title: Elevated Red Cell Distribution Width is Associated with Cerebral Infarction in Aneurysmal Subarachnoid Hemorrhage.
abstract: 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.
authors.affiliation: Departments of Neurology and Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA. james.siegler@uphs.upenn.edu.
authors.forename: James E
authors.initials: JE
authors.lastname: Siegler
authors.affiliation: Departments of Neurology and Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA.
authors.forename: Christy
authors.initials: C
authors.lastname: Marcaccio
authors.affiliation: Departments of Neurology and Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA.
authors.forename: Kelsey
authors.initials: K
authors.lastname: Nawalinski
authors.affiliation: Departments of Neurology and Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA.
authors.forename: Francis
authors.initials: F
authors.lastname: Quattrone
authors.affiliation: Departments of Neurology and Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA.
authors.forename: Danielle K
authors.initials: DK
authors.lastname: Sandsmark
authors.affiliation: Departments of Neurology and Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA.
authors.forename: Eileen
authors.initials: E
authors.lastname: Maloney-Wilensky
authors.affiliation: Departments of Neurology and Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Frangos
authors.affiliation: Departments of Neurology and Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Levine
authors.affiliation: Departments of Neurology and Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA.
authors.forename: Sherman C
authors.initials: SC
authors.lastname: Stein
authors.affiliation: Departments of Neurology and Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Kasner
authors.affiliation: Departments of Neurology and Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA.
authors.forename: Monisha A
authors.initials: MA
authors.lastname: Kumar
mesh_terms: D000328:Adult; D000368:Aged; D002544:Cerebral Infarction / Q000097:blood*; D004909:Erythrocyte Indices / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000097:blood*
keywords: Hypercoagulability; Outcomes research; Red blood cell distribution width; Stroke; Subarachnoid hemorrhage