Can a Simple Blood Test Predict Prognosis in Intracerebral Hemorrhage?

Lauren Derhodge, DO, for Medscape

January 13, 2022

The study covered in this summary was published in Research Square as a preprint and has not yet been peer reviewed.

Key Takeaways

  • Higher levels of red cell distribution width (RDW), neutrophil to lymphocyte ratio (NLR), neutrophil count, and platelet count are associated with increased severity and mortality in patients with intracerebral hemorrhage (ICH).

  • RDW may be a predictive biomarker for 3-month survival in ICH patients, but this needs to be validated in larger prospective studies.

  • This study was published as a preprint and has not yet been peer reviewed.

Why This Matters

  • The prevalence of intracerebral hemorrhage (ICH) has increased, with 20.66 million cases worldwide in 2019.

  • ICH is associated with high rates of disability and mortality. 

  • The complete blood count (CBC), a routinely ordered laboratory test, includes measures that appear to be predictive for ICH prognosis.

Study Design

  • This retrospective cohort study included a random sample of 140 hospitalized patients with ICH in Tabriz, Iran.

  • Patient demographics, CBC parameters, and National Institutes of Health Stroke Scale (NIHSS) scores were measured within 24 hours of admission.

  • The authors evaluated mortality at the time of discharge within a 28-day hospitalization and 3-month follow-up.

  • The primary objective was to assess the relationship between RDW, NLR, and neutrophil to platelet ratio (NPR), as well as prognosis in ICH.

Key Results

  • There were significant differences in mean NLR (P = .05) and platelet counts (P = .05) between patients who had died within 3 months and those who had survived.

  • Higher NIHSS scores were correlated with 3-month mortality (P < .01), whereas higher neutrophil count was correlated with increased survival (P = .04).

  • On regression analysis, RDW (P = .006), platelet count (P = .047), red blood cell count (P = .007), and NIHSS score (P < .001) were independent predictors of 3-month mortality.


  • The study was retrospective, lacked a control group, and was conducted at a single institution.

  • Study outcomes were assessed at only two timepoints, and follow-up was short at 3 months.

  • Abnormal RDW has been associated with prognosis in multiple health conditions and could also be associated with poorer general health.

  • More extensive, prospective studies are needed to further assess the relationships between the study variables and ICH prognosis and to control for other variables that may impact RDW.

Study Disclosures

  • The study received no commercial funding.

  • None of the authors disclosed relevant financial relationships.

This is a summary of a preprint research study, "Correlation Between Red Blood Cell Distribution Width, Neutrophil to Lymphocyte Ratio and Neutrophil to Platelet Ratio With 3-Month Prognosis of Patients With Intracerebral Hemorrhage: A Retrospective Study," written by Dr Sheida Shaafi from Tabriz University of Medical Sciences and colleagues on Research Square, provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on

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