Red blood cell distribution width to platelet ratio predicts early neurological deterioration in acute ischemic stroke patients receiving intravenous thrombolysis

Min Jiang; Jun Shen; Bilal Muhammad; Deqin Geng

doi:10.1016/j.jstrokecerebrovasdis.2023.107146

Red blood cell distribution width to platelet ratio predicts early neurological deterioration in acute ischemic stroke patients receiving intravenous thrombolysis

J Stroke Cerebrovasc Dis. 2023 Jul;32(7):107146. doi: 10.1016/j.jstrokecerebrovasdis.2023.107146. Epub 2023 May 4.

Authors

Min Jiang¹, Jun Shen², Bilal Muhammad³, Deqin Geng⁴

Affiliations

¹ The First School of Clinical Medicine, Nanjing Medical University, Nanjing, Jiangsu 210029, China; Department of Neurology, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, Jiangsu 223002, China.
² Department of Neurology, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, Jiangsu 223002, China.
³ School of Graduate, Xuzhou Medical University, Xuzhou, Jiangsu 221002, China.
⁴ The First School of Clinical Medicine, Nanjing Medical University, Nanjing, Jiangsu 210029, China; Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, China. Electronic address: gengdeqin@126.com.

PMID: 37148627
DOI: 10.1016/j.jstrokecerebrovasdis.2023.107146

Abstract

Background: Inflammation plays a prominent role in the pathogenesis and progression of acute ischemic stroke (AIS). The red blood cell distribution width to platelet ratio (RPR) has been demonstrated as a novel biomarker to indicate the severity of inflammatory reaction. This study aimed to explore the association between RPR before intravenous thrombolysis and early neurological deterioration (END) after thrombolysis in AIS patients.

Methods: AIS patients accepting intravenous thrombolysis were recruited continuously. Postthrombolysis END was defined as death or an increase in the National Institute of Health Stroke Scale (NIHSS) score ≥4 points within 24 h after intravenous thrombolysis compared to the NIHSS score before intravenous thrombolysis. We constructed univariate and multivariate logistic regression analyses to investigate the relationship of RPR before intravenous thrombolysis to postthrombolysis END. Moreover, a receiver operating characteristic (ROC) curve was applied to examine the discriminative utility of RPR before intravenous thrombolysis in predicting postthrombolysis END.

Results: A total of 235 AIS patients were included, and 31 (13.19%) subjects underwent postthrombolysis END. The univariate logistic regression analysis demonstrated that RPR before intravenous thrombolysis was significantly related to postthrombolysis END (odds ratio [OR], 2.162; 95% confidence interval [CI], 1.605-2.912; P < 0.001). After adjusting for potential confounding variables with P < 0.15 in the univariate logistic regression analysis, the difference remained statistically significant (OR, 2.031; 95% CI, 1.436-2.873; P < 0.001). Furthermore, an optimal cutoff value of 7.66 for RPR before intravenous thrombolysis in predicting postthrombolysis END was observed in the ROC curve analysis, and the sensitivity and specificity were calculated as 61.3% and 81.9%, respectively (area under the curve [AUC], 0.772; 95% CI, 0.684-0.860; P < 0.001).

Conclusions: RPR before intravenous thrombolysis might be an independent risk factor for postthrombolysis END in AIS patients. Elevated levels of RPR before intravenous thrombolysis may predict postthrombolysis END.

Keywords: Acute ischemic stroke; Early neurological deterioration; Intravenous thrombolysis; Red blood cell distribution width to platelet ratio.

MeSH terms

Brain Ischemia* / diagnosis
Brain Ischemia* / drug therapy
Erythrocytes
Humans
Ischemic Stroke* / complications
Stroke* / diagnosis
Stroke* / drug therapy
Thrombolytic Therapy / adverse effects