The Association between Red Cell Distribution Width and Stroke in Patients with Atrial Fibrillation.
Am J Med. 2014 Oct 15;
Authors: Saliba W, Barnett-Griness O, Elias M, Rennert G
Abstract
BACKGROUND: Red cell distribution width is associated with increased risk of cardiovascular morbidity and mortality. We aimed to assess its association with stroke in patients with atrial fibrillation.
METHODS: Using the computerized database of the largest HMO in Israel we identified a cohort of adults with atrial fibrillation diagnosed before January 1(st) 2012. Eligible subjects were not on anticoagulants at baseline, and had at least one blood cell count performed in 2011 (41,140 subjects). The cohort was followed for the first occurrence of stroke until December 31(st) 2012.
RESULTS: Overall 1,692 subjects developed stroke during 38,024 person-years follow up, (stroke rate, 4.45 per 100 person-years). Stroke incidence rate increased across red cell distribution width quartiles; 3.26, 3.71, 5.01, and 6.05 per 100 person-years, respectively. On multivariate analysis adjusting for CHADS2 score risk factors, the HR for stroke was 1.29 (95% CI, 1.17-1.42) in subjects with red cell distribution width >14.5% compared to those with values ≤14.5%, and was similar in subjects with and without anemia. When analyzed as quartiles, the HR for stroke was 1.33 (1.15-1.53) in the highest quartile compared to the lowest quartile, and was similar in subjects with and without anemia. The area under the receiver operating characteristic curve was 0.598 for CHADS2 score, and increased to 0.618 when red cell distribution width was included in the model (P<0.001).
CONCLUSIONS: Red cell distribution width is directly associated with the risk of stroke regardless of anemia status, and improves the predictive accuracy for stroke in patients with atrial fibrillation.
PMID: 25447618 [PubMed - as supplied by publisher]