Elevated Red Cell Distribution Width is Associated with Cerebral Infarction in Aneurysmal Subarachnoid Hemorrhage
Elevated Red Cell Distribution Width is Associated with Cerebral Infarction in Aneurysmal Subarachnoid Hemorrhage
复制标题
DOI：
10.1007/s12028-016-0306-2
复制
发表时间：
2017-02-01
影响因子：
3.5
通讯作者：
Kumar, Monisha A.
中科院分区：
文献类型：
--
作者：
Siegler, James E.;Marcaccio, Christy;Kumar, Monisha A.
红细胞分布宽度（RDW）升高与血栓性疾病相关，包括心肌梗死、静脉血栓栓塞和缺血性中风，独立于其他炎症和凝血生物标志物。本研究的目的是确定RDW升高是否与动脉瘤性蛛网膜下腔出血（aSAH）后脑梗死和预后不良有关。在2009年10月至2014年9月的aSAH患者回顾性单中心队列研究中，RDW升高被定义为aSAH后14天内平均RDW升高14.5%。结局包括任何机制的脑梗死（CI）和功能不良结局，定义为出院修正Rankin量表（mRS） bbbb4，表明严重残疾或死亡。179例患者中，27%为高Hunt-Hess分级（IV-V级），76%为女性。24例患者（13.4%）接受了红细胞（RBC）输血，与RDW正常的患者相比，RDW升高的患者输血的几率更大（OR 2.56 [95% CI, 1.07-6.11], p = 0.035）。在单因素分析中，更多RDW升高的患者出现CI （30.8% vs. 13.7%, p = 0.017）。在多变量模型中，RDW升高与CI显著相关（OR 3.08 [95% CI, 1.30-7.32], p = 0.011），独立于已知混杂因素，包括但不限于年龄、性别、种族、高Hunt-Hess分级和红细胞输血。在多变量分析中，RDW升高也与出院时较差的功能预后（mRS bbbb4）相关（OR 2.59 [95% CI, 1.04-629], p = 0.040）。RDW升高与aSAH后脑梗死和不良预后相关。进一步评估这种关联是有必要的，因为它可能揭示aSAH后贫血、炎症和血栓形成之间的机制关系。
Elevated red blood cell distribution width (RDW) has been associated with thrombotic disorders including myocardial infarction, venous thromboembolism, and ischemic stroke, independent of other inflammatory and coagulation biomarkers. The purpose of this study was to determine whether elevated RDW is associated with cerebral infarction and poor outcome after aneurysmal subarachnoid hemorrhage (aSAH).In this retrospective single-center cohort of aSAH patients (October 2009-September 2014), elevated RDW was defined as a mean RDW > 14.5 % during the first 14 days after aSAH. Outcomes included cerebral infarction (CI) by any mechanism and poor functional outcome, defined as discharge modified Rankin Scale (mRS) > 4, indicating severe disability or death.Of 179 patients, 27 % had a high Hunt-Hess grade (IV-V), and 76 % were women. Twenty-four patients (13.4 %) underwent red blood cell (RBC) transfusion and compared to patients with normal RDW, patients with an elevated RDW were at greater odds of RBC transfusion (OR 2.56 [95 % CI, 1.07-6.11], p = 0.035). In univariate analysis, more patients with elevated RDW experienced CI (30.8 vs. 13.7 %, p = 0.017). In the multivariable model, elevated RDW was significantly associated with CI (OR 3.08 [95 % CI, 1.30-7.32], p = 0.011), independent of known confounders including but not limited to age, sex, race, high Hunt-Hess grade, and RBC transfusion. In multivariable analysis, RDW elevation was also associated with poor functional outcome (mRS > 4) at discharge (OR 2.59 [95 % CI, 1.04-629], p = 0.040).RDW elevation is associated with cerebral infarction and poor outcome after aSAH. Further evaluation of this association is warranted as it may shed light on mechanistic relations between anemia, inflammation, and thrombosis after aSAH.