A cohort study of patients with anemia on admission and fatality after acute ischemic stroke

Zeng, Hao; Wu, Bo; Wang, Deren; Lin, Sen; Tao, Wendan; Liu, Ming

doi:10.1016/j.jocn.2012.05.020

Cited by 63 publications

(66 citation statements)

References 34 publications

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“…After detailed screening, 20 studies were included in our systematic review; the flow chart of study selection is shown in Figure 4, and Tables 5 and 6 show the key features of the selected studies. Overall, 10 studies assessed the impact of anemia on stroke1, 2, 10, 16, 17, 18, 19, 20, 21, 22 and 10 evaluated the association between stroke and hemoglobin levels 6, 7, 8, 9, 23, 24, 25, 26, 27, 28. In terms of study design, 3 were retrospective cohort studies,1, 16, 20 13 were prospective cohort studies,2, 6, 7, 8, 9, 10, 17, 18, 19, 22, 23, 24, 25 and 2 were secondary analyses of randomized control trials 27, 28.…”

Section: Resultsmentioning

confidence: 99%

“…There were also 2 studies that did not state the design 21, 26. There was a high degree of diversity in geographic location, with cohorts from Germany,8, 19, 25 Switzerland,16, 20 the United States,18, 24 the People's Republic of China,2, 22 Canada,23, 28 India,6 Israel,10 the Republic of Korea,9 Denmark,21 Taiwan,17 the United Kingdom,26 and Poland 7. In addition, 2 studies were conducted across multiple countries 1, 27.…”

Section: Resultsmentioning

confidence: 99%

“…In addition, 2 studies were conducted across multiple countries 1, 27. Regarding stroke type, 9 studies assessed patients with ischemic stroke,1, 2, 8, 9, 17, 20, 21, 27, 28 6 assessed patients with hemorrhagic stroke,9, 18, 22, 23, 24, 25 and 5 evaluated both types of stroke 6, 7, 10, 16, 26. The number of participants in the studies ranged from 106 to 3020.…”

Section: Resultsmentioning

confidence: 99%

“…Imaging (computed tomography, magnetic resonance imaging, or both) was used in 17 studies,1, 2, 6, 7, 8, 10, 17, 18, 19, 20, 21, 22, 23, 24, 25, 27, 28 1 study relied on clinical evaluation alone,26 and 2 did not state the method used 9, 16. The methods used to ascertain mortality also varied.…”

Section: Resultsmentioning

confidence: 99%

“…Hospital‐based studies have reported prevalence up to ≈30% 1, 2. Although anemia has been independently associated with increased mortality in a variety of conditions including chronic kidney disease,3 heart failure,4 and acute coronary syndromes,5 observational studies investigating the association between anemia and mortality in stroke have shown conflicting results.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Hemoglobin Levels and Anemia on Mortality in Acute Stroke: Analysis of UK Regional Registry Data, Systematic Review, and Meta‐Analysis

Barlas¹,

Honney

Loke

et al. 2016

JAHA

136

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BackgroundThe impact of hemoglobin levels and anemia on stroke mortality remains controversial. We aimed to systematically assess this association and quantify the evidence.Methods and ResultsWe analyzed data from a cohort of 8013 stroke patients (mean±SD, 77.81±11.83 years) consecutively admitted over 11 years (January 2003 to May 2015) using a UK Regional Stroke Register. The impact of hemoglobin levels and anemia on mortality was assessed by sex‐specific values at different time points (7 and 14 days; 1, 3, and 6 months; 1 year) using multiple regression models controlling for confounders. Anemia was present in 24.5% of the cohort on admission and was associated with increased odds of mortality at most of the time points examined up to 1 year following stroke. The association was less consistent for men with hemorrhagic stroke. Elevated hemoglobin was also associated with increased mortality, mainly within the first month. We then conducted a systematic review using the Embase and Medline databases. Twenty studies met the inclusion criteria. When combined with the cohort from the current study, the pooled population had 29 943 patients with stroke. The evidence base was quantified in a meta‐analysis. Anemia on admission was found to be associated with an increased risk of mortality in both ischemic stroke (8 studies; odds ratio 1.97 [95% CI 1.57–2.47]) and hemorrhagic stroke (4 studies; odds ratio 1.46 [95% CI 1.23–1.74]).ConclusionsStrong evidence suggests that patients with anemia have increased mortality with stroke. Targeted interventions in this patient population may improve outcomes and require further evaluation.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Impact of Hemoglobin Levels and Anemia on Mortality in Acute Stroke: Analysis of UK Regional Registry Data, Systematic Review, and Meta‐Analysis

