Krongsut Sarawut, Na-Ek Nat, Khongthon Nop
Division of Neurology, Department of Internal Medicine, Saraburi Hospital, Saraburi, Thailand.
Division of Pharmacy Practice, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand; Pharmacoepidemiology, Social and Administrative Pharmacy (P- SAP) Research Unit, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.
J Stroke Cerebrovasc Dis. 2025 Apr;34(4):108254. doi: 10.1016/j.jstrokecerebrovasdis.2025.108254. Epub 2025 Jan 31.
Red blood cell distribution width (RDW) is an inflammatory marker potentially linked to stroke-associated pneumonia (SAP). This study assessed RDW's role in predicting SAP, mortality, and poor outcomes in acute ischemic stroke (AIS) patients treated with thrombolysis.
A retrospective analysis (2015-2022) of AIS patients treated with thrombolysis examined admission RDW levels. Outcomes included SAP, in-hospital (IHM) and 3-month mortality, and poor functional outcomes. Associations were analyzed using multivariable logistic regression, with predictive performance assessed via area under a receiver operating characteristic curve (AuROC), net reclassification index (NRI), and integrated discrimination improvement (IDI) metrics.
Of 345 patients, 70 (20.3 %) developed SAP. A 1-SD increase in RDW was associated with SAP (adjusted odds ratio [aOR]: 1.73; 95 % CI: 1.27-2.35), IHM (aOR: 2.14; 95 % CI: 1.43-3.21), and 3-month mortality (aOR: 1.74; 95 % CI: 1.19-2.56). The association was stronger in non-diabetics and those under 65. Although RDW did not improve the AuROC for SAP or mortality predictions, it significantly improved the NRI and IDI (p < 0.05).
RDW is independently associated with increased risk of SAP, IHM, and 3-month mortality in AIS patients treated with thrombolysis, suggesting its potential as a prognostic marker.
红细胞分布宽度（RDW）是一种炎症标志物，可能与卒中相关性肺炎（SAP）有关。本研究评估了RDW在预测接受溶栓治疗的急性缺血性卒中（AIS）患者发生SAP、死亡率和不良预后方面的作用。
对2015年至2022年接受溶栓治疗的AIS患者进行回顾性分析，检测入院时的RDW水平。结局包括SAP、住院期间（IHM）和3个月死亡率以及不良功能结局。采用多变量逻辑回归分析相关性，并通过受试者操作特征曲线下面积（AuROC）、净重新分类指数（NRI）和综合判别改善（IDI）指标评估预测性能。
在345例患者中，70例（20.3%）发生了SAP。RDW每增加1个标准差与SAP（调整优势比[aOR]：1.73；95%置信区间[CI]：1.27-2.35）、IHM（aOR：2.14；95%CI：1.43-3.21）和3个月死亡率（aOR：1.74；95%CI：1.19-2.56）相关。在非糖尿病患者和65岁以下患者中这种关联更强。尽管RDW并未改善SAP或死亡率预测的AuROC，但它显著改善了NRI和IDI（p<0.05）。
RDW与接受溶栓治疗的AIS患者发生SAP、IHM和3个月死亡率增加独立相关，提示其作为预后标志物的潜力。
