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. 2023 Apr 12;15(8):3052-3063.
doi: 10.18632/aging.204657. Epub 2023 Apr 12.

Association between red blood cell distribution width and ischemic stroke recurrence in patients with acute ischemic stroke: a 10-years retrospective cohort analysis

Zhan Shen  1   2 , Ying Huang  2   3 , Ying Zhou  2   3 , Jingying Jia  4 , Xian Zhang  1   2 , Tingting Shen  2   3 , Shengjie Li  5 , Siyang Wang  1   2 , Yunxiao Song  6 , Jie Cheng  1   2   7
Affiliations

Association between red blood cell distribution width and ischemic stroke recurrence in patients with acute ischemic stroke: a 10-years retrospective cohort analysis

Zhan Shen et al. Aging (Albany NY). .

Abstract

Numerous studies have reported that a higher red blood cell distribution width (RDW) level was associated with adverse outcomes in patients with the first stroke. However, no studies have examined the association between RDW and recurrent ischemic stroke. We performed a population-based cohort data analysis from 2007 to 2017. Baseline RDW was measured in 6402 first ischemic stroke participants, who were followed for about five years on average. During 62 months of median follow-up, 205 participants (3.20%) reported a recurrence (self-reported). RDW showed a nonlinear relationship with the risk of ischemic stroke recurrence. When RDW was assessed as quartiles (quartile 1, RDW<12.4; quartile 2, 12.4 to 12.8; quartile 3,12.8 to 13.3, quartile4, RDW>13.3), compared with the reference group (quartile 1), the hazard ratios (HRs) of ischemic stroke recurrence were 1.372 (95% confidence interval [CI]=0.671-2.805, P=0.386) in quartile 2, 1.835 (95% CI=1.222-2.755, P=0.003) in quartile 3, and 1.732 (95% CI=1.114-2.561, P<0.001) in quartile 4. The trend test was significant (P<0.001). When quartiles 3 and 4 were combined, the adjusted HR of ischemic stroke recurrence was 1.439 (95% CI=1.330-1.556, P<0.001) compared with the combined quartiles 1 and 2 subgroups. This study demonstrated that elevated RDW levels were positively associated with an increased risk of recurrent ischemic stroke. RDW can provide a new perspective for initial risk assessment and identify high-risk patients early. Further research is required to confirm our results.

Keywords: cohort; ischemic stroke; recurrence; red blood cell distribution width; stroke.

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Conflict of interest statement

CONFLICTS OF INTEREST: The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Smoothing curves derived from generalized additive models illustrating the association between RDW levels (as a continuous variable) and recurrent ischemic stroke. The median follow-up period was 62 months (1–115 months).
Figure 2
Figure 2
Kaplan–Meier estimates of recurrent ischemic stroke according to baseline RDW levels. (A) RDW was assessed as a categorical variable based on quartile: quartile 1, RDW≤12.4%; quartile 2, 12.8%≥RDW>12.4%; quartile 3, 13.3%≥RDW>12.8%; quartile 4, RDW>13.3%. (B) Quartiles 1 and 2 were combined into one group, and quartiles 3 and 4 were combined into one group.
Figure 3
Figure 3
Flow chart of enrollment of participants in the study.
See this image and copyright information in PMC

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