Red Blood Cell Distribution Width Is an Independent Predictor of Outcome in Patients Undergoing Thrombolysis for Ischemic Stroke

Turcato, Gianni; Cappellari, Manuel; Follador, Luca; Dilda, Alice; Bonora, Antonio; Zannoni, M; Bovo, Chiara; Ricci, Giorgio; Bovi, Paolo; Lippi, Giuseppe

doi:10.1055/s-0036-1592165

Cited by 59 publications

(51 citation statements)

References 15 publications

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“…Finally, along with hematocrit, additional erythrocyte parameters such as the red blood cell distribution width may offer heightened understanding of the intriguing biological interplay between red blood cell biology and stroke. 81…”

Section: Resultsmentioning

confidence: 99%

Hematocrit and Stroke: A Forgotten and Neglected Link?

Stavropoulos

Imprialos

Bouloukou

et al. 2017

Semin Thromb Hemost

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Stroke is considered among the most common causes of mortality and disability, leading to dramatic socioeconomic consequences. From a pathophysiologic perspective, enhanced blood viscosity due to increased hematocrit might be associated with stroke through impaired cerebral blood perfusion. This association has remained rather neglected during previous decades, but newly emerged as an epicenter of scientific interest due to the unexpected elevation of stroke rates with sodium-glucose cotransporter-2 inhibitors, a new class of hypoglycemic drugs with otherwise dramatic cardiovascular benefits. The purpose of this article is to review available data on the relation between stroke and hematocrit values. Data from large observational studies point toward an increased risk for stroke in individuals with elevated hematocrit. Data also suggest that the coexistence of increased hematocrit values and hypertension significantly enhance the risk of cerebrovascular events compared with each condition alone. Additionally, high hematocrit values seem related to worse survival outcomes in post-stroke patients. Collectively, the association between hematocrit and stroke seems to be strong and independent in high hematocrit values (>0.50) in both previously healthy individuals and post-stroke patients, but remains less clarified in patients with normal hematocrit values.

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Section: Resultsmentioning

confidence: 99%

Hematocrit and Stroke: A Forgotten and Neglected Link?

Stavropoulos

Imprialos

Bouloukou

et al. 2017

Semin Thromb Hemost

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“…An increased RDW, even an RDW within the normal reference range, was recently demonstrated to be a strong independent predictor of adverse outcomes not only in chronic conditions, such as heart failure, coronary artery disease [1], pulmonary hypertension [2] and cancer [3], but also in acute illnesses, such as acute coronary syndrome [4], acute heart failure [5] and ischemic stroke [6]; however, the mechanism underlying this phenomenon is incompletely elucidated.…”

Section: Introductionmentioning

confidence: 99%

Red Blood Cell Distribution Width is an Independent Predictor of AKI and Mortality in Patients in the Coronary Care Unit

Hu¹,

Liu²,

Fu³

et al. 2017

Kidney Blood Press Res

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Background/Aims: We investigated the hypothesis that RDW is an independent predictor of acute kidney injury (AKI) and mortality in patients in the coronary care unit (CCU). Methods: In this prospective, observational study, we screened 412 adults admitted to the CCU at Zhongnan Hospital of Wuhan University from January 1, 2014 to June 1, 2015. AKI was defined based on the KDIGO-AKI criteria. The survivors were followed up for up to 2 years after hospital discharge. The primary endpoint of the study was the incidence of AKI, while the secondary endpoints of the study were in-hospital mortality and 2-year mortality. Results: RDW was significantly correlated with the acute physiology and chronic health evaluation II (APACHEII) score, hemoglobin, mean corpuscular volume, inflammatory marker levels, nutrition and renal function at the time of CCU admission. The incidence of AKI was much higher in the high RDW group (RDW ≥14.0%) than in the low RDW group, a finding that was confirmed by multivariable logistic regression, which showed that RDW was independently associated with the incidence of AKI (odds ratio (OR), 1.059, 95% coincidence interval (95% CI), 1.024-1.095, P=0.001). A total of 61 patients died during their hospital stay, and baseline RDW was also an independent predictor of in-hospital mortality (hazard ratio (HR), 1.129, 95% CI 1.005-1.268, P=0.041). Patients with a high RDW exhibited significantly higher 2-year mortality than patients with a low RDW during a median follow-up period of 19.8 months (P<0.001), and RDW independently predicted the risk of 2-year mortality (HR, 1.189, 95% CI 1.045 to 1.354, P=0.009) in the multivariate Cox proportional hazard analysis after adjustments for other clinical and laboratory variables. Conclusion: RDW is an independent predictor of AKI and mortality in patients in the CCU.

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“…19,20 Moreover, other previous studies have reported that RDW may provide prognostic information for the functional outcome of stroke patients. 21,22 The cause and mechanism underlying the association between RDW and mortality risk are not clearly known yet. Salvagno et al recently summarized the clinical significance of RDW in several biological and metabolic abnormalities, including shorter telomere lengths, increased erythrocyte fragmentation, and release of iron contained in the hemoglobin molecules.…”

Section: Discussionmentioning

confidence: 99%

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

Ye¹,

Li²,

Li³

et al. 2020

CIA

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These authors contributed equally to this workPurpose: 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.

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Red Blood Cell Distribution Width Is an Independent Predictor of Outcome in Patients Undergoing Thrombolysis for Ischemic Stroke

Cited by 59 publications

References 15 publications

Hematocrit and Stroke: A Forgotten and Neglected Link?

Hematocrit and Stroke: A Forgotten and Neglected Link?

Red Blood Cell Distribution Width is an Independent Predictor of AKI and Mortality in Patients in the Coronary Care Unit

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

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