Wei Feiran, Liu Na, Zhang Min, Yin Yanhang, Wang Liumin, Chen Tianyue, Zhu Xinmei, Zhang Xue, Chen Li, Wang Lina, Xie Wen, Shen Xiaobing, Zhang Yanli, Li Mingquan
Department of Epidemiology and Health Statistics, Southeast University School of Public Health, Nanjing, China.
Department of Neurology, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
BMJ Open. 2025 Jun 22;15(6):e097075. doi: 10.1136/bmjopen-2024-097075.
To evaluate the prognostic ability of the haemoglobin-to-red blood cell distribution width ratio in predicting in-hospital mortality among elderly patients diagnosed with acute ischaemic stroke.
Retrospective, longitudinal, observational study using a hospital-based database.
Claims data from 1 January 2014 until 31 January 2020 were extracted from the database of two hospitals affiliated with Nanjing University.
Patients aged ≥80 years who were diagnosed with acute ischaemic stroke, excluding those with cancers or other malignant diseases.
Patients were stratified into three groups based on the tertiles of the haemoglobin-to-red blood cell distribution width ratio. The dose-dependent relationship between this ratio and in-hospital mortality risk was determined with robust locally weighted regression analyses and restrictive cubic spline on continuous variables. The primary endpoint was defined as all-cause mortality during the hospital stay, and the secondary endpoint centred on the duration of the hospital stay.
A total of 606 patients constituted the dataset for the conclusive analysis (mean age, 84.6 ± 3.2 years; female, 40.3%). The haemoglobin-to-red blood cell distribution width ratio was categorised into three tertiles (T1, <6.52; T2, 6.53-8.33; and T3, >8.34). After adjusting for relevant demographic and clinical variables, a statistically significant inverse correlation was observed between higher ratios and lower risk of in-hospital mortality, with HRs of 0.48 (95% CI, 0.34 to 0.68) for T2:T1 and 0.14 (95% CI, 0.08 to 0.23) for T3:T1. A dose-dependent relationship was evident between the haemoglobin-to-red blood cell distribution width ratio and in-hospital mortality risk. The sensitivity analysis indicated that no attenuation was observed in the HR in both non-anaemic and anaemic cases. The results also indicated that a shorter length of hospital stay was associated with a higher haemoglobin-to-red blood cell distribution width ratio.
A high haemoglobin-to-red blood cell distribution ratio may be an independent protective factor for in-hospital mortality and reduced length of stay in elderly patients suffering from acute ischaemic stroke.
评估血红蛋白与红细胞分布宽度比值对诊断为急性缺血性卒中的老年患者院内死亡的预测能力。
使用基于医院数据库的回顾性、纵向观察性研究。
从南京大学附属的两家医院数据库中提取2014年1月1日至2020年1月31日的理赔数据。
年龄≥80岁且诊断为急性缺血性卒中的患者，排除患有癌症或其他恶性疾病的患者。
根据血红蛋白与红细胞分布宽度比值的三分位数将患者分为三组。通过稳健的局部加权回归分析和连续变量的限制性立方样条确定该比值与院内死亡风险之间的剂量依赖关系。主要终点定义为住院期间的全因死亡率，次要终点以住院时间为中心。
共有606例患者构成最终分析数据集（平均年龄84.6±3.2岁；女性占40.3%）。血红蛋白与红细胞分布宽度比值分为三个三分位数（T1，<6.52；T2，6.53 - 8.33；T3，>8.34）。在调整相关人口统计学和临床变量后，观察到较高比值与较低的院内死亡风险之间存在统计学显著的负相关，T2:T1的风险比为0.48（95%置信区间，0.34至0.68），T3:T1的风险比为0.14（95%置信区间，0.08至0.23）。血红蛋白与红细胞分布宽度比值与院内死亡风险之间存在明显的剂量依赖关系。敏感性分析表明，在非贫血和贫血病例中，风险比均未观察到衰减。结果还表明，住院时间较短与较高的血红蛋白与红细胞分布宽度比值相关。
高血红蛋白与红细胞分布比值可能是急性缺血性卒中老年患者院内死亡和缩短住院时间的独立保护因素。
