Relationship Between Red Blood Cell Distribution Width And Hematoma Expansion And Prognosis In Spontaneous Intracerebral Hemorrhage

Objective: To investigate whether red blood cell distribution width(RDW)can predict hematoma expansion and 3-month poor prognosis in spontaneous intracerebral hemorrhage.Methods: Consecutive patients with acute spontaneous intracerebral hemorrhage(within 12 hours of onset)admitted to Baotou Central Hospital from March 2018 to October2021 were collected.This study is a continuous observational registry.The baseline data of patients were collected,including demographics including gender and age;clinical information data included smoking and drinking history,hypertension and diabetes history,admission systolic blood pressure(SBP),admission stroke scale score(NIHSS)and Glasgow Coma Index score(GCS);imaging data included initial hematoma volume and ventricular rupture;hematological parameters on admission included red blood cell distribution width(RDW),white blood cell(WBC),neutrophil and lymphocyte ratio(NLR),international standard value(INR),hemoglobin,etc.CT follow-up was repeated within 24 hours after the first head unenhanced CT(NCCT)scan,and two neurologists in the cerebral hemorrhage research group independently assessed the CT scan results of all patients without knowledge of the patients.Hematoma volume was estimated by the Dotian formula:(ax bx c)/2method.Hematoma expansion was defined as an absolute increase of 6 ml or a relative increase of greater than 33% in the amount of hematoma from the baseline volume on repeat head CT within 24 hours of onset.The patients were divided into two groups according to whether the hematoma was enlarged,and the baseline data of the patients were compared by univariate analysis to determine whether RDW was associated with hematoma enlargement.Regarding prognosis,patients who met the criteria were followed up in the outpatient department or by telephone for 90 ± 7 days,and the prognosis of the patients was assessed by the modified Rankin Scale(m RS)score,with m RS ≤ 2 as the good prognosis group and m RS > 2 as the poor prognosis group.Baseline data were compared between the two by univariate analysis to assess whether RDW was associated with poor prognosis.Using logistics regression analysis,three models were established,Model1 was not adjusted for univariate;Model2 was adjusted for gender,age,smoking history,drinking history,diabetes history,and hypertension history;Model3 was adjusted for admission NIHSS score,admission GCS score,systolic blood pressure,hemoglobin,INR,WBC,NLR,and hematoma volume on the basis of Model2,which ruptured into the ventricle to explore whether RDW could independently predict hematoma expansion and poor 3-month prognosis.Receiver operating characteristic curves(ROC curves)were used to investigate the predictive ability of RDW for hematoma expansion and 3-month prognosis.The correlation between RDW and WBC,NLR was analyzed using pearson or spearman regression.Results: A total of 352 patients were included,and hematoma enlargement was 20.5%(72 patients).The prognosis was poor in 64.5%(227 patients).The RDW of hematoma expansion and poor prognosis were higher than those of the control group,and the difference was significant.Univariate analysis of hematoma expansion group revealed that previous history of diabetes(P = 0.015),NIHSS score at admission(P = 0.001),initial hematoma volume(P = 0.001),and RDW(P < 0.001)were significantly associated with hematoma expansion.Logistic regression analysis revealed that RDW could independently predict hematoma expansion(OR 1.55 [95% CI 1.31 – 1.85])(P < 0.001),with an area under the ROC curve of 0.71,95% CI 0.64 – 0.77,cutoff value of13.40,sensitivity of 66.67%,and specificity of 67.14%;univariate analysis in the poor prognosis group revealed that older age,previous smoking history,higher NIHSS score on admission,lower GCS score,larger hematoma volume,and increased penetration into the ventricles were associated with poor prognosis.WBC(P < 0.001),NLR(P < 0.001),and RDW(P < 0.001)values were significantly increased in poor prognosis.Logistic regression analysis revealed that RDW could independently predict 3-month poor prognosis(OR 1.68 [95% CI1.44 – 1.96])(P < 0.001),with an area under the ROC curve of 0.73,95% CI 0.67 – 0.78,a cutoff value of 13.0,a sensitivity of 67.40%,and a specificity of 66.40%.In addition,there was a positive correlation between RDW and inflammatory cells WBC and NLR.Conclusion:Higher levels of RDW may be associated with hematoma expansion and poor 3-month prognosis;the increase of RDW values may be associated with chronic inflammatory status.