Early Mortality of Brain Infarction Patients and Red Blood Cell Distribution Width.

Leonardo Lorente,Pedro Abreu-González,Alejandro Jiménez,Luis Ramos-Gómez,Juan J Cáceres,María M Martín,Jordi Solé-Violán,Antonia Pérez-Cejas,Victor García-Marín,Agustín F González-Rivero,Mónica Argueso

doi:10.3390/brainsci10040196

Abstract

Background: Meta-analysis has found that high baseline red blood cell distribution width (RDW) is associated with increased long-term mortality (mortality at one year or more) in ischemic stroke. The objectives of this study were to determine whether there is an association between RDW and 30-day mortality, and to explore whether RDW during the first week of ischemic stroke could be a 30-day mortality biomarker. Methods: We included patients with malignant middle cerebral artery infarction (MMCAI). RDW at days 1, 4, and 8 of MMCAI were determined. The end-point study was 30-day mortality. Results: We found that survivor (n = 37) in respect to non-survivor patients (n = 37) had lower RDW at days 1 (p < 0.001), 4 (p < 0.001), and 8 (p = 0.02). The area under curve (95% CI) for prediction of 30-day mortality by RDW at days 1, 4, and 8 of MMCAI were 0.80 (0.69–0.89; p < 0.001), 0.79 (0.66–0.89; p < 0.001), and 0.73 (0.58–0.84; p = 0.02). Regression analysis showed an association between RDW (odds ratio = 1.695; 95% CI = 1.230–2.335; p < 0.001) and 30-day mortality. Conclusions: The association between RDW and early mortality, and the potential role of RDW during the first week of MMCAI as a prognostic biomarker of early mortality were the main novelties of our study.

Highlights

The capacity by red blood cell distribution width (RDW) at days 1, 4, and 8 of malignant middle cerebral artery infarction (MMCAI) for 30-day mortality prediction was determined by receiver operating characteristic (ROC) analyses; and we reported specificities and sensitivities for the cut-offs of RDW at days 1, 4, and 8
We found that the 37 survivor patients in respect to the 37 non-survivor patients had higher
We found a positive association between RDW and serum tumor necrosis factor (TNF)-alpha levels at days 1, 4, and 8 of MMCAI

Summary

Introduction

Red blood cell distribution width (RDW) represents the variability of form and size in red blood cells of a subject and is a hemogram index that is used for the differential diagnosis of anemia [1].High RDW has been associated with increased mortality in patients with coronary disease [2], cardiac arrest [3], heart failure [4], pancreatitis [5], liver disease [6], sepsis [7,8], or traumatic brain injury [9].RDW has been previously scarcely explored in patients with ischemic stroke [10,11,12,13,14]. In a recently published meta-analysis, it has been found that high baseline RDW is associated with increased mortality in ischemic stroke, over all long-term mortality (mortality at one year or more) [10]. There is not conclusive data on the role of RDW for early mortality prediction in ischemic stroke, and the objectives of this study were to compare RDW during the first week of brain infarction in 30-day surviving and non-surviving patients, to determine whether there is an association between RDW and 30-day mortality, and to explore whether RDW during the first week of brain infarction could be a 30-day mortality biomarker. Meta-analysis has found that high baseline red blood cell distribution width (RDW) is associated with increased long-term mortality (mortality at one year or more) in ischemic stroke.

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