001). Similarly, the ACM remained substantially higher in those patients with a lower HRR than in the patients with higher HRR after PSM. (4) Conclusion: A lower HRR (<5.877) was evidently associated with an increased risk of ACM, which made it applicable as a prognostic predictor of clinical outcomes for those septic patients with atrial fibrillation.

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

Background

Red blood cell distribution width (RDW) is considered to be related to coronary heart disease and heart failure and all-cause mortality, but its relationship with acute ischemic stroke is still unclear. In this study, we aimed to explore the relationship between RDW and the stroke severity and functional outcomes of ischemic stroke.

Methods

We retrospectively reviewed patients with acute ischemic stroke between September 2016 and January 2020. Demographic, clinical, stroke complications, laboratory data, and treatment were collected for all patients. Stroke severity and functional outcomes were evaluated by NIHSS score, modified Rankin Scale (mRS), and Barthel Index (BI) at 3 months. Furthermore, multiple logistic regression analysis was used to assess the relationship between RDW and stroke severity and functional outcomes.

Results

A total of 629 patients with acute ischemic stroke were included and were categorized into four groups according to the quartiles of RDW (&lt; 12.4, 12.4–12.9, 13.0–13.4, &gt; 13.4). After multivariable analysis, higher RDW was directly associated with moderate to severe stroke (OR 2.21, 95% CI, 1.30–3.75, P = 0.003), mRS score of 3–6 at 3 months (OR 1.86, 95% CI, 1.02–3.41, P = 0.044), and BI score below 85 at 3 months (OR 2.27, 95% CI, 1.25–4.12, P = 0.007) in patients with ischemic stroke.

Conclusion

Our results demonstrate that RDW is associated with stroke severity and unfavorable functional outcomes at 3 months in patients with ischemic stroke.

Laboratory prognostic factors for the long-term survival of multiple system atrophy

To elucidate the biomarkers related to survival in multiple system atrophy(MSA), we analyzed the predictability of retrospectively collected blood markers for survival in 650 probable MSA. High absolute neutrophil count, red-cell distribution width, C-reactive protein, erythrocyte sedimentation rate, and low hemoglobin, protein, albumin, and creatinine were correlated with higher mortality in MSA. Systemic alteration in inflammation and nutritional status in the early stage are associated with higher mortality in MSA.

Association of Red Blood Cell Distribution Width with Stroke Prognosis Among Patients with Small Artery Occlusion: A Hospital-Based Prospective Follow-Up Study

Objective

Stroke is the leading cause of mortality and disability worldwide. However, there is no study on the relationship between red blood cell distribution width and the prognosis of small artery occlusion, which is a stroke subtype. This study aimed to assess the association of red blood cell distribution width at admission with outcomes among patients with small artery occlusion.

Methods

In this hospital-based follow-up study, all included patients were diagnosed with small artery occlusion. Outcomes included death, recurrence, and dependency at 3, 12, and 36 months after stroke onset. Multivariate analysis was performed to explore the association of red blood cell distribution width with stroke outcomes.

Results

This study included 1576 patients with small artery occlusion who were followed up at 3, 12, and 36 months. For every unit increase in red blood cell distribution width, the risk of stroke recurrence and dependency increased by 5.1% (95% CI 1.002–1.102, P=0.039) at 3 months after stroke onset. At the 12-month follow-up, for every unit increase in red blood cell distribution width, the risk of stroke recurrence increased by 3.4% (95% CI 1.000–1.069, P=0.047). However, the relationship between red blood cell distribution width and mortality rate was not significant at 36 months after stroke onset after adjustment of covariates.

Conclusion

Red blood cell distribution width is an important hematological index of small artery occlusion. It may be used to predict the recurrence of acute ischemic stroke in small artery occlusion. Therefore, patients with higher baseline values of red blood cell distribution width may need more risk factor control to reduce recurrence and dependency.

