Full Length Article| Volume 164, P4-8, April 2018

Red cell distribution width as a predictor of 1-year survival in ischemic stroke patients treated with intravenous thrombolysis

Published:February 06, 2018DOI:


      • RDW was found to be a prognostic marker in several conditions
      • Higher RDW is associated with decreased survival after thrombolysis in ischemic stroke
      • The predictive role of RDW is not dependent on stroke severity
      • The predictive role of RDW is dependent on age and early post-stroke infection



      Red cell distribution width (RDW) has been found to be a prognostic marker in vascular diseases. Increased RDW predicted mortality and outcome after ischemic stroke however, the underlying mechanisms are unclear. Our study aimed to clarify the relation of RDW with stroke severity and 1-year survival.

      Material and methods

      Single-centre retrospective cohort study based on a prospective database of consecutive patients with acute anterior circulation ischemic stroke treated with intravenous thrombolysis (IVT) in a 9-year period. Clinical characteristics were collected from the registry. Additional information, namely pre-IVT RDW, was retrieved from individual patient records. Information concerning survival during the first year after stroke was collected from the national Health Data Platform.


      602 patients were included. Patients in the higher RDW quartiles were older, and more frequently presented hypertension and cardioembolic etiology. RDW was higher in patients who presented early infection and a positive correlation was found between RDW and C-reactive protein. RDW was not associated with admission severity of stroke, neurological status 24 h after stroke or occurrence of symptomatic intracranial hemorrhage (sICH). Patients in the higher quartiles of RDW presented a lower 1-year survival (p < 0.001). After stepwise adjustment for variables of interest, including severity of ischemic stroke, sICH, and response to IVT, RDW remained a predictor of 1-year survival, specifically in patients ≥75 years and in patients with early post-stroke infection.


      RDW is a predictor of 1-year survival in patients with ischemic stroke treated with IVT, specifically in older patients and those who develop early infection, and its prediction value is independent from stroke severity and response to IVT.


