Wang Lu, Wang Changyi, Wu Simiao, Li Yuxiao, Guo Wen, Liu Ming
Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China.
Ann Transl Med. 2020 Feb;8(4):81. doi: 10.21037/atm.2019.12.142.
Whether red blood cell distribution width (RDW) is associated with the prognosis of acute ischemic stroke is inconclusive according to recent studies. We performed a cohort study and meta-analysis to explore the association between RDW and functional outcome.
Patients with ischemic stroke admitted to the Department of Neurology within 24 hours of stroke onset between January 1, 2015 to December 31, 2018 were enrolled. Blood was sampled within 24 hours after admission. We searched PubMed, Embase, Web of Science databases up to Nov 2019 to identify studies investigating the association between RDW values and prognosis following stroke. Outcomes included 3-month death and poor functional outcome [defined by modified Rankin Scale (mRS) score ≥3].
We included 1,558 patients in cohort study. RDW was independently associated with 3-month death [odds ratio (OR), 1.19; 95% confidence interval (CI), 1.03, 1.37], but not associated with 3-month poor outcome (OR 1.05, 95% CI, 0.95, 1.16), after adjustment for confounders. A dose-dependent relationship between RDW levels and 3-month death was revealed in the restricted cubic spline plot. Seven observational studies with 4,407 patients were identified for systematic review. When combining our study and previous studies, the association was significant for RDW predicting death (5 studies with 3,366 patients, OR 1.25, 95% CI, 1.15, 1.35), as well as for poor outcome (4 studies with 3,483 patients, OR 1.23, 95% CI, 1.05, 1.44).
RDW was an independent predictor of 3-month functional outcome, and a trend of dose-dependent relationship between RDW and 3-month death was detected.
根据近期研究，红细胞分布宽度（RDW）是否与急性缺血性卒中的预后相关尚无定论。我们进行了一项队列研究和荟萃分析，以探讨RDW与功能结局之间的关联。
纳入2015年1月1日至2018年12月31日期间在卒中发作后24小时内入住神经内科的缺血性卒中患者。入院后24小时内采集血液样本。我们检索了截至2019年11月的PubMed、Embase、Web of Science数据库，以确定研究RDW值与卒中后预后之间关联的研究。结局包括3个月时的死亡和功能结局不良[根据改良Rankin量表（mRS）评分≥3定义]。
我们的队列研究纳入了1558例患者。在调整混杂因素后，RDW与3个月时的死亡独立相关[比值比（OR）为1.19；95%置信区间（CI）为1.03，1.37]，但与3个月时的功能结局不良无关（OR为1.05，95%CI为0.95，1.16）。受限立方样条图显示了RDW水平与3个月时死亡之间的剂量依赖关系。我们确定了7项观察性研究，共4407例患者进行系统评价。将我们的研究与既往研究合并后，RDW预测死亡的关联具有显著性（5项研究，共3366例患者，OR为1.25，95%CI为1.15，1.35），预测功能结局不良的关联也具有显著性（4项研究，共3483例患者，OR为1.23，95%CI为1.05，1.44）。
RDW是3个月功能结局的独立预测因素，并且检测到RDW与3个月时死亡之间存在剂量依赖关系趋势。
