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

Authors Ye WY, Li J, Li X, Yang XZ, Weng YY, Xiang WW, Zhang O, Ke BX, Zhang X

Received 9 October 2019

Accepted for publication 28 December 2019

Published 20 February 2020 Volume 2020:15 Pages 255—263

DOI https://doi.org/10.2147/CIA.S233701

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Zhi-Ying Wu


Wei-Yi Ye,1,2 Jia Li,2 Xiang Li,2 Xue-Zhi Yang,2 Yi-Yun Weng,2 Wei-Wei Xiang,3 Ou Zhang,2 Bo-Xi Ke,4,* Xu Zhang2,*

1Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Zhejiang, People’s Republic of China; 2Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of China; 3School of Mental Health, Wenzhou Medical University, Wenzhou, People’s Republic of China; 4Taizhou Central Hospital (Taizhou University Hospital), Zhejiang, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Xu Zhang
Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, People’s Republic of China
Tel +86 577 5557 9372
Fax +86 577 5557 9318
Email 1102805261@qq.com
Bo-Xi Ke
Taizhou Central Hospital (Taizhou University Hospital), Zhejiang 318000, People’s Republic of China
Tel +86 139 5769 8220
Email keboxi@163.com

Purpose: 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.

Keywords: red blood cells, death, inflammatory, cerebrovascular accident, fibrinolytic therapy, predictor

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