Prognostic relevance of admission blood parameters in hemorrhagic stroke: A large-scale, total sampling study

Objectives: Hemorrhagic stroke remains one of the deadliest cerebrovascular events, carrying high risks of mortality and long-term disability, particularly in low- and middle-income countries where access to advanced diagnostic modalities is limited. The objective of this study was to evaluate the prognostic value of simple hematological parameters, specifically red cell distribution width-standard deviation (RDW-SD), neutrophil-to-lymphocyte ratio (NLR), and serum sodium in predicting functional outcomes and in-hospital mortality among patients with hemorrhagic stroke in East Kalimantan, Indonesia. Materials and Methods: A retrospective, population-based cohort design was applied using total sampling of 219 patients admitted to Abdoel Wahab Sjahranie General Hospital in 2024 with radiologically confirmed hemorrhagic stroke. Clinical and laboratory data were retrieved from medical records, including hematological and biochemical indicators. Functional outcome was assessed using the Barthel Index, while survival status at discharge was analyzed as the primary endpoint. Statistical analyses included correlation testing, linear and logistic regression, and decision tree modeling. Results: The results demonstrated that RDW-SD was a robust independent predictor of both functional impairment and mortality, with higher RDW-SD values significantly associated with lower Barthel Index scores ( P = 0.003; B = –0.318) and greater in-hospital mortality risk ( P = 0.006; odds ratio (OR) = 1.148). Elevated NLR and serum sodium levels were also linked to poorer prognosis, particularly with respect to mortality. Decision tree analysis revealed that patients presenting with RDW-SD >41.5 combined with NLR >8.9 had the lowest functional outcomes and the highest mortality risk. Although the regression models explained only a modest proportion of variance (7.1% for functional outcomes and 19.7% for mortality), these findings emphasize the clinical utility of routine hematological testing. Conclusion: RDW-SD, NLR, and serum sodium represent accessible, inexpensive, and reproducible markers with meaningful prognostic value in hemorrhagic stroke. Their integration into triage and early risk stratification protocols may improve clinical decision-making, especially in healthcare systems with limited neuroimaging and intensive monitoring resources.