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The relationship between hemoglobin/red blood cell distribution width ratio and mortality in patients with intracranial hemorrhage: a possible protective effect for the elderly?

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Abstract

Intracranial hemorrhage (ICH) is a neurological emergency with a poor prognosis. This study aimed to understand the association between hemoglobin levels, red blood cell distribution width ratio (HRR), and mortality in patients with ICH. Information on patients with ICH was extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Cox proportional risk models were used to assess the relationship between HRR and 28-day and 90-day mortality, and constructed by adjusting for relevant covariates. Segmented regression models and smoothing curves were used to analyze the linear relationship between HRR and mortality. This study recruited 4,716 patients with ICH. The HRR Q4 group was negatively associated with the 28- and 90-day mortality. For patients aged > 65 years, the right-hand threshold inflection points of the HRR were 0.92 and 0.93, respectively, which were negatively associated with 28-day mortality (HR:0.06, 95% CI 0.01, 0.35, p = 0.0016) and with 90-day mortality (p = 0.0006). In the non-linear model, both 28-day mortality (HR, 0.17; 95% CI 0.04–0.75, p = 0.0191; HRR > 0.89) and 90-day mortality (HR, 0.13; 95% CI 0.04–0.49, p = 0.0022; HRR > 0.85) were associated in men. In the subgroup analysis, the negative association between HRR and mortality was more pronounced in patients > 65 years of age, as well as in patients with non-dementia, diabetes, and malignant cancer. We found a non-linear relationship between mortality and the HRR in elderly patients, and a higher HRR was negatively associated with mortality in patients with ICH.

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Data availability

Data supporting the results of this study are available from the Massachusetts Institute of Technology (MIT) and the Beth Israel Deaconess Medical Center (BIDMC) with restrictions on the availability of these data, which were used with permission in this study and are therefore not publicly available. However, upon reasonable request, the data are available with permission from MIT and BIDMC.

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Funding

Science and Technology Plan Project of Jiangxi Administration of Traditional Chinese Medicine (No. 2022B952).

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Authors and Affiliations

  1. Vascular Breast Surgery, Jiangxi Provincial People’s Hospital, Nanchang, 330006, Jiangxi, China

    QianXia Lin & Fang Zhou

  2. The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China

    QianXia Lin, WeiHua Dong, Fang Zhou & Yun Xu

  3. Department of Infectious Diseases, Jiujiang First People’s Hospital, Jiujiang, 330006, Jiangxi, China

    JinPing Liao

  4. Medical Security Division, Jiangxi Provincial People’s Hospital, Nanchang, 330006, Jiangxi, People’s Republic of China

    WeiHua Dong & Yun Xu

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  4. Fang Zhou
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  5. Yun Xu
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Contributions

All authors contributed significantly to and agree with the content of the manuscript. Conceptualization: FZ and YX. Methodology: QXL, Software: WHD, JPL, Validation: FZ. Formal Analysis: QXL. Data Curation: WHD. Writing of the original draft: QXL. Writing, Review & Editing: All authors. Visualization: QXL. Supervision: FZ and YX.

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Correspondence to Fang Zhou or Yun Xu.

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This study did not include any research conducted on human or animal participants. The authors declare no conflict of interest.

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Lin, Q., Liao, J., Dong, W. et al. The relationship between hemoglobin/red blood cell distribution width ratio and mortality in patients with intracranial hemorrhage: a possible protective effect for the elderly?. Intern Emerg Med 18, 2301–2310 (2023). https://doi.org/10.1007/s11739-023-03431-4

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