Red blood cell distribution width in different time-points of peripheral thrombolysis period in acute ischemic stroke is associated with prognosis

The relationship between red blood cell distribution width (RDW) in peripheral thrombolysis period and prognosis is not fully clarified in those who underwent intravenous thrombolysis (IVT) for acute ischemic stroke (AIS). Our study aimed to clarify this issue. A retrospective analysis of about 510 consecutive thrombolysis cases for AIS from January 2015 to March 2019 in a single-center database was done and followed-up for 3 months. We used univariate and multivariable models to evaluate the relationship between RDW levels at various time-points after IVT and the occurrence risk of hemorrhagic transformation (HT) and recurrent stroke, and used COX regression to assess the hazard ratios of outcomes with RDW levels. Elevated risk of HT was found in higher tertiles of RDW (OR = 10.282, 95% confidence interval (CI) 2.841–39.209, P < 0.001 in Tp tertile G3; OR = 5.650, 95% CI 1.992–16.025, P = 0.001 in T24 tertile G3; OR = 4.308, 95% CI 1.480–12.542, P = 0.007 in T48 tertile G3 and OR = 6.384, 95% CI 2.201–18.515, P = 0.001 in T72 tertile G3, respectively). Occurrence of recurrent stroke was highest in the RDW tertile G3 (HR = 4.580, 95% CI 2.123–9.883, P < 0.001 in Tp tertile G3; HR = 5.731, 95% CI 2.498–13.151, P = 0.001 in T24 tertile G3; HR = 3.019, 95% CI 1.969–4.059, P = 0.031 in T48 tertile G3; HR = 3.318, 95% CI 1.598–6.890, P = 0.001 in T72 tertile G3, respectively). Mean RDW levels ≥13.60 among AIS patients undergoing thrombolysis was associated with higher risk of HT and recurrent stroke.

Acute Myocardial Infarction (AMI) as the Effect Modifiers to Modify the Association Between Red Blood Cell Distribution Width (RDW) and Mortality in Critically Ill Patients With Stroke

Background and Objectives

Few studies have evaluated the impact of red blood cell distribution width (RDW) on prognosis for critically ill patients with acute stroke according to recent studies. The aim of this study was to investigate the association between RDW and mortality in these patients.

Methods

Clinical data were extracted from the eICU Collaborative Research Database (eICU-CRD) and analyzed. The exposure of interest was RDW measured at admission. The primary outcome was in-hospital mortality. Binary logistic regression models and interaction testing were performed to examine the RDW-mortality relationship and effect modification by acute myocardial infarction and hypertension (HP).

Results

Data from 10,022 patients were analyzed. In binary logistic regression analysis, after adjusting for potential confounders, RDW was found to be independently associated with in-hospital mortality {odds ratio (OR) 1.07, [95% confidence interval (CI) 1.03 to 1.11]; p = 0.001}. Higher RDW linked to an increase in mortality (OR, 1.07; 95% CI, 1.03 to 1.11; P for trend < 0.0001). Subgroup analysis showed that, in patients combined with AMI and without HP (both P-interaction <0.05), the correlation between RDW and in-hospital mortality is stronger (AMI group: OR, 1.30; 95% CI, 1.07 to 1.58, not the AMI group: OR, 1.06; 95% CI, 1.02, 1.10; the HP group: OR,.98; 95% CI,.91 to 1.07, not the HP group: OR, 1.09; 95% CI, 1.05 to 1.14).

Conclusions

A higher baseline RDW is independently correlated with prognosis in critically ill patients with acute stroke, and the correlation can be modified by AMI and HP duration.

The red blood cell distribution width-albumin ratio: A promising predictor of mortality in heart failure patients - A cohort study

BACKGROUND

Epidemiological studies suggest that increases in red blood cell distribution width (RDW) and decreases in albumin level can independently predict adverse cardiovascular outcomes. The prognostic value of RDW-albumin ratio (RAR), an innovate biomarker of inflammation, in heart failure (HF) patients has not been assessed. This study aimed to explore the association between RAR and mortality of HF patients.

METHODS

Data on patients diagnosed with HF were extracted from MIMIC-III database version 1.4. Cox proportional hazards models were used to investigate the associations between RAR and mortality of HF patients. HF patients admitted to the Second Affiliated Hospital of Wenzhou Medical University were also enrolled to explore the relationship between RAR and existing indicators of HF.

