Relationship Between the Hemoglobin-to-Red Cell Distribution Width Ratio and All-Cause Mortality in Ischemic Stroke Patients with Atrial Fibrillation: An Analysis from the MIMIC-IV Database

Zuoan Qin; Nuohan Liao; Xuelin Lu; Xiangjie Duan; Quan Zhou; Liangqing Ge

doi:10.2147/NDT.S350588

Relationship Between the Hemoglobin-to-Red Cell Distribution Width Ratio and All-Cause Mortality in Ischemic Stroke Patients with Atrial Fibrillation: An Analysis from the MIMIC-IV Database

Neuropsychiatr Dis Treat. 2022 Feb 18:18:341-354. doi: 10.2147/NDT.S350588. eCollection 2022.

Authors

Zuoan Qin^{1

2}, Nuohan Liao³, Xuelin Lu⁴, Xiangjie Duan⁵, Quan Zhou⁶, Liangqing Ge^{1

2}

Affiliations

¹ Jinan University, Guangzhou, 510632, People's Republic of China.
² Department of Cardiology, The First People's Hospital of Changde City, Changde, 415003, People's Republic of China.
³ University of South China, Hengyang, Hunan, 421002, People's Republic of China.
⁴ Department of Pathology, The First People's Hospital of Changde City, Changde, 415003, People's Republic of China.
⁵ Department of Infectious Diseases, The First People's Hospital of Changde City, Changde, 415003, People's Republic of China.
⁶ Department of Science and Education, The First People's Hospital of Changde City, Changde, 415003, People's Republic of China.

Abstract

Aim: To investigate the association between the hemoglobin-to-red cell distribution width (RDW) ratio (HRR) and all-cause mortality in ischemic stroke patients with atrial fibrillation (AF).

Design: This study was a retrospective cohort analysis. In total, 1018 ischemic stroke patients with AF were enrolled using the Medical Information Mart for Intensive Care database, (MIMIC)-IV. The patients were divided into four groups according to the HRR values. The primary outcome was 180-day all-cause mortality.

Methods: Multivariate Cox proportional risk regression models were used to examine the association between HRR and all-cause mortality. The non-linear relationship between HRR and all-cause mortality was confirmed using a Cox proportional risk regression model fitted by cubic spline function and smooth curve fitting.

Results: A total of 246/1018 patients (24.17%) died. The serum HRR values were negatively associated with 180-day all-cause mortality (hazard ratio (HR) 0.80, 95% confidence interval (CI) 0.68-0.94). A two-piecewise regression model was used to obtain a threshold inflection point value of 9.74. The HR and the 95% CI on the left inflection point were 0.73 and 0.61-0.87 (p = 0.0005); on the right inflection point they were 1.06 and 0.82-1.38 (p = 0.6383).

Conclusion: The relationship between all-cause mortality and the HRR values was non-linear in ischemic stroke patients with AF. All-cause mortality and HRR values were negatively correlated when the HRR value was ≤9.74.

Keywords: MIMIC-IV; all-cause mortality; atrial fibrillation; ischemic stroke.

Grants and funding

This article is funded by the Technology Research and Development Funding Project of Hunan Provincial Innovation Platform and Talent Program Clinical Medical Research Center (No.2021SK4042).