Barlas¹,

Honney

Loke

et al. 2016

JAHA

136

View full text Add to dashboard Cite

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Assessment of Discrepancies Between Follow-up Infarct Volume and 90-Day Outcomes Among Patients With Ischemic Stroke Who Received Endovascular Therapy

et al. 2021

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IMPORTANCE Some patients have poor outcomes despite small infarcts after endovascular therapy (EVT), while others with large infarcts do well. Understanding why these discrepancies occur may help to optimize EVT outcomes. OBJECTIVETo validate exploratory findings from the Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion with Emphasis on Minimizing CT to Recanalization Times (ESCAPE) trial regarding pretreatment, treatment-related, and posttreatment factors associated with discrepancies between follow-up infarct volume (FIV) and 90-day functional outcome. DESIGN, SETTING, AND PARTICIPANTS This cohort study is a post hoc analysis of the Safety and Efficacy of Nerinetide in Subjects Undergoing Endovascular Thrombectomy for Stroke (ESCAPE-NA1) trial, a double-blind, randomized, placebo-controlled, international, multicenter trial conducted from March 2017 to August 2019. Patients who participated in ESCAPE-NA1 and had available 90-day modified Rankin Scale (mRS) scores and 24-hour to 48-hour posttreatment follow-up parenchymal imaging were included. EXPOSURES Small FIV (volume Յ25th percentile) and large FIV (volume Ն75th percentile) on 24-hour computed tomography/magnetic resonance imaging. Baseline factors, outcomes, treatments, and poststroke serious adverse events (SAEs) were compared between discrepant cases (ie, patients with 90-day mRS score Ն3 despite small FIV or those with mRS scores Յ2 despite large FIV) and nondiscrepant cases. MAIN OUTCOMES AND MEASURES Area under the curve (AUC) and goodness of fit of prespecified logistic models, including pretreatment (eg, age, cancer, vascular risk factors) and treatment-related and posttreatment (eg, SAEs) factors, were compared with stepwise regression-derived models for ability to identify small FIV with higher mRS score and large FIV with lower mRS score. RESULTS Among 1091 patients (median [IQR] age, 70.8 [60.8-79.8] years; 549 [49.7%] women;median [IQR] FIV, 24.9 mL [6.6-92.2 mL]), 42 of 287 patients (14.6%) with FIV of 7 mL or less (ie, Յ25th percentile) had an mRS score of at least 3; 65 of 275 patients (23.6%) with FIV of 92 mL or greater (ie, Ն75th percentile) had an mRS score of 2 or less. Prespecified models of pretreatment factors (ie, age, cancer, vascular risk factors) associated with low FIV and higher mRS score performed similarly to models selected by stepwise regression (AUC, 0.92 [95% CI, 0.89-0.95] vs 0.93 [95% CI, 0.90-0.95]; P = .42). SAEs, specifically infarct in new territory, recurrent stroke, pneumonia, and congestive heart failure, were associated with low FIV and higher mRS scores; stepwise models also identified 24-hour hemoglobin as treatment-related/posttreatment factor (continued) Key Points Question Why do some patients have poor outcomes despite small infarcts after endovascular therapy, while others with large infarcts fare better? Findings In this cohort study of 1091 patients who received endovascular therapy as part of a randomized clinical trial, discrepancies between infarct volume and function...

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Anemia predicts lower white matter volume and cognitive performance in sickle and non‐sickle cell anemia syndrome

et al. 2019

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Severe chronic anemia is an independent predictor of overt stroke, white matter damage, and cognitive dysfunction in the elderly. Severe anemia also predisposes to white matter strokes in young children, independent of the anemia subtype. We previously demonstrated symmetrically decreased white matter (WM) volumes in patients with sickle cell disease (SCD). In the current study, we investigated whether patients with non-sickle anemia also have lower WM volumes and cognitive dysfunction. Magnetic Resonance Imaging was performed on 52 clinically asymptomatic SCD patients (age = 21.4 ± 7.7; F = 27, M = 25; hemoglobin = 9.6 ± 1.6 g/dL), 26 non-sickle anemic patients (age = 23.9 ± 7.9; F = 14, M = 12; hemoglobin = 10.8 ± 2.5 g/dL) and 40 control subjects (age = 27.7 ± 11.3; F = 28, M = 12; hemoglobin = 13.4 ± 1.3 g/dL). Voxel-wise changes in WM brain volumes were compared to hemoglobin levels to identify brain regions that are vulnerable to anemia. White matter volume was diffusely lower in deep, watershed areas proportionally to anemia severity. After controlling for age, sex, and hemoglobin level, brain volumes were independent of disease. WM volume loss was associated with lower Full Scale Intelligence Quotient (FSIQ; P = .0048; r 2 = .18) and an abnormal burden of silent cerebral infarctions (P = .029) in males, but not in females.Hemoglobin count and cognitive measures were similar between subjects with and without white-matter hyperintensities. The spatial distribution of volume loss suggests chronic hypoxic cerebrovascular injury, despite compensatory hyperemia. Neurocognitive consequences of WM volume changes and silent cerebral infarctionwere strongly sexually dimorphic. Understanding the possible neurological consequences of chronic anemia may help inform our current clinical practices.

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A cohort study of patients with anemia on admission and fatality after acute ischemic stroke

Cited by 63 publications

References 34 publications

Impact of Hemoglobin Levels and Anemia on Mortality in Acute Stroke: Analysis of UK Regional Registry Data, Systematic Review, and Meta‐Analysis

Impact of Hemoglobin Levels and Anemia on Mortality in Acute Stroke: Analysis of UK Regional Registry Data, Systematic Review, and Meta‐Analysis

Assessment of Discrepancies Between Follow-up Infarct Volume and 90-Day Outcomes Among Patients With Ischemic Stroke Who Received Endovascular Therapy

Anemia predicts lower white matter volume and cognitive performance in sickle and non‐sickle cell anemia syndrome

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