RESULTS

For 90-day mortality, the HR (95% CI) for the second (4.33＜RAR＜5.44) and the third (RAR＞5.44) tertiles were 2.00 (1.58, 2.54) and 3.63 (2.91, 4.53), respectively, compared to the first tertile (RAR＜4.33). When adjusted for age, gender and ethnicity in Model 1, the adjusted HR (95% CI) value of third tertiles was 3.66 (2.93, 4.56). Further adjust the vital signs, blood biochemical indicators, SOFA score and other parameters in Model II, the adjusted HR value of third tertiles was still statistically significant (HR: 2.70, 95% CI: 2.07-3.51, P < 0.0001). A similar trend was observed for 30-day, one-year mortality. For HF patients, high RAR significantly increased the risk of sepsis and requirement for renal replacement therapy. Additionally, there is a positive correlation between RAR, CRP levels, and NT-proBNP respectively.

CONCLUSION

High level of RAR is associated with increased short- and long-term mortality of patients with heart failure. The RAR is a promising biomarker that is easy to obtain and readily predicts mortality in heart failure patients.

Red blood cell distribution width as a predictor of mortality among patients regularly visiting the nephrology outpatient clinic

The association between increased red blood cell distribution width (RDW) and mortality among patients treated on an outpatient basis in the nephrology outpatient clinic is unclear. Therefore, our study aimed to investigate the association between baseline and time-averaged RDW and mortality risk in patients treated in our nephrology outpatient clinic. Our multi-center retrospective analysis was based on data of 16,417 outpatient nephrology patients with available baseline renal function and RWD values. The median baseline RDW was 13.0% (range, 10.0–32.1%). The high-RDW group was defined as the top quartile (≥ 13.8%, n = 4302). The crude mortality rate was 15.0% (n = 1806) at a median follow-up of 127.5 months. From the results of the multivariate Cox proportional hazards regression model adjusted for covariates, including eGFR, hemoglobin, and factors of anemia treatment, patients with a high time-averaged RDW had increased mortality risk (adjusted hazard ratio, 1.505; 95% confidence interval, 1.326–1.708; P < 0.001), irrespective of sex, presence of anemia, and chronic kidney disease, except in individuals aged < 45 years. Thus, increased baseline and time-averaged RDW were significantly associated with increased mortality in patients aged > 45 years treated on an outpatient basis in the nephrology clinic.

Prognostic value of red blood cell distribution width in predicting 3-month functional outcome of patients undergoing thrombolysis treatment for acute ischemic stroke

This study was performed to determine whether red blood cell distribution width (RDW) is associated with 3-month poor functional outcome in patients undergoing thrombolytic therapy for acute ischemic stroke.RDW was measured in patients with thrombolytic therapy in emergency department. Functional outcome was assessed after 3 months and poor functional outcome was defined as modified Rankin scale 3 to 6.A total of 240 patients were enrolled, and 82 (34.2%) had a poor functional outcome. The median RDW was significantly elevated in patients with a poor functional outcome compare with those with a good outcome. RDW was independently associated with a 3-month poor functional outcome (odds ratio 3.369, 95% confidence interval 2.214-5.125). The optimal RDW cutoff for predicting 3-month poor functional outcome was 12.8%, and the area under the curve for RDW was 0.818 (95% confidence interval 0.761-0.876). The area under the curve for RDW was higher in male patients than in female patients. The RDW correlated positively with the modified Rankin scale score after 3 months and the initial National Institutes of Health Stroke Scale score.Initial higher RDW level is related to a 3-month poor functional outcome in patients undergoing thrombolytic therapy for acute ischemic stroke.

High red blood cell distribution width levels could increase the risk of hemorrhagic transformation after intravenous thrombolysis in acute ischemic stroke patients

The association between the red blood cell distribution width (RDW) and hemorrhagic transformation (HT) after thrombolysis in acute ischemic stroke patients remains inconclusive. Our study aimed to assess whether high RDW levels are associated with the occurrence of HT after thrombolysis. Data were consecutively collected and retrospectively analyzed for stroke patients treated with thrombolysis between 1 January 2017 and 31 December 2019. The primary outcomes were the occurrence of HT and symptomatic HT. Among the 286 patients enrolled, 36 (12.6%) developed HT and15 (5.2%) were classified as symptomatic HT. Patients with high RDW levels were associated with a higher percentage of HT and symptomatic HT (P<0.05). The RDW levels in the HT and symptomatic HT groups were also greater compared with the no-HT group (P<0.001). Multivariable logistic regression analysis revealed that high RDW levels were independently associated with an increased risk of HT (adjusted odds ratio 2.5, 95 % CI, 1.74–3.83 P < 0.001). In conclusion, we found that high RDW levels may be an independent predictor of HT in stroke patients after thrombolysis.

