Abstract
An appropriate and timely management, including early diagnosis and accurate prognostication,
is the mainstay for managed care of patients with acute ischemic stroke. Since red
blood cell distribution width (RDW) was found to be an independent predictor of clinical
outcomes in patients with thrombotic disorders, we designed a retrospective observational
study to investigate whether the RDW value may also retain predictive significance
in stoke patients undergoing thrombolytic therapy. This retrospective study was based
on all patients admitted to the Emergency Department (ED) of the University Hospital
of Verona (Italy) with a diagnosis of ischemic stroke, who underwent systemic thrombolysis
between January 2013 and June 2015. The RDW value along with basal clinical characteristics
was recorded at ED admission. The final study population consisted of 316 patients.
A significant association was found between stroke severity (NIHSS score) and RDW
(r = 0.322; p < 0.001). The median RDW value in patients with clinical improvement after thrombolysis
was significantly lower than in patients without (13.4 vs. 14.1%; p < 0.001). The diagnostic accuracy (area under the curve) of RDW for predicting the
lack of neurological improvement was 0.667. In univariate analysis, RDW >14.5% was
associated with increased rate of no neurological improvement (odds ratio [OR], 2.38;
95% confidence interval [CI], 1.37–4.13), an association remaining significant also
in multivariate analysis (OR, 1.85; 95% CI, 1.13–3.32). Survivor curve analysis showed
that patients with RDW values ≥14.5% had a higher risk of 1-year mortality and shorter
survival. These results suggest that RDW assessment at ED admission may provide valuable
diagnostic and prognostic information in patients with acute ischemic stroke.
Keywords
stroke - thrombolysis - mortality - red blood cell distribution width
