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Association Between Red Blood Cell Distribution width and Long-Term Mortality in Patients with Intracerebral Hemorrhage

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Abstract

Background

The association between the red cell distribution width (RDW) and long-term mortality in patients with intracerebral hemorrhage (ICH) has not been clearly established.

Methods

We conducted a retrospective cohort study of patients with ICH admitted to two tertiary hospitals. The primary outcome was long-term mortality, and the effect of elevated RDW (RDW coefficient of variation [RDW-CV]; RDW standard deviation [RDW-SD]) on outcomes was assessed by using logistic regression analysis. Serum RDW levels was divided into four levels by quartiles (the lowest quartile [Q1]; the highest quartile [Q4]).

Results

This study included 4223 patients with ICH. After adjustment for potential confounders, admission RDW-CV (Quartile 4 [Q4] vs. Quartile 1 [Q1], adjusted hazard ratio [HR] 1.61, 95% confidence interval [CI] 1.34–1.92) and median RDW-CV within the first month after admission (Q4 vs. Q1, adjusted HR 1.69, 95% CI 1.40–2.04) were both associated with 1-year mortality following ICH. Parallel results were found for RDW-SD. In the receiver operating characteristic analyses, both RDW-CV and RDW-SD outperformed some inflammatory biomarkers, such as albumin, hemoglobin, total cholesterol, platelet count, lymphocyte, and fibrinogen, in predicting long-term mortality following ICH. Additionally, compared with admission RDW, median RDW-CV and RDW-SD (areas under the curve [AUC] 0.668 and 0.652, respectively) was superior to predict long-term mortality, (P < 0.001). Furthermore, median RDW-CV level was a better predictor than RDW-SD (P = 0.03).

Conclusions

In patients with ICH, RDW independently predicted long-term mortality. Median RDW levels within the first month after admission were better predictors of long-term mortality compared with RDW levels on admission. Additionally, median RDW-CV showed superior predictive capacity than median RDW-SD for long-term mortality following ICH.

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References

  1. Krishnamurthi RV, Feigin VL, Forouzanfar MH, et al. Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990–2010: findings from the global Burden of disease study 2010. Lancet Glob Health. 2013;1:e259-281. https://doi.org/10.1016/s2214-109x(13)70089-5.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Sipilä JOT, Ruuskanen JO, Rautava P, et al. Case fatality of hospital-treated intracerebral hemorrhage in Finland–a nationwide population-based registry study. J Neurol Sci. 2021;425: 117446. https://doi.org/10.1016/j.jns.2021.117446.

    Article  PubMed  Google Scholar 

  3. Hansen BM, Nilsson OG, Anderson H, et al. Long term (13 years) prognosis after primary intracerebral haemorrhage: a prospective population based study of long term mortality, prognostic factors and causes of death. J Neurol Neurosurg Psychiatry. 2013;84:1150–5. https://doi.org/10.1136/jnnp-2013-305200.

    Article  PubMed  Google Scholar 

  4. Sembill JA, Gerner ST, Volbers B, et al. Severity assessment in maximally treated ICH patients: the max-ICH score. Neurology. 2017;89:423–31. https://doi.org/10.1212/wnl.0000000000004174.

    Article  PubMed  Google Scholar 

  5. Rost NS, Smith EE, Chang Y, et al. Prediction of functional outcome in patients with primary intracerebral hemorrhage: the FUNC score. Stroke. 2008;39:2304–9. https://doi.org/10.1161/strokeaha.107.512202.

    Article  PubMed  Google Scholar 

  6. Fogelholm R, Murros K, Rissanen A, et al. Long term survival after primary intracerebral haemorrhage: a retrospective population based study. J Neurol Neurosurg Psychiatry. 2005;76:1534–8. https://doi.org/10.1136/jnnp.2004.055145.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Vermeer SE, Algra A, Franke CL, et al. Long-term prognosis after recovery from primary intracerebral hemorrhage. Neurology. 2002;59:205–9. https://doi.org/10.1212/wnl.59.2.205.