Red blood cell distribution width predicts in-hospital mortality in patients with a primary diagnosis of seizures in the ICU: a retrospective database study

Purpose

The aim of this study was to determine the predictive value of red blood cell distribution width (RDW) in patients with a primary diagnosis of seizures admitted to the intensive care unit (ICU) in terms of in-hospital mortality.

Methods

This was a retrospective study of the eICU Collaborative Research Database of adult patients (aged 18–88 years) with a primary diagnosis of seizures in 2014 and 2015. The prognostic value of RDW was investigated using a receiver operating characteristic (ROC) curve, multiple logistic regression model, and net reclassification index (NRI).

Results

We identified 1568 patients who met the inclusion criteria. High RDW was significantly correlated with in-hospital mortality after adjusting for potential confounders with an odds ratio (OR) of 3.513 (95% confidence interval [CI]:1.699–7.266). The area under the ROC curve of RDW for in-hospital mortality was 0.7225. Compared with the prediction of in-hospital mortality using APACHE IV score alone, the continuous NRI with the RDW variable was 0.3507 (95%CI: 0.0584–0.6431, p < 0.05). The length of stay in the ICU of patients with an RDW >14.65% was significantly increased compared to those with normal RDW (log-rank test, p < 0.0001).

Conclusion

RDW width can be useful for prediction of in-hospital mortality in patients with seizures admitted to the ICU, and it provides additional prognostic value beyond the APACHE IV score alone.

Prognostic Value of the Hemoglobin/Red Cell Distribution Width Ratio in Resected Lung Adenocarcinoma

BACKGROUND

The ratio of hemoglobin to red cell distribution width (HRR) has been described as an effective prognostic factor in several types of cancer. The aim of this study was to investigate the prognostic role of preoperative HRR in resected-lung-adenocarcinoma patients.

METHODS

We enrolled 342 consecutive patients. Age, sex, surgical resection, adjuvant treatments, pathological stage, preoperative hemoglobin, red cell distribution width, and their ratio were recorded for each patient.

RESULTS

Mean age was 66 years (SD: 9.0). There were 163 females (47.1%); 169 patients (49.4%) had tumors at stage I, 71 (20.8%) at stage II, and 102 (29.8%) at stage III. In total, 318 patients (93.0%) underwent lobectomy, and 24 (7.0%) pneumonectomy. Disease-free survival multivariable analysis disclosed an increased hazard ratio (HR) of relapse for preoperative HRR lower than 1.01 (HR = 2.20, 95%CI: (1.30-3.72), p = 0.004), as well as for N1 single-node (HR = 2.55, 95%CI: (1.33-4.90), p = 0.005) and multiple-level lymph node involvement compared to N0 for both N1 (HR = 9.16, 95%CI:(3.65-23.0), p < 0.001) and N2 (HR = 10.5, 95%CI:(3.44-32.2, p < 0.001).

CONCLUSION

Pre-operative HRR is an effective prognostic factor of disease-free survival in resected-lung-adenocarcinoma patients, together with the level of pathologic node involvement.

Factors associated with time to successful weaning in mechanically ventilated organophosphate poisoned patients

We designed this study to identify the factors associated with time to successful weaning in mechanically ventilated organophosphate (OP)-poisoned patients as the primary outcomes while duration of mechanical ventilation (MV) support, intensive care unit (ICU), and hospital length of stay (LOS) and in-hospital mortality as the secondary outcomes. We conducted a retrospective study of mechanically ventilated OP-poisoned patients admitted to the ICU of Poison Control Center of Ain Shams, Cairo, Egypt, starting from January 2019 to December 2019. Weaning was considered successful if the patient succeeded in the first spontaneous breathing trial of weaning and did not need reinstitution of MV. We used Cox proportional hazards regression models to identify factors associated with time to successful weaning in the studied patients. A total of 55 patients were enrolled in the study. Thirty-eight patients were weaned successfully. Lower initial red cell distribution width (RDW) levels [adjusted hazard ratio (HR), 0.299, 95% confidence interval (CI) (0.184-0.486)] and lower initial doses of atropine [adjusted HR, 0.97, 95% CI (0.935-0.999)] were independently associated with shorter time to achieve successful weaning. Successfully weaned patients had significantly longer hospital LOS (p = 0.019) and no reported in-hospital mortality (p < 0.001) compared with patients who failed to wean. We concluded that initial RDW and initial doses of atropine were found to be the strongest factors associated with time to successful weaning in mechanically ventilated OP-poisoned patients. RDW and atropine can be used as simple risk assessment tools in OP poisoning.

