Research Paper|Volume 15, Issue 8|pp 3052—3063

Association between red blood cell distribution width and ischemic stroke recurrence in patients with acute ischemic stroke: a 10-years retrospective cohort analysis

Zhan Shen^1,², Ying Huang^2,³, Ying Zhou^2,³, Jingying Jia⁴, Xian Zhang^1,², Tingting Shen^2,³, Shengjie Li⁵, Siyang Wang^1,², Yunxiao Song⁶, Jie Cheng^1,^2,⁷

¹Department of Geratology, Shanghai Xuhui Central Hospital, Fudan University, Shanghai, People’s Republic of China
²Department of Neurology, Shanghai Xuhui Central Hospital, Fudan University, Shanghai, People’s Republic of China
³Department of General Medicine, Shanghai Xuhui Central Hospital, Fudan University, Shanghai, People’s Republic of China
⁴Department of Central Laboratory, Shanghai Xuhui Central Hospital, Fudan University, Shanghai, People’s Republic of China
⁵Shanghai Internet Hospital Engineering Technology Research Center, Shanghai Xuhui Central Hospital, Fudan University, Shanghai, People’s Republic of China
⁶Department of Clinical Laboratory, Shanghai Xuhui Central Hospital, Fudan University, Shanghai, People’s Republic of China
⁷Department of Urinary Surgery, Shanghai Xuhui Central Hospital, Fudan University, Shanghai, People’s Republic of China

* Equal contribution

Received: January 8, 2023Accepted: March 24, 2023Published: April 12, 2023

https://doi.org/10.18632/aging.204657

Copyright: © 2023 Shen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Numerous studies have reported that a higher red blood cell distribution width (RDW) level was associated with adverse outcomes in patients with the first stroke. However, no studies have examined the association between RDW and recurrent ischemic stroke. We performed a population-based cohort data analysis from 2007 to 2017. Baseline RDW was measured in 6402 first ischemic stroke participants, who were followed for about five years on average. During 62 months of median follow-up, 205 participants (3.20%) reported a recurrence (self-reported). RDW showed a nonlinear relationship with the risk of ischemic stroke recurrence. When RDW was assessed as quartiles (quartile 1, RDW<12.4; quartile 2, 12.4 to 12.8; quartile 3,12.8 to 13.3, quartile4, RDW>13.3), compared with the reference group (quartile 1), the hazard ratios (HRs) of ischemic stroke recurrence were 1.372 (95% confidence interval [CI]=0.671-2.805, P=0.386) in quartile 2, 1.835 (95% CI=1.222-2.755, P=0.003) in quartile 3, and 1.732 (95% CI=1.114-2.561, P<0.001) in quartile 4. The trend test was significant (P<0.001). When quartiles 3 and 4 were combined, the adjusted HR of ischemic stroke recurrence was 1.439 (95% CI=1.330-1.556, P<0.001) compared with the combined quartiles 1 and 2 subgroups. This study demonstrated that elevated RDW levels were positively associated with an increased risk of recurrent ischemic stroke. RDW can provide a new perspective for initial risk assessment and identify high-risk patients early. Further research is required to confirm our results.