Red cell distribution width as a predictor of 1-year survival in ischemic stroke patients treated with intravenous thrombolysis

Introduction: Red cell distribution width (RDW) has been found to be a prognostic marker in vascular diseases. Increased RDW predicted mortality and outcome after ischemic stroke however, the underlying mechanisms are unclear. Our study aimed to clarify the relation of RDW with stroke severity and 1-year survival. Material and methods: Single-centre retrospective cohort study based on a prospective database of consecutive patients with acute anterior circulation ischemic stroke treated with intravenous thrombolysis (IVT) in a 9-year period. Clinical characteristics were collected from the registry. Additional information, namely pre-IVT RDW, was retrieved from individual patient records. Information concerning survival during the first year after stroke was collected from the national Health Data Platform. Results: 602 patients were included. Patients in the higher RDW quartiles were older, and more frequently presented hypertension and cardioembolic etiology. RDW was higher in patients who presented early infection and a positive correlation was found between RDW and C-reactive protein. RDW was not associated with admission severity of stroke, neurological status 24 h after stroke or occurrence of symptomatic intracranial hemorrhage (sICH). Patients in the higher quartiles of RDW presented a lower 1-year survival (p < 0.001). After stepwise adjustment for variables of interest, including severity of ischemic stroke, sICH, and response to IVT, RDW remained a predictor of 1-year survival, specifically in patients >= 75 years and in patients with early post-stroke infection. Conclusions: RDW is a predictor of 1-year survival in patients with ischemic stroke treated with IVT, specifically in older patients and those who develop early infection, and its prediction value is independent from stroke severity and response to IVT.