Red Cell Distribution Width is Associated with 30-day Mortality in Patients with Spontaneous Intracerebral Hemorrhage

Abstract

Background Red cell distribution width (RDW) has been associated with mortality and outcome in a wide variety of non-neurological and neurological diseases, namely in myocardial infarction and acute ischemic stroke, and the reason for this is not completely understood. We aimed to investigate RDW as a potential prognostic marker in patients with intracerebral hemorrhage (ICH). Methods This is a retrospective study of consecutive patients with acute non-traumatic ICH admitted to a single center during a 4-year period. We reviewed individual clinical records to collect demographic and baseline information, including RDW at admission, 3-month functional status, and incidence of death during follow-up. Baseline computed tomography imaging was reviewed to classify the location of ICH, and to measure ICH volume and perihematomal edema volume. Patients were divided according to quartile distribution of RDW (RDW-Q1-4). Results The final study population consisted of 358 patients, median age 71 years (interquartile range [IQR] 60–80), 55% were male, and median Glasgow Coma Scale was 14 (IQR 10–15), with a mean follow-up of 17.6 months. Patients with higher RDW values were older (p = 0.003), more frequently presented with an active malignancy (p = 0.005), atrial fibrillation (p < 0.001), intraventricular hemorrhage (p = 0.048), and were anticoagulated (p < 0.001). Three-month functional independence was similar throughout RDW quartiles. RDW-Q4 was independently associated with increased 30-day mortality (adjusted odds ratio = 3.36, 95%CI = 1.48–7.62, p = 0.004), but not independently associated with increased mortality after 30 days (adjusted hazards ratio = 0.71, 95%CI = 0.29–1.73, p = 0.448). Conclusions RDW is a robust and independent predictor of 30-day mortality in non-traumatic ICH patients, and further studies to understand this association are warranted.

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

“…In patients undergoing ischemic stroke, RDW predicts worse neurological improvement and mortality (37,38). RDW also shows predictive performance in hemorrhagic cerebrovascular diseases like spontaneous intracerebral hemorrhage (39) and aSAH (7)(8)(9), the latter of which our study focused on.…”

A nomogram incorporating red blood cell indices to predict post-stroke cognitive impairment in the intracerebral hemorrhage population

“…For instance, RDW is closely related to the outcome of carotid atherosclerosis and ischemic stroke (Chugh et al, 2015;Li et al, 2017;Turcato et al, 2017). It is also reported that RDW is an independent predictor of 30-day mortality in ICH patients (Pinho et al, 2021). Altintas et al (2017) showed elevated RDW levels to be significantly positively correlated with hematoma growth in a retrospective study based on 60 patients with cerebral parenchymal hemorrhage.…”

“…A routine complete blood count is the most commonly measured laboratory test in hospital, for the advantage of being widely available, non-invasive, easy, economical, and rapid to perform ( Gilev et al, 2017 ). Several studies have shown the significance of red blood cell (RBC) indices in predicting mortality, clinical outcomes, and functional rehabilitation after stroke ( Roh et al, 2019 ; Pinho et al, 2021 ). In addition, increasing evidence suggests that RBC indices may also be indicative of cognitive impairment ( Dlugaj et al, 2016 ).…”

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

“…[12][13][14] An RDW study of the short-term prognosis after stroke showed that higher RDW was associated with poor function at discharge or 3 months later and that RDW had a dose-dependent relationship with 3-month mortality. [15][16][17][18] There have also been studies on the relationship between RDW and the prognosis of patients with large artery cerebral infarction. These found that RDW is associated with 1-month mortality in patients with malignant middle cerebral artery infarction 19 and that high RDW is a poor prognostic factor.…”