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Systematic Review ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Neurol. | doi: 10.3389/fneur.2019.01237

Baseline red blood cell distribution width as a predictor of stroke occurrence and outcome: A comprehensive Meta-Analysis of 31 studies

 SIYING SONG1, 2, 3,  Ran Meng1, 2*, Chang Hua4, Ruijun Kang5, Xiaoxi Zhao1, Xin Du4* and Wen He5*
  • 1Department of Neurology, Xuanwu Hospital, Capital Medical University, China
  • 2Center of Stroke, Beijing Institute for Brain Disorders, China
  • 3Xuanwu Hospital, Capital Medical University, China
  • 4Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, China
  • 5Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, China

Background: Red blood cell distribution (RDW) may be a potential biomarker of inflammation in patients with stroke. Elevated RDW is associated with higher incidence of stroke, unfavorable functional outcome and increased mortality, although results are inconsistent in the reported literature. This study aims to evaluate the predictive power of RDW regarding stroke occurrence and outcome.
Methods: A thorough literature search was conducted utilizing the PubMed Central (PMC) and EMBASE databases to identify studies up to May 2019. Data from these studies was pooled, and combined odds ratios/risk ratios (ORs/RRs) were estimated for the risk of stroke, functional outcome and mortality. Subgroup analysis was also performed to explore heterogeneity in terms of population status, demographic factors (age, gender distribution, and country), and vascular risk factors (hypertension, diabetes mellitus and current smoking).
Results: A total of 31 studies with 3,487,896 patients were included in the analysis. Elevated RDW was found to be a risk factor in ischemic stroke (OR 1.528; 95% CI 1.372-1.703), while combined OR in subarachnoid hemorrhage (SAH) was not statistically significant (OR 1.835; 95% CI 0.888-3.792). Elevated RDW posed increased risk in populations with conventionally higher risk of stroke, such as atrial fibrillation (AF) (OR 1.292; 95% CI 1.107-1.508) and diabetes mellitus (OR 2.101; 95% CI 1.488-2.968), and in community cohorts (OR 1.245; 95% CI 1.216-1.275). In addition, higher RDW was associated with unfavorable functional outcome, either at discharge (OR 1.220; 95% CI 1.070-1.39) or at 90 days (OR 1.277; 95% CI 1.155-1.413). Higher mortality was found in patients with increased RDW (OR 1.278; 95% CI 1.221-1.337), independent of demographic factors (age, gender distribution, country).
Conclusions: Baseline RDW should be integrated into clinical practice as a predictor of ischemic stroke occurrence and outcome. Future studies should also explore the dynamic change of RDW in post-stroke patients to evaluate the clinical significance of RDW and its impact on the inflammatory state of ischemic stroke.

Keywords: Stroke, Red blood cell distribution width (RDW), Risk factor (source: MeSH, Mortality, functional outcome after acute stroke, Meta - analysis

Received: 11 Jun 2019; Accepted: 06 Nov 2019.

Copyright: © 2019 SONG, Meng, Hua, Kang, Zhao, Du and He. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Dr. Ran Meng, Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China, victor65@126.com
Mx. Xin Du, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China, duxinheart@sina.com
Mx. Wen He, Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, hewen168@sohu.com