Relationship between platelet indices and red cell distribution width and short-term mortality in traumatic brain injury with 30-day mortality

The association between the dynamics of red cell distribution width to lymphocyte ratio and clinical outcomes in patients with traumatic brain injury

BACKGROUND

Traumatic brain injury (TBI) is a major cause of morbidity and mortality, particularly among young individuals. This study investigates the correlation between the dynamic of Red Cell Distribution Width to Lymphocyte Ratio (RDWLR) and clinical outcomes in patients with moderate to severe TBI.

METHODS

A retrospective analysis was conducted on 405 consecutive patients with moderate to severe TBI admitted between July 2018 and July 2023. Clinical outcomes were assessed using the Glasgow Outcome Scale (GOS), categorized into favorable (GOS 4,5) and unfavorable outcomes (GOS 1,2,3). Data on demographics, clinical presentation, radiological findings, and laboratory tests were collected. Binary logistic regression analyzed the independent associations between variables, including changes in RDWLR over four days.

RESULTS

Among the 405 patients, 53.1% were male, with an average age of 33.21 years. ROC curve analysis identified a delta RDWLR threshold of 0.001. Of the patients, 67.1% had low delta RDWLR, while 33.8% had high delta RDWLR. Multivariate analysis showed that Glasgow Coma Scale (GCS) (OR 3.22; p < 0.001), light reflex (OR 1.87; p = 0.025), Rotterdam CT score (OR 2.33; p = 0.025), and change in RDWLR (OR 1.68; p = 0.031) were significantly associated with poor clinical outcomes.

CONCLUSIONS

These findings suggest that delta RDWLR has potential as as a prognostic indicator of poor clinical outcomes in patients with moderate to severe traumatic brain injury (TBI), providing a cost-effective biomarker for clinical prognosis. However, further validation through prospective multicenter studies is needed.

Red blood cell distribution width as a predictor of mortality and poor functional outcome after acute ischemic stroke: a meta-analysis and meta-regression

BACKGROUND

This study aimed to review evidence on the ability of red cell distribution width (RDW) to predict mortality and poor functional outcomes after acute ischemic stroke (AIS).

METHODS

Databases of PubMed, CENTRAL, Scopus, Embase, and Web of Science were searched online from inception to 25th Jul 2023 for all studies reporting the association between RDW and outcomes as adjusted ratios. A random-effects meta-analysis was done. Meta-regression was conducted using multiple moderators.

RESULTS

15 studies with 14,968 patients were included. Meta-analysis found that RDW, both as a categorical variable (OR: 2.10 95% CI: 1.74, 2.55 I2 = 42%) and continuous variable OR: 1.16 95% CI: 1.05, 1.28 I2 = 64%) was a significant predictor of mortality after AIS. Age and number of hypertensives were found to be significant moderators in the meta-regression. Also, high RDW, as a categorical variable (OR: 1.68 95% CI: 1.20, 2.35 I2 = 84%), was associated with significantly higher odds of poor functional outcomes after AIS, but not as a continuous variable (OR: 1.07 95% CI: 0.99, 1.16 I2 = 61%). Meta-regression showed that the association was stronger in small sample-sized studies.

CONCLUSION

RDW can be a useful, readily available, and cost-effective biomarker to rapidly stratify AIS patients at risk of poor outcomes. High RDW was consistently associated with an increased risk of mortality after AIS, however, its ability to predict poor functional outcomes needs to be verified by further studies.