Association between red cell distribution width and prognosis of acute ischemic stroke patients receiving intravenous thrombolysis: a meta-analysis_West China Medical Journal

Authors：

WANG Jiaxin ¹ ,  LI Wei ² , GUO Hena ²

1. Graduate School, Xi’an Medical University, Xi’an, Shaanxi 710068, P. R. China;
2. Department of Neurology, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi 710068, P. R. China;

Corresponding author：

LI Wei, Email: liwei.996@163.com

Keywords：

Acute ischemic stroke; Red cell distribution width; Intravenous thrombolysis; Prognosis; Meta-analysis

DOI：

10.7507/1002-0179.202104134

Video：

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Objective To systematically evaluate the association between red cell distribution width (RDW) and prognosis of patients with acute ischemic stroke (AIS) undergoing intravenous thrombolytic therapy.Methods We searched the PubMed, Embase, Cochrane Library, Web of Science, Chinese Biomedical Literature Service System, China National Knowledge Infrastructure, Wanfang database, and CQVIP database to identify eligible studies evaluating the relation between RDW and prognosis in AIS patients receiving intravenous thrombolysis from the establishment of databases to May 2021. The Newcastle-Ottawa Scale was used to evaluate the literature quality, and RevMan 5.3 software was used to process the data. The relationship between RDW and prognosis in AIS patients treated with intravenous thrombolytic therapy was analyzed using odds ratio (OR) and 95% confidence interval (CI).Results Five studies with a total of 1 269 participants were included into this meta-analysis. All the studies were retrospective case-control studies. Because of statistical heterogeneity (I²=59%, P=0.04), random-effects model was chosen. Meta-analysis result showed that among AIS patients who received intravenous thrombolysis, those with elevated RDW before thrombolysis were more likely to have poor prognosis than those without elevated RDW [OR=1.50, 95%CI (1.14, 1.98), P=0.004].Conclusion Elevated RDW is associated with adverse outcome of AIS patients treated with thrombolysis, and may be a risk factor for poor prognosis in patients treated with thrombolytic therapy.

Citation： WANG Jiaxin, LI Wei, GUO Hena. Association between red cell distribution width and prognosis of acute ischemic stroke patients receiving intravenous thrombolysis: a meta-analysis. West China Medical Journal, 2021, 36(6): 758-763. doi: 10.7507/1002-0179.202104134 Copy