Prognostic Value of Red Blood Cell Distribution Width in Resected pN1 Lung Adenocarcinoma

Simple Summary

Red blood cell distribution width is a measure of the variation of erythrocyte volume. Impaired erythropoiesis can lead to a wide variation in erythrocyte dimension—defined as anisocytosis—indicating that pathological modifications are taking place. Recently, red blood cell distribution width has been advocated as an effective prognostic factor in cardiovascular diseases, acute kidney injury, autoimmune disease, and oncologic settings. In many advanced and several early-stage oncologic conditions, it has shown excellent prognostic efficacy; we therefore investigated what prognostic role red blood cell distribution width may have in resected lung cancer, focusing on pN1 adenocarcinoma patients in whom adjuvant treatments—although well-established—are still proposed case by case. Our findings suggest that red blood cell distribution width is strictly related to disease-free survival; it could therefore be considered as a further tool for planning postoperative adjuvant treatments and setting up an adequate follow-up program.

Abstract

Background: Red blood cell distribution width is a measure of the variation of erythrocyte volume and has recently been advocated as a prognostic tool in neoplastic and non-neoplastic diseases. We studied the prognostic role of preoperative red blood cell distribution width (RDW) in resected pN1 lung adenocarcinoma patients. Methods: Sixty-seven consecutive pN1 lung adenocarcinoma patients operated in the last two years were retrospectively evaluated in the present study. Age, sex, smoking status, type of surgical resection, neoadjuvant and adjuvant treatments, pathological stage, T and N status, tumor size, preoperative hemoglobin (Hb) and RDW, preoperative neutrophils, lymphocytes, and their ratio were collected for each patient. Outpatient follow-up was performed and date of relapse was recorded. Results: There were 24 females (35.8%). Twenty-eight patients (41.8%) belonged to stage 3A and thirty-nine patients (58.2%) to stage 2B. Mean preoperative RDW % was 14.1 (IQR: 12.9–14.8). Univariate analysis disclosed preoperative RDW as strictly related to disease-free survival (p = 0.02), which was confirmed in the exploratory multivariable analysis (p = 0.003). Conclusions: Pre-operative RDW is an effective prognostic factor of disease-free survival in resected pN1 lung adenocarcinoma; it could therefore be considered as a further tool for planning postoperative adjuvant treatments and setting up an adequate follow-up program.

Association between red blood cell distribution width and long-term mortality in acute respiratory failure patients

The red cell distribution width (RDW) has been reported to be positively correlated with short-term mortality of pulmonary disease in adults. However, it is not clear whether RDW was associated with the long-term prognosis for acute respiratory failure (ARF). Thus, an analysis was conducted to evaluate the association between RDW and 3-year mortality of patients by the Cox regression analysis, generalized additives models, subgroup analysis and Kaplan–Meier analysis. A total of 2999 patients who were first admitted to hospital with ARF were extracted from the Medical Information Mart for Intensive Care III database (MIMIC-III). The Cox regression analysis showed that the high RDW was associated with 3-year mortality (HR 1.10, 95% CI 1.07, 1.12, P < 0.0001) after adjusting for age, gender, ethnicity and even co-morbid conditions. The ROC curve illustrated the AUC of RDW was 0.651 (95% CI 0.631, 0.670) for prediction of 3-year mortality. Therefore, there is an association between the RDW and survival time of 3 years follow-up, particularly a high RDW on admission was associated with an increased risk of long-term mortality in patients with ARF. RDW may provide an alternative indicator to predict the prognosis and disease progression and more it is easy to get.