Predictive value of elevated red blood cell distribution width for no early improvement after intravenous thrombolysis in patients with acute ischemic stroke

Abstract

Objective To investigate the predictive value of red blood cell distribution width (RDW) for no early improvement after intravenous thrombolysis in patients with acute ischemic stroke. Methods Patients with acute ischemic stroke received intravenous thrombolysis in the Department of Neurology, the Second Hospital of Tianjin Medical University between January 2017 and December 2018 were enrolled retrospectively. The National Institutes of Health Stroke Scale (NIHSS) score declined ≥4 or the NIHSS score 0-1 in 24 h after thrombolytic therapy was defined as early improvement, and the NIHSS score declined<4 was defined as no early improvement. Multivariate logistic regression analysis was used to determine the independent risk factors for no early improvement. Receiver operator characteristic (ROC) curve was used to analyze the predictive value of RDW for no early improvement after intravenous thrombolysis in patients with acute ischemic stroke. Results A total of 119 patients were enrolled in the study, 46 (38.7%) had early improvement and 73 (61.3%) had no early improvement. Hypersensitive C-reactive protein, RDW, the time from onset to thrombolysis, and the proportion of complicated hypertension and fasting blood glucose in the no early improvement group were higher or longer than those in the early improvement group, and the differences were statistically significant (all P<0.05). Multivariate logistic regression analysis showed that the elevated RDW was an independent risk factor for no early improvement (odds ratio 3.119, 95% confidence interval 1.584-6.141; P=0.001). ROC curve analysis showed that the best cut-off value of RDW for predicting no early improvement after intravenous thrombolysis in acute ischemic stroke was 13.35%. The area under the curve was 0.737 (95% confidence interval 0.645-0.828). The sensitivity and specificity were 64.4% and 87.0%, respectively. Conclusion Elevated RDW has certain predictive value for no early improvement after intravenous thrombolysis in patients with acute ischemic stroke. Key words: Stroke; Brain ischemia; Thrombolytic therapy; Tissue plasminogen activator; Erythrocyte indices; Treatment outcome; Risk factors; Time factor