Title : Exploring the role of the red cell distribution width in predicting clinical outcomes among adult patients admitted for stroke in a resource-limited setting: A 3-year retrospective single-center study

Background: Stroke is a leading cause of mortality and disability, and early identification of patients at risk for poor outcomes is important for timely intervention. Red cell distribution width(RDW), a routinely reported complete blood count parameter, has emerged as a potential marker of inflammation and adverse cardiovascular outcomes. This study evaluated its association with mortality and nosocomial infection among adults admitted with stroke.

Methods: This retrospective single-center study included adults admitted with stroke from January 2023 through December 2025. Medical records were reviewed for age, sex, smoking history, alcohol intake, comorbidities, admission Glasgow Coma Scale score, stroke type and chronicity, admission red cell distribution width, and clinical outcomes. Outcomes included 7day mortality, in-hospital mortality, nosocomial infection, infection-free duration, and length of hospital stay. Logistic regression was used to assess RDW as a predictor of 7-day mortality, while Cox proportional hazards regression evaluated in-hospital mortality and nosocomial infection. Kaplan–Meier survival analysis and linear regression were used for survival and length of stay, respectively. Sensitivity, specificity, and area under the curve (AUC) were calculated to assess the diagnostic performance of RDW.

Results: A total of 115 patients were included. Mean red cell distribution width was 13.36 ± 1.03% and was significantly higher among patients who died (P=0.018). Seven-day mortality was 6.09%, while overall in-hospital mortality was 7.83%. Nosocomial infection occurred in 57.39%, most commonly pneumonia. Mean infection-free duration was 4.52 ± 3.70 days, and mean hospital stay was 11.50 ± 9.05 days. Higher red cell distribution width was independently associated with 7-day mortality (adjusted odds ratio, 2.44; 95% confidence interval, 1.13–5.28; P=0.024) and in-hospital mortality (adjusted hazard ratio, 3.08; 95% confidence interval, 1.20– 7.78; P=0.019). Optimal red cell distribution width cutoffs were 14.24% for 7-day mortality and 14.15% for in-hospital mortality, with high specificity and negative predictive value.

Conclusions: Elevated red cell distribution width (RDW) is an inexpensive and readily available biomarker that independently predicts early and in hospital mortality among patients with stroke. Incorporating RDW into the initial assessment may improve risk stratification, enabling closer monitoring, timely interventions, and more efficient allocation of healthcare resources for highrisk patients, ultimately contributing to improved clinical outcomes.

Dr. Arvie Dorothy V. Parcon completed her residency training in Internal Medicine at Iloilo Mission Hospital. She earned her Bachelor of Science in Biological Science from West Visayas State University. Her interests include clinical practice and medical research, with a focus on improving patient care and outcomes.