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

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Elevated red blood cell distribution width predicts mortality in persons with known stroke February 2009

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

Jie Xue, Dong Zhang, Xiao-Guang Zhang, Xiao-Qiong Zhu, Xu-Shen Xu and Yun-hua Yue^*

• Department of Neurology, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China

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 (< 12.4, 12.4–12.9, 13.0–13.4, > 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.

Introduction

Red cell distribution width (RDW) is an indicator reflecting the volume of red blood cells (RBCs) which is routinely calculated during automated cell counters (1). As a measurement method of circulating erythrocyte size variability, it is expressed by the erythrocyte size variation coefficient (2). In previous studies, RDW has been proven to be related to the prognosis of patients with cardiovascular diseases, such as coronary heart disease (3) and heart failure (4, 5), as well as the incidence of all-cause mortality (6, 7).

Acute ischemic stroke is the leading cause of disability and mortality around the globe (8). The annual death rate of stroke in China is about 157 per 100,000 people (9). Given the huge burden of stroke, it is increasingly important to find indicators to evaluate the clinical severity and prognosis of stroke. A large population-based prospective study found an independent relation between higher RDW and the risk of stroke in patients with coronary disease during a median follow-up of 5 years (10). Furthermore, several studies reported that higher RDW was a prognostic factor of poor functional outcome at 3 months (11, 12) and increased mortality (12, 13) in patients with ischemic stroke. In addition, recent studies have shown that in patients with ischemic stroke, higher RDW at baseline is more likely to have poor 1-year prognosis and mortality (14, 15).

There are few reports on the relationship between RDW and stroke severity and functional outcomes in Chinese patients with ischemic stroke. In this study, we aimed to evaluate the association between RDW and stroke severity and functional outcomes in patients with ischemic stroke based on the Chinese population.

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