    Article  CAS  PubMed  Google Scholar 

  8. Zhang W, Wang Y, Wang J, et al. Association between red blood cell distribution width and long-term mortality in acute respiratory failure patients. Sci Rep. 2020;10:21185. https://doi.org/10.1038/s41598-020-78321-2.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Dai Y, Konishi H, Takagi A, et al. Red cell distribution width predicts short- and long-term outcomes of acute congestive heart failure more effectively than hemoglobin. Exp Ther Med. 2014;8:600–6. https://doi.org/10.3892/etm.2014.1755.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Pinho J, Silva L, Quintas-Neves M, et al. Red cell distribution width is associated with 30-day mortality in patients with spontaneous intracerebral hemorrhage. Neurocrit Care. 2021;34:825–32. https://doi.org/10.1007/s12028-020-01103-1.

    Article  CAS  PubMed  Google Scholar 

  11. Lorente L, Martín MM, González-Rivero AF, et al. Red blood cell distribution width and mortality of spontaneous intracerebral hemorrhage patients. Clin Neurol Neurosurg. 2020;195: 106066. https://doi.org/10.1016/j.clineuro.2020.106066.

    Article  PubMed  Google Scholar 

  12. Hoffmann JJ, Nabbe KC, van den Broek NM. Effect of age and gender on reference intervals of red blood cell distribution width (RDW) and mean red cell volume (MCV). Clin Chem Lab Med. 2015;53:2015–9. https://doi.org/10.1515/cclm-2015-0155.

    Article  CAS  PubMed  Google Scholar 

  13. Tonelli M, Wiebe N, James MT, et al. Red cell distribution width associations with clinical outcomes: a population-based cohort study. PLoS ONE. 2019;14: e0212374. https://doi.org/10.1371/journal.pone.0212374.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Chan KW. The chinese Hukou system at 50. Eurasian Geogr Econ. 2009;50:197–221.

    Article  Google Scholar 

  15. Sun J, Guo X, Lu Z, et al. The gap between cause-of-death statistics and Household Registration reports in Shandong, China during 2011–2013: evaluation and adjustment for underreporting in the mortality data for 262 subcounty level populations. PLoS ONE. 2018;13: e0199133. https://doi.org/10.1371/journal.pone.0199133.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Maldonado G, Greenland S. Simulation study of confounder-selection strategies. Am J Epidemiol. 1993;138:923–36. https://doi.org/10.1093/oxfordjournals.aje.a116813.

    Article  CAS  PubMed  Google Scholar 

  17. Govindarajulu US, Spiegelman D, Thurston SW, et al. Comparing smoothing techniques in Cox models for exposure-response relationships. Stat Med. 2007;26:3735–52. https://doi.org/10.1002/sim.2848.

    Article  PubMed  Google Scholar 

  18. Durrleman S, Simon R. Flexible regression models with cubic splines. Stat Med. 1989;8:551–61. https://doi.org/10.1002/sim.4780080504.

    Article  CAS  PubMed  Google Scholar 

  19. Haneuse S, VanderWeele TJ, Arterburn D. Using the e-value to assess the potential effect of unmeasured confounding in observational studies. JAMA. 2019;321:602–3. https://doi.org/10.1001/jama.2018.21554.

    Article  PubMed  Google Scholar 

  20. Steven S, Frenis K, Oelze M, et al. Vascular inflammation and oxidative stress: major triggers for cardiovascular disease. Oxid Med Cell Longev. 2019;2019:7092151. https://doi.org/10.1155/2019/7092151.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Macdougall IC, Cooper A. The inflammatory response and epoetin sensitivity. Nephrol, Dial, Transp Off Publ Eur Dial Transp Assoc – Eur Renal Assoc. 2002;17(Suppl 1):48–52. https://doi.org/10.1093/ndt/17.suppl_1.48.