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        • Whiteley W.
        • Chong W.L.
        • Sengupta A.
        • Sandercock P.
        Blood markers for the prognosis of ischemic stroke: a systematic review.
        Stroke. 2009; 40e380-e389
        • Dabbah S.
        • Hammerman H.
        • Markiewicz W.
        • Aronson D.
        Relation between red cell distribution width and clinical outcomes after acute myocardial infarction.
        Am. J. Cardiol. 2010; 105: 312-317
        • Felker G.M.
        • Allen L.A.
        • Pocock S.J.
        • Shaw L.K.
        • McMurray J.J.
        • Pfeffer M.A.
        • Swedberg K.
        • Wang D.
        • Yusuf S.
        • Michelson E.L.
        • Granger C.B.
        Red cell distribution width as a novel prognostic marker in heart failure: data from the CHARM program and the Duke databank.
        J. Am. Coll. Cardiol. 2007; 50: 40-47
        • Borné Y.
        • Smith J.G.
        • Melander O.
        • Engström G.
        Red cell distribution width in relation to incidence of coronary events and case fatality rates: a population-based cohort.
        Heart. 2014; 100: 1119-1124
        • Chen P.C.
        • Sung F.C.
        • Chien K.L.
        • Hsu H.C.
        • Su T.C.
        • Lee Y.T.
        Red blood cell distribution width and risk of cardiovascular events and mortality in a community cohort in Taiwan.
        Am. J. Epidemiol. 2010; 171: 214-220
        • Tonelli M.
        • Sacks F.
        • Arnold M.
        • Moye L.
        • Davis B.
        • Pfeffer M.
        • for the Cholesterol and Recurrent Events (CARE) Trial Investigators
        Relation between red blood cell distribution width and cardiovascular event rate in people with coronary disease.
        Circulation. 2008; 117: 163-168
        • Ani C.
        • Ovbiagele B.
        Elevated red blood cell distribution width predicts mortality in persons with known stroke.
        J. Neurol. Sci. 2009; 277: 103-108
        • Kim J.
        • Kim Y.D.
        • Song T.J.
        • Park J.H.
        • Lee H.S.
        • Nam C.M.
        • Nam H.S.
        • Heo J.H.
        Red blood cell distribution width is associated with poor clinical outcome in acute cerebral infarction.
        Thromb. Haemost. 2012; 108: 349-356
        • Turcato G.
        • Cervellin G.
        • Cappellari M.
        • Bonora A.
        • Zannoni M.
        • Bovi P.
        • Ricci G.
        • Lippi G.
        Early function decline after ischemic stroke can be predicted by a nomogram based on age, use of thrombolysis, RDW and NIHSS score at admission.
        J. Thromb. Thrombolysis. 2017; 43: 394-400
        • Barber P.A.
        • Demchuk A.M.
        • Zhang J.
        • Buchan A.M.
        Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy.
        Lancet. 2000; 355: 1670-1674
        • Hacke W.
        • Kaste M.
        • Fieschi C.
        • von Kummer R.
        • Davalos A.
        • Meier D.
        • Larrue V.
        • Bluhmki E.
        • Davis S.
        • Donnan G.
        • Schneider D.
        • Diez-Tejedor E.
        • Trouillas P.
        Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators.
        Lancet. 1998; 352: 1245-1251
        • Turcato G.
        • Cappellari M.
        • Follador L.
        • Dilda A.
        • Bonora A.
        • Zannoni M.
        • Bovo C.
        • Ricci G.
        • Bovi P.
        • Lippi G.
        Red blood cell distribution width is an independent predictor of outcome in patients undergoing thrombolysis for ischemic stroke.
        Semin. Thromb. Hemost. 2017; 43: 30.35
        • Fan L.
        • Gui L.
        • Chai E.Q.
        • Wei C.J.
        Routine hematological parameters are associated with short- and long-term prognosis of patients with ischemic stroke.
        J. Clin. Lab. Anal. 2017; (17 May 22 [Epub ahead of print])e22244
        • Machado C.
        • Pinho J.
        • Alves J.N.
        • Santos A.F.
        • Ferreira MdC
        • Abreu M.J.
        • Oliveira L.
        • Mota J.
        • Fontes J.R.
        • Ferreira C.
        Five-year outcome in stroke patients submitted to thrombolysis.
        Stroke. 2015; 46: 2312-2314
        • Desilles J.P.
        • Meseguer E.
        • Labreuche J.
        • Lapergue B.
        • Sirimarco G.
        • Gonzalez-Varcacel J.
        • Lavallée P.
        • Cabrejo L.
        • Guidoux C.
        • Klein I.
        • Amarenco P.
        • Mazighi M.
        Diabetes mellitus, admission glucose, and outcomes after stroke thrombolysis: a registry and systematic review.
        Stroke. 2013; 44: 1915-1923
        • Yaghi S.
        • Boehme A.K.
        • Dibu J.
        • Leon Guerrero C.R.
        • Ali S.
        • Martin-Schild S.
        • Sands K.A.
        • Noorian A.R.
        • Blum C.A.
        • Chaudhary S.
        • Schwamm L.H.
        • Liebeskind D.S.
        • Marshall R.S.
        • Willey J.Z.
        Treatment and outcome of thrombolysis-related hemorrhage: a multicenter retrospective study.
        JAMA Neurol. 2015; 72: 1451-1457
        • Ghaffari S.
        • Pourafkari L.
        • Sepehrvand N.
        • Aslanabadi N.
        • Faridi L.
        • Tajlil A.
        • Masoumi N.
        • Nader N.D.
        Red cell distribution width is a predictor of ST resolution and clinical outcome following thrombolysis in acute ST elevation myocardial infarction.
        Thromb. Res. 2016; 140: 1-6
        • Patel K.V.
        • Ferruci L.
        • Ershler W.B.
        • Longo D.L.
        • Guralnik J.M.
        Red blood cell distribution width and the risk of death in middle-aged and older adults.
        Arch. Intern. Med. 2009; 169: 515-523
        • Hsieh Y.P.
        • Tsai S.M.
        • Chang C.C.
        • Kor C.T.
        • Lin C.C.
        Association between red cell distribution width and mortality in patients undergoing continuous ambulatory peritoneal dialysis.
        Sci. Rep. 2017; 745632
        • Rhodes C.J.
        • Wharton J.
        • Howard L.S.
        • Gibbs J.S.
        • Wilkins M.R.
        Red cell distribution width outperforms other potential circulating biomarkers in predicting survival in idiopathic pulmonary hypertension.
        Heart. 2011; 97: 1054-1060
        • Sadaka F.
        • O'Brien J.
        • Prakash S.
        Red cell distribution width and outcome in patients with septic shock.
        J. Intensive Care Med. 2013; 28: 307-313
        • Kim J.
        • Kim K.
        • Lee J.H.
        • Jo Y.H.
        • Rhee J.E.
        • Kim T.Y.
        • Kang K.W.
        • Kim Y.J.
        • Hwang S.S.
        • Jang H.Y.
        Red blood cell distribution width as an independent predictor of all-cause mortality in out of hospital cardiac arrest.
        Resuscitation. 2012; 83: 1248-1252
        • Förhécz Z.
        • Gombos T.
        • Borgulya G.
        • Pozsonyi Z.
        • Prohászka Z.
        • Jánoskuti L.
        Red cell distribution width in heart failure: prediction of clinical events and relationship with markers of ineffective erythropoiesis, inflammation, renal function, and nutritional state.
        Am. Heart J. 2009; 158: 659-666
        • Jaffe J.P.
        • Schilling R.F.
        Erythrocyte folate levels: a clinical study.
        Am. J. Hematol. 1991; 36: 116-121
        • Patel K.V.
        • Mohanty J.G.
        • Kanapuru B.
        • Hesdorffer C.
        • Ershler W.B.
        • Rifkind J.M.
        Association of the red cell distribution width with red blood cell deformability.
        Adv. Exp. Med. Biol. 2013; 765: 211-216
        • Zöller B.
        • Melander O.
        • Svensson P.
        • Engström G.
        Red cell distribution width and risk for venous thromboembolism: a population-based cohort study.
        Thromb. Res. 2014; 133: 334-339
        • Ellingsen T.S.
        • Lappegård J.
        • Skjelbakken T.
        • Brækkan S.K.
        • Hansen J.B.
        Red cell distribution width is associated with incident venous thromboembolism (VTE) and case-fatality after VTE in a general population.
        Thromb. Haemost. 2015; 113: 193-200