High Red Blood Cell Distribution Width Levels Could Increase The Risk Of Neurological Outcomes After Intravenous Thrombolysis In Acute Ischemic Stroke Patients

Objective The correlation between red blood cell distribution width(RDW)and function prognosis and hemorrhagic transformation with in acute ischemic stroke(AIS)underwent recombinant tissue-type plasminogen activator(rt-PA)has not been determined.The purpose of this study was to explore the correlation between the red blood cell distribution width level and the prognosis and hemorrhagic transformation in patients with AIS treated with rt-PA.Methods AIS patients who received rt-PA in Subei Hospital between 1 January 2017 and 31 December 2019 were consecutively recruited into this study.Gender,age,cerebrovascular disease risk factors,and laboratory tests such as the baseline data,RDW of before thrombolysis patients were collected.CT examination was performed to assess the presence of symptomatic hemorrhagic transformation(sHT)and asymptomatic hemorrhagic transformation(asHT)24 hours after thrombolysis.The 3-month function prognosis of patients were evaluated by the modified Rankin Scale(mRS).All patients are divided into RDW<13.1%group and RDW≥13.1%group according to the median of RDW level,the unifactor analysis between the two groups of patients with the incidence of hemorrhagic transformation and poor functional prognosis,using the binary logistic regression analysis independent risk factors of functional prognosis at 3-month in AIS patients with rt-PA thrombolysis therapy.The receiver operating characteristic(ROC)analysis was conducted to evaluate the predictive ability of RDW to the poor function prognosis.All patients were divided into no HT group,asymptomatic HT group,and symptomatic HT group according to the presence of HT and sHT.The unifactor analysis between the three groups of the incidence of HT,sHT,and functional prognosis.Using the binary logistic regression analysis to clear independent risk factors of HT and sHT after thrombolysis.The ROC was conducted to evaluate the predictive ability of the RDW to the HT and sHT after thrombolysis.Restricted cubic spline model was used to investigate the linear relationship between RDW and HT and sHT.Results 1.A total of 286 patients were included for statistical analysis,RDW<13.1%group(140;49%)and RDW≥13.1%group(146;51%).Compared with RDW<13.1%group,the incidence of HT[4(2.9%)VS32(21.9%)],the incidence of sHT[2(1.4%)VS13(8.9%)]and the proportion of poor function prognosis[30(21.4%)VS61(41.8%)]in RDW≥13.1%group were significantly higher(all P<0.05).2.Spearman analysis showed that RDW was positively correlated with NIHSS score at admission(r=0.189,P<0.001),age(r=0.242,P<0.001),D-dimer(r=0.25,P<0.001),and negatively correlated with platelet count(r=-0.18,P=0.003).3.After adjusting for confounding factors,binary logistic regression analysis showed that RDW was an independent risk factor for 3-month poor prognosis of AIS patients underwent rt-PA thrombolysis,OR 1.43(95%CL:1.103-1.857,P=0.007).ROC analysis was used to analyze the predictive value of RDW on the function prognosis at 3-month.The results showed that the area under the curve(AUC)was 0.636,(95%CL:0.56-0.7;P<0.001),a sensitivity of 37.4%and a specificity of 35.2.4.By comparing with RDW levels and incidence of poor outcomes in no HT group,asymptomatic HT group and symptomatic HT group.Compared with no HT group,the RDW of asymptomatic HT group(13.06±0.92%VS14.28±0.73%%)and symptomatic HT group(13.06±0.92%VS14.55±2.04%%)were higher(P<0.05).However,there was no significant difference in RDW between asymptomatic HT group and symptomatic HT group(14.28±0.73%VS14.55±2.04%%)(P>0.05).Compared no HT group,the incidence of poor prognosis in symptomatic HT group[8(38.1%)VS11(73.3%)]was significantly higher(P=O.002),and compared asymptomatic HT group,the incidence of poor prognosis in no HT group[(72(28.8%)VS11(73.3%)]and symptomaticHT[8(38.1%)VS11(73.3%)]were no significant(P>0.05).5.Binary multivariate logistic regression analysis showed that RDW was an independent risk factor for HT and sHT in AIS patients received rt-PA thrombolytic therapy,with OR 2.48(95%CI 1.68-3.667,P<0.001)and 1.82(95%CI 1.25-2.66,P=0.002),respectively.6.The ROC indicated that the AUC of RDW for evaluating HT was 0.842(95%CL:0.78-0.9;P<0.001),a sensitivity of 86.1%,and a specificity of 72.4%.The AUC for assessing sHT was 0.78(95%CL:0.67-0.88;P<0.001),a sensitivity of 80%,and a specificity of 67.5%.7.Restricted cubic spline model shows a dose-dependent increase in RDW levels with the risk of HT and sHT after thrombolysis.Conclusions 1.For acute ischemic stroke patients underwent rt-PA,elevated RDW level before thrombolysis may be an independent risk factor for the 3-month poor function;2.RDW level before thrombolysis was positively correlated with the incidence of HT and sHT after rt-PA thrombolysis in acute ischemic stroke patients;3.RDW level before thrombolysis may be a biomarker to predict the HT,sHT,and poor function prognosis after rt-PA thrombolytic in acute ischemic stroke patients.