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. 2025 Jul 8:16:1534098.
doi: 10.3389/fneur.2025.1534098. eCollection 2025.

The association between hemoglobin-to-red blood cell distribution width ratio and 28-day mortality in epidural hemorrhage: a cohort study

Hua Liu #  1   2 , Hong Huang #  1   2 , Jinrong Wang #  1   2 , Wenming Wang  1 , Min Ruan  3 , Jiangang Liu  4
Affiliations

The association between hemoglobin-to-red blood cell distribution width ratio and 28-day mortality in epidural hemorrhage: a cohort study

Hua Liu et al. Front Neurol. .

Abstract

Background: This study leverages the eICU collaborative research database (eICU-CRD) to investigate the relationship between the hemoglobin-to-red blood cell distribution width ratio (HRR) and 28-day mortality in patients with epidural hematoma (EDH).

Methods: A total of 2,161 patients admitted between 2014 and 2015 with EDH were selected. Data included demographics, medical history, and laboratory tests. HRR was calculated and stratified into quartiles. Covariates included Glasgow Coma Scale (GCS), HDL, TG, hospital time, ICU time, LDL, age, BMI, gender, coma status, race, and medical conditions like COPD, CHF, and diabetes. Non-normal data distributions were analyzed using Kruskal-Wallis and chi-square tests, with logistic regression to explore the association of HRR and 28-day mortality.

Results: Higher HRR quartiles correlated with lower 28-day mortality (p = 0.024) and higher healthy discharge rates (p = 0.013). Univariate logistic analysis showed age positively associated with mortality (OR = 1.011, 95% CI: 1.004-1.018), while GCS, ICU time, hospital time, and HRR were negatively associated. Adjusted models confirmed an inverse relationship between HRR and mortality, with the fourth quartile showing a 40% reduced probability of mortality. Linear regression models indicated a 72% reduction in mortality risk per unit HRR increase and a critical HRR value of 1.12 for significant risk reduction.

Conclusion: HRR is significantly associated with 28-day mortality in EDH patients, with higher HRR values correlating with improved survival. ICU time also showed a correlation with reduced mortality, particularly up to a critical point.

Keywords: 28-day mortality; ICU; eICU-CRD; epidural hematoma; hemoglobin-to-red blood cell distribution width ratio.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Research flowchart.
Figure 2
Figure 2
Relationship between HRR and the 28-day mortality in EDH patients.
Figure 3
Figure 3
Relationship between HRR and the 28-day mortality in EDH patients.
See this image and copyright information in PMC

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