1.	GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1204-1222.
2.	Katan M, Luft A. Global burden of stroke. Semin Neurol, 2018, 38(2): 208-211.
3.	Wang D, Liu J, Liu M, et al. Patterns of stroke between university hospitals and nonuniversity hospitals in Mainland China: prospective multicenter hospital-based registry study. World Neurosurg, 2017, 98: 258-265.
4.	Wang W, Jiang B, Sun H, et al. Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480 687 adults. Circulation, 2017, 135(8): 759-771.
5.	彭斌, 吴波. 中国急性缺血性脑卒中诊治指南2018. 中华神经科杂志, 2018, 51(9): 666-682.
6.	Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2019, 50(12): e344-e418.
7.	Bray BD, Campbell J, Hoffman A, et al. Stroke thrombolysis in England: an age stratified analysis of practice and outcome. Age Ageing, 2013, 42(2): 240-245.
8.	Kellert L, Sykora M, Gumbinger C, et al. Blood pressure variability after intravenous thrombolysis in acute stroke does not predict intracerebral hemorrhage but poor outcome. Cerebrovasc Dis, 2012, 33(2): 135-140.
9.	Lin SF, Chao AC, Hu HH, et al. Hyperglycemia predicts unfavorable outcomes in acute ischemic stroke patients treated with intravenous thrombolysis among a Chinese population: a prospective cohort study. J Neurol Sci, 2018, 388: 195-202.
10.	李治璋, 孔玉明, 王佳辉, 等. 红细胞分布宽度与急性缺血性卒中静脉溶栓患者发病严重程度及预后的关系研究. 中国卒中杂志, 2020, 15(7): 747-752.
11.	梁安心, 汤颖. 红细胞分布宽度对急性缺血性卒中患者静脉溶栓预后的预测作用. 中国脑血管病杂志, 2018, 15(2): 68-72.
12.	薛娟娟, 路蔚, 夏晓爽, 等. 红细胞分布宽度对急性缺血性卒中患者静脉溶栓转归的预测价值. 天津医药, 2020, 48(4): 284-288.
13.	Cong L, Gao H, Ma W. Prognostic relationship between peripheral red cell distribution width and acute cerebral infarction in patients with rtPA thrombolysis. Neurotox Res, 2020, 38(1): 211-218.
14.	Ye WY, Li J, Li X, et al. Predicting the one-year prognosis and mortality of patients with acute ischemic stroke using red blood cell distribution width before intravenous thrombolysis. Clin Interv Aging, 2020, 15: 255-263.
15.	Shahsavarinia K, Ghavam LY, Moharramzadeh P, et al. The predictive value of red cell distribution width for stroke severity and outcome. BMC Res Notes, 2020, 13(1): 288.
16.	Wells G, Shea BJ, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of non-randomized studies in meta-analysis. Appl Eng Agric, 2014, 18(6): 727-734.
17.	Emans ME, Gaillard CA, Pfister R, et al. Red cell distribution width is associated with physical inactivity and heart failure, independent of established risk factors, inflammation or iron metabolism; the EPIC-Norfolk study. Int J Cardiol, 2013, 168(4): 3550-3555.
18.	Li H, Gu Y, Liu M, et al. The relationship between red blood cell distribution width and atrial fibrillation in Asian population: a cross-sectional study. Pacing Clin Electrophysiol, 2019, 42(9): 1197-1203.
19.	Wang P, Wang Y, Li H, et al. Relationship between the red blood cell distribution width and risk of acute myocardial infarction. J Atheroscler Thromb, 2015, 22(1): 21-26.
20.	Furer A, Finkelstein A, Halkin A, et al. High red blood cell distribution width and preclinical carotid atherosclerosis. Biomarkers, 2015, 20(6/7): 376-381.
21.	Jia H, Li H, Zhang Y, et al. Association between red blood cell distribution width (RDW) and carotid artery atherosclerosis (CAS) in patients with primary ischemic stroke. Arch Gerontol Geriatr, 2015, 61(1): 72-75.
22.	Wonnerth A, Krychtiuk KA, Mayer FJ, et al. Red cell distribution width and mortality in carotid atherosclerosis. Eur J Clin Invest, 2016, 46(2): 198-204.
23.	Lappegård J, Ellingsen TS, Skjelbakken T, et al. Red cell distribution width is associated with future risk of incident stroke. The Tromsø Study. Thromb Haemost, 2016, 115(1): 126-134.
24.	Kara H, Degirmenci S, Bayir A, et al. Red cell distribution width and neurological scoring systems in acute stroke patients. Neuropsychiatr Dis Treat, 2015, 11: 733-739.
25.	Wang C, Wang L, Zhong D, et al. Association between red blood cell distribution width and hemorrhagic transformation in acute ischemic stroke patients. Cerebrovasc Dis, 2019, 48(3/4/5/6): 193-199.
26.	Avci E, Kiris T, Demirtas AO, et al. Relationship between high-density lipoprotein cholesterol and the red cell distribution width in patients with coronary artery disease. Lipids Health Dis, 2018, 17(1): 53.
27.	Sato M, Ido Y, Yoshimura Y, et al. Relationship of malnutrition during hospitalization with functional recovery and postdischarge destination in elderly stroke patients. J Stroke Cerebrovasc Dis, 2019, 28(7): 1866-1872.
28.	Pistoia F, Sacco S, Tiseo C, et al. The epidemiology of atrial fibrillation and stroke. Cardiol Clin, 2016, 34(2): 255-268.
29.	Lippi G, Targher G, Montagnana M, et al. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med, 2009, 133(4): 628-632.
30.	Pinho J, Marques SA, Freitas E, et al. Red cell distribution width as a predictor of 1-year survival in ischemic stroke patients treated with intravenous thrombolysis. Thromb Res, 2018, 164: 4-8.
31.	Zhou J, Wu J, Zhang J, et al. Association of stroke clinical outcomes with coexistence of hyperglycemia and biomarkers of inflammation. J Stroke Cerebrovasc Dis, 2015, 24(6): 1250-1255.
32.	Rodrigo R, Fernandez-Gajardo R, Gutierrez RA, et al. Oxidative stress and pathophysiology of ischemic stroke: novel therapeutic opportunities. CNS Neurol Disord Drug Targets, 2013, 12(5): 698-714.
33.	Rodrigo J, Fernández AP, Serrano J, et al. The role of free radicals in cerebral hypoxia and ischemia. Free Radic Biol Med, 2005, 39(1): 26-50.
34.	Roumeliotis S, Stamou A, Roumeliotis A, et al. Red blood cell distribution width is associated with deterioration of renal function and cardiovascular morbidity and mortality in patients with diabetic kidney disease. Life (Basel), 2020, 10(11): 301.
35.	Yilmaz O, Mehmet C, Kelekci S, et al. Association between red blood cell distribution width and polycystic ovary syndrome. Endocr Res, 2015, 40(4): 181-187.
36.	Zhang T, Li J, Lin Y, et al. Association between red blood cell distribution width and all-cause mortality in chronic kidney disease patients: a systematic review and meta-analysis. Arch Med Res, 2017, 48(4): 378-385.

1. GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1204-1222.
2. Katan M, Luft A. Global burden of stroke. Semin Neurol, 2018, 38(2): 208-211.
3. Wang D, Liu J, Liu M, et al. Patterns of stroke between university hospitals and nonuniversity hospitals in Mainland China: prospective multicenter hospital-based registry study. World Neurosurg, 2017, 98: 258-265.
4. Wang W, Jiang B, Sun H, et al. Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480 687 adults. Circulation, 2017, 135(8): 759-771.
5. 彭斌, 吴波. 中国急性缺血性脑卒中诊治指南2018. 中华神经科杂志, 2018, 51(9): 666-682.
6. Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2019, 50(12): e344-e418.
7. Bray BD, Campbell J, Hoffman A, et al. Stroke thrombolysis in England: an age stratified analysis of practice and outcome. Age Ageing, 2013, 42(2): 240-245.
8. Kellert L, Sykora M, Gumbinger C, et al. Blood pressure variability after intravenous thrombolysis in acute stroke does not predict intracerebral hemorrhage but poor outcome. Cerebrovasc Dis, 2012, 33(2): 135-140.
9. Lin SF, Chao AC, Hu HH, et al. Hyperglycemia predicts unfavorable outcomes in acute ischemic stroke patients treated with intravenous thrombolysis among a Chinese population: a prospective cohort study. J Neurol Sci, 2018, 388: 195-202.
10. 李治璋, 孔玉明, 王佳辉, 等. 红细胞分布宽度与急性缺血性卒中静脉溶栓患者发病严重程度及预后的关系研究. 中国卒中杂志, 2020, 15(7): 747-752.
11. 梁安心, 汤颖. 红细胞分布宽度对急性缺血性卒中患者静脉溶栓预后的预测作用. 中国脑血管病杂志, 2018, 15(2): 68-72.
12. 薛娟娟, 路蔚, 夏晓爽, 等. 红细胞分布宽度对急性缺血性卒中患者静脉溶栓转归的预测价值. 天津医药, 2020, 48(4): 284-288.
13. Cong L, Gao H, Ma W. Prognostic relationship between peripheral red cell distribution width and acute cerebral infarction in patients with rtPA thrombolysis. Neurotox Res, 2020, 38(1): 211-218.
14. Ye WY, Li J, Li X, et al. Predicting the one-year prognosis and mortality of patients with acute ischemic stroke using red blood cell distribution width before intravenous thrombolysis. Clin Interv Aging, 2020, 15: 255-263.
15. Shahsavarinia K, Ghavam LY, Moharramzadeh P, et al. The predictive value of red cell distribution width for stroke severity and outcome. BMC Res Notes, 2020, 13(1): 288.
16. Wells G, Shea BJ, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of non-randomized studies in meta-analysis. Appl Eng Agric, 2014, 18(6): 727-734.
17. Emans ME, Gaillard CA, Pfister R, et al. Red cell distribution width is associated with physical inactivity and heart failure, independent of established risk factors, inflammation or iron metabolism; the EPIC-Norfolk study. Int J Cardiol, 2013, 168(4): 3550-3555.
18. Li H, Gu Y, Liu M, et al. The relationship between red blood cell distribution width and atrial fibrillation in Asian population: a cross-sectional study. Pacing Clin Electrophysiol, 2019, 42(9): 1197-1203.
19. Wang P, Wang Y, Li H, et al. Relationship between the red blood cell distribution width and risk of acute myocardial infarction. J Atheroscler Thromb, 2015, 22(1): 21-26.
20. Furer A, Finkelstein A, Halkin A, et al. High red blood cell distribution width and preclinical carotid atherosclerosis. Biomarkers, 2015, 20(6/7): 376-381.
