İskemik İnmeli Acil Servis Hastalarında Başvuru Hemoglobin-Eritrosit Dağılım Genişliği Oranı ve 90 Günlük Sonlanımlar: Retrospektif Kohort Çalışması

Öz

Amaç: Rutin tam kan sayımından elde edilen düşük maliyetli bir belirteç olan hemoglobin-eritrosit dağılım genişliği oranının (HRR) başvuru anındaki değerinin, iskemik inmeli acil servis hastalarında 90 günlük mortalite ve fonksiyonel sonlanım ile bağımsız ilişkisini ve ayırt ediciliğini araştırmayı amaçladık. Gereç ve Yöntem: Bu retrospektif tek merkezli kohort çalışmasında, Nisan 2022–Mart 2023 arasında acil servise iskemik inme ile başvuran ardışık erişkin hastalar incelendi. Başvuru HRR'si hemoglobin (g/dL) / RDW (%) olarak hesaplandı. Birincil sonlanım 90 günlük tüm nedenlere bağlı mortalite; ikincil sonlanım 90. günde kötü fonksiyonel sonlanımdı (modifiye Rankin Skalası 3–6; ölen hastalara 6 puanı atandı). Ayırt edicilik eğri altındaki alan (AUC) ile, bağımsız ilişki ise yaş, cinsiyet, komorbidite ve başvuru NIHSS için düzeltilmiş çok değişkenli lojistik regresyon ile değerlendirildi. Bulgular: 518 hastanın 117'si (%22,6) 90 gün içinde öldü ve 209'unda (%40,3) kötü fonksiyonel sonlanım gelişti. Ölenlerde başvuru HRR'si sağ kalanlardan düşüktü (0,86'ya karşı 0,93; p<0,001). Tek başına HRR mortaliteyi sınırlı düzeyde ayırt etti (AUC 0,609, %95 GA 0,549–0,669; Youden eşiği 0,835). Düzeltme sonrası yüksek HRR bağımsız olarak düşük mortalite ile ilişkiliydi (standart sapma başına düzeltilmiş olasılık oranı 0,70, %95 GA 0,55–0,90; p=0,005) ve bu ilişki çoklu atama ve ikili sınıflamada tutarlıydı. HRR'nin klinik değişkenlere eklenmesi ayırt ediciliği artırmadı (ΔAUC 0,008, %95 GA −0,009–0,026; DeLong p=0,370). Sonuç: Başvuru anındaki düşük HRR, iskemik inme sonrası yüksek 90 günlük mortalite ve kötü fonksiyonel sonlanım ile bağımsız olarak ilişkiliydi. Tek başına sınırlı ayırt ediciliği göz önüne alındığında, HRR klinik değerlendirmeyi tamamlayabilir; ancak bu kohortta ek öngörü değeri gösterilmemiştir.

Anahtar Kelimeler

• Acil tıp
• Eritrosit indisleri
• Hemoglobinler
• İskemik inme
• Prognoz

Etik Beyan

Çalışma, Bolu Abant İzzet Baysal Üniversitesi Klinik Araştırmalar Etik Kurulu tarafından onaylanmıştır (karar no. 2023/219, tarih 20 Haziran 2023)

Admission Hemoglobin-to-Red-Cell-Distribution-Width Ratio and 90-Day Outcomes in Emergency Department Patients with Ischemic Stroke: A Retrospective Cohort Study

Öz

Objective: Hemoglobin-to-red-cell-distribution-width ratio (HRR) is an inexpensive complete blood count index. We examined whether admission HRR is independently associated with and discriminates 90-day mortality and functional outcome after emergency department ischemic stroke. Material and Methods: In this retrospective single-center cohort study, consecutive adults with ischemic stroke presenting to the emergency department between April 2022 and March 2023 were analyzed. Admission HRR was hemoglobin (g/dL) divided by red cell distribution width (RDW, %). The endpoints were 90-day all-cause mortality (primary) and poor functional outcome (modified Rankin Scale 3–6 at 90 days, death assigned 6; secondary). Discrimination was assessed by the area under the curve (AUC) and independent association by multivariable logistic regression adjusted for age, sex, comorbidity, and admission stroke severity. Results: Of 518 patients, 117 (22.6%) died by 90 days and 209 (40.3%) had a poor functional outcome. Non-survivors had a lower admission HRR than survivors (0.86 vs 0.93; p<0.001). In isolation, HRR discriminated mortality only modestly (AUC 0.609, 95% CI 0.549–0.669; Youden cut-off 0.835). After adjustment, a higher HRR was independently associated with lower mortality (adjusted odds ratio 0.70 per standard deviation, 95% CI 0.55–0.90; p=0.005), consistent across sensitivity analyses. Adding HRR to clinical covariates did not improve discrimination (ΔAUC 0.008, 95% CI −0.009 to 0.026; DeLong p=0.370). Conclusion: A lower admission HRR was independently associated with higher 90-day mortality and worse functional outcome after ischemic stroke. Given its modest stand-alone discrimination, HRR may complement clinical assessment, but its added predictive value was not demonstrated in this cohort.

Anahtar Kelimeler

• Emergency Medicine
• Erythrocyte Indices
• Hemoglobins
• Ischemic Stroke
• Prognosis

Etik Beyan

The study was approved by the Bolu Abant İzzet Baysal University Clinical Research Ethics Committee (decision no. 2023/219, dated 20 June 2023).

Kaynakça

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