    Article  Google Scholar 

  22. Libby P, Loscalzo J, Ridker PM, et al. Inflammation, immunity, and infection in atherothrombosis: JACC review topic of the week. J Am Coll Cardiol. 2018;72:2071–81. https://doi.org/10.1016/j.jacc.2018.08.1043.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Rost NS, Wolf PA, Kase CS, et al. Plasma concentration of C-reactive protein and risk of ischemic stroke and transient ischemic attack: the Framingham study. Stroke. 2001;32:2575–9. https://doi.org/10.1161/hs1101.098151.

    Article  CAS  PubMed  Google Scholar 

  24. Patel KV, Ferrucci L, Ershler WB, et al. Red blood cell distribution width and the risk of death in middle-aged and older adults. Arch Intern Med. 2009;169:515–23. https://doi.org/10.1001/archinternmed.2009.11.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Förhécz Z, Gombos T, Borgulya G, et al. Red cell distribution width in heart failure: prediction of clinical events and relationship with markers of ineffective erythropoiesis, inflammation, renal function, and nutritional state. Am Heart J. 2009;158:659–66. https://doi.org/10.1016/j.ahj.2009.07.024.

    Article  PubMed  Google Scholar 

  26. Zhao Z, Liu T, Li J, et al. Elevated red cell distribution width level is associated with oxidative stress and inflammation in a canine model of rapid atrial pacing. Int J Cardiol. 2014;174:174–6. https://doi.org/10.1016/j.ijcard.2014.03.189.

    Article  PubMed  Google Scholar 

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Funding

This work was supported by the National Natural Science Foundation of China (NSFC) (no. 82271364); the innovation team project of the Affiliated Hospital of Clinical Medicine College of Chengdu University (no. CDFYCX202203); the project of Sichuan Science and Technology Bureau (no. 22ZDYF0798); the 1·3·5 Project for Disciplines of Excellence–Clinical Research Incubation Project, West China Hospital, Sichuan University (no. 21HXFH046); the Nursing Association of Sichuan Province (no. H21003); and the opening subject under KF-202204 in the State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, by an NSFC grant (no. 82074003).

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Author notes

  1. Jialing He and Yu Zhang have contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China

    Jialing He, Xin Cheng, Chao You, Fang Fang & Chaofeng Fan

  2. Department of Neurosurgery, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China

    Jialing He

  3. Department of Neurosurgery, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China

    Yu Zhang, Yangchun Xiao, Liyuan Peng, Yuning Feng, Haidong Deng, Peng Wang & Lvlin Chen

  4. Department of Neurosurgery, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, China

    Pengfei Hao

  5. Department of Neurosurgery, The First People’s Hospital of Longquanyi District, Chengdu, Sichuan, China

    Tiangui Li

  6. Thomas Jefferson University, Philadelphia, PA, USA

    Weelic Chong & Yang Hai

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  1. Jialing He
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Contributions

Study concept: C.F. Design: All authors. Acquisition, analysis, or interpretation of data: J.H., Y.Z., and H.P. Statistical analysis: J.H. and Y.Z. Drafting of the manuscript: J.H. and Y.Z. Critical revision of the manuscript for important intellectual content: All authors. The final manuscript was approved by all authors.

Corresponding author

Correspondence to Chaofeng Fan.

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Conflicts of interest

None.

Ethical Approval/Informed Consent

The ethics committee of West China Hospital (No. 20211701), and the ethics committee of the First People’s Hospital of Longquanyi District, Chengdu (No. AF-KY-2022010) approved this study. Written informed consent was waived for the patients due to the retrospective design of the study.

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He, J., Zhang, Y., Hao, P. et al. Association Between Red Blood Cell Distribution width and Long-Term Mortality in Patients with Intracerebral Hemorrhage. Neurocrit Care (2023). https://doi.org/10.1007/s12028-023-01875-2

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