21. Jia H, Li H, Zhang Y, et al. Association between red blood cell distribution width (RDW) and carotid artery atherosclerosis (CAS) in patients with primary ischemic stroke. Arch Gerontol Geriatr, 2015, 61(1): 72-75.
22. Wonnerth A, Krychtiuk KA, Mayer FJ, et al. Red cell distribution width and mortality in carotid atherosclerosis. Eur J Clin Invest, 2016, 46(2): 198-204.
23. Lappegård J, Ellingsen TS, Skjelbakken T, et al. Red cell distribution width is associated with future risk of incident stroke. The Tromsø Study. Thromb Haemost, 2016, 115(1): 126-134.
24. Kara H, Degirmenci S, Bayir A, et al. Red cell distribution width and neurological scoring systems in acute stroke patients. Neuropsychiatr Dis Treat, 2015, 11: 733-739.
25. Wang C, Wang L, Zhong D, et al. Association between red blood cell distribution width and hemorrhagic transformation in acute ischemic stroke patients. Cerebrovasc Dis, 2019, 48(3/4/5/6): 193-199.
26. Avci E, Kiris T, Demirtas AO, et al. Relationship between high-density lipoprotein cholesterol and the red cell distribution width in patients with coronary artery disease. Lipids Health Dis, 2018, 17(1): 53.
27. Sato M, Ido Y, Yoshimura Y, et al. Relationship of malnutrition during hospitalization with functional recovery and postdischarge destination in elderly stroke patients. J Stroke Cerebrovasc Dis, 2019, 28(7): 1866-1872.
28. Pistoia F, Sacco S, Tiseo C, et al. The epidemiology of atrial fibrillation and stroke. Cardiol Clin, 2016, 34(2): 255-268.
29. Lippi G, Targher G, Montagnana M, et al. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med, 2009, 133(4): 628-632.
30. Pinho J, Marques SA, Freitas E, et al. Red cell distribution width as a predictor of 1-year survival in ischemic stroke patients treated with intravenous thrombolysis. Thromb Res, 2018, 164: 4-8.
31. Zhou J, Wu J, Zhang J, et al. Association of stroke clinical outcomes with coexistence of hyperglycemia and biomarkers of inflammation. J Stroke Cerebrovasc Dis, 2015, 24(6): 1250-1255.
32. Rodrigo R, Fernandez-Gajardo R, Gutierrez RA, et al. Oxidative stress and pathophysiology of ischemic stroke: novel therapeutic opportunities. CNS Neurol Disord Drug Targets, 2013, 12(5): 698-714.
33. Rodrigo J, Fernández AP, Serrano J, et al. The role of free radicals in cerebral hypoxia and ischemia. Free Radic Biol Med, 2005, 39(1): 26-50.
34. Roumeliotis S, Stamou A, Roumeliotis A, et al. Red blood cell distribution width is associated with deterioration of renal function and cardiovascular morbidity and mortality in patients with diabetic kidney disease. Life (Basel), 2020, 10(11): 301.
35. Yilmaz O, Mehmet C, Kelekci S, et al. Association between red blood cell distribution width and polycystic ovary syndrome. Endocr Res, 2015, 40(4): 181-187.
36. Zhang T, Li J, Lin Y, et al. Association between red blood cell distribution width and all-cause mortality in chronic kidney disease patients: a systematic review and meta-analysis. Arch Med Res, 2017, 48(4): 378-385.

West China Medical Journal

Association between red cell distribution width and prognosis of acute ischemic stroke patients receiving intravenous thrombolysis: a meta-analysis

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