Early Mortality of Brain Infarction Patients and Red Blood Cell Distribution Width

Abstract

Background: Meta-analysis has found that high baseline red blood cell distribution width (RDW) is associated with increased long-term mortality (mortality at one year or more) in ischemic stroke. The objectives of this study were to determine whether there is an association between RDW and 30-day mortality, and to explore whether RDW during the first week of ischemic stroke could be a 30-day mortality biomarker. Methods: We included patients with malignant middle cerebral artery infarction (MMCAI). RDW at days 1, 4, and 8 of MMCAI were determined. The end-point study was 30-day mortality. Results: We found that survivor (n = 37) in respect to non-survivor patients (n = 37) had lower RDW at days 1 (p < 0.001), 4 (p < 0.001), and 8 (p = 0.02). The area under curve (95% CI) for prediction of 30-day mortality by RDW at days 1, 4, and 8 of MMCAI were 0.80 (0.69–0.89; p < 0.001), 0.79 (0.66–0.89; p < 0.001), and 0.73 (0.58–0.84; p = 0.02). Regression analysis showed an association between RDW (odds ratio = 1.695; 95% CI = 1.230–2.335; p < 0.001) and 30-day mortality. Conclusions: The association between RDW and early mortality, and the potential role of RDW during the first week of MMCAI as a prognostic biomarker of early mortality were the main novelties of our study.

Association between red blood cell distribution width and mortality of COVID-19 patients

“…One of the strengths of the study is that the association between RDW at ICU admission and mortality was found in all regression models, and that this association is in line with the results we found in previous studies in septic or cerebral ischemic patients [22] , [23] , as well as the results found by other researchers in patients with coronary heart disease [18] , liver disease [19] or pancreatitis [20] .…”

“…Some studies have showed an association between RDW and inflammatory cytokines as tumour necrosis factor (TNF)-alpha, interleukin (IL)-1 and IL-6 [31] , [32] , and between RDW and oxidative stress [32] , [33] . Previously, we have reported in patients with sepsis [23] or brain infarction [22] an association between RDW and blood levels of TNF-alpha and malondialdehyde (which appears by lipid peroxidation of cellular membrane phospholipids). We speculated that the association between RDW and mortality of COVID-19 patients found in our study could be due to a higher degree of inflammation and oxidation in those patients who end up dying.…”

“…We had previously found that RDW at ICU admission was associated with mortality in brain infarction [22] and in septic patients [23] , but this association in COVID-19 patients has not been reported so far. Thus, the objective of this study was to determine whether or not there is an association between RDW at ICU admission and mortality.…”

“…Red blood cell distribution width (RDW) is a parameter of the haemogram used in the differential diagnosis of anaemia and involves the variability in form and size of red blood cells in the subject [17] . An association between high RDW and mortality has been found in patients with coronary disease [18] , liver disease [19] , pancreatitis [20] and ischemic stroke [21] , [22] . This association has also been found in septic patients [23] , [24] , [25] .…”

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

“…It is commonly used to identify different types of anemia and reactive bone marrow states and it is also a simple, widely used, and inexpensive parameter. In recent years, some clinical studies have shown that there is a correlation between RDW and some acute diseases, such as brain infarction, sepsis, infective endocarditis and diabetic ketoacidosis 7 – 11 . In addition, several studies have reported the predictive effect of RDW on lung disease 12 – 16 , while the predictive effect of RDW on acute respiratory failure has not been reported.…”