Anemia increases the mortality risk in patients with stroke: A meta-analysis of cohort studies

Li, Zhanzhan; Zhou, Tao; Li, Yanyan; Chen, Peng

doi:10.1038/srep26636

Cited by 68 publications

(61 citation statements)

References 42 publications

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“…The covariates examined included age (per 5-year increase above 65), marital status (married/not married), hypertension, diabetes, COPD, history of CAD, AF, anemia, renal dysfunction (estimated glomerular filtration rate <60 mL/min/1.73 m2), time from stroke onset to rehabilitation admission <30 days, ischemic stroke, dysphagia, neglect, motor FIM score at admission, and cognitive FIM score at admission. These variables were selected based on availability at time of presentation and prior studies showing an association with the outcomes of interest (4,6,11,12,17,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) and were included in all analyses.…”

Section: Covariatesmentioning

confidence: 99%

Sex Differences in Long-Term Mortality and Functional Outcome After Rehabilitation in Patients With Severe Stroke

et al. 2020

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Objective: We sought to determine sex differences in outcomes in patients with severe stroke who had been admitted to inpatient rehabilitation.Methods: We studied 1,316 patients aged 18 to 99 (mean 72) classified as case-mix groups 0108, 0109, and 0110 of the Medicare case-mix classification system. These groups encompass the most severe strokes. Three outcomes were analyzed: (1) 3-year mortality from admission to rehabilitation; (2) combined outcome of transfer to acute care or death within 90 days from admission to rehabilitation; (3) functional outcome, including proportional recovery in motor functioning and good functional outcome as defined by achievement of a Functional Independence Measure (FIM)-motor score ≥65 points at discharge. Multivariable regression analyses were used to assess sex-difference in each outcome between women and men. The covariates examined included age, marital status, comorbidities, time from stroke onset to rehabilitation admission <30 days, ischemic stroke, dysphagia, neglect, motor FIM score at admission, and cognitive FIM score at admission.Results: Kaplan-Meier estimated 3-year mortality rate was 20.7% in women and 22.0% in men. The crude hazard ratio (HR) of death for women compared with men was 0.94 (95% CI 0.74-1.20). After adjustment for significant covariates, the HR of 3-year mortality was 0.73 (95% CIs 0.56-0.96; p = 0.025). Comorbidity, including diabetes, anemia, coronary artery disease, atrial fibrillation, and chronic obstructive pulmonary disease, significantly increased mortality risk by 49-88%. The incidence of the combined outcome was 8.3% in women and 8.4% in men. The crude HR of the combined end-point for women compared with men was 1.05 (95% CI 0.72-1.53). After adjustment for significant covariates, the HR was 0.95 (95% CIs 0.65-1.40; p = 0.810). Likewise, no significant difference in proportional recovery or in the rate of achievement of a good functional outcome between women and men was observed.Conclusion: Among patients admitted to inpatient rehabilitation after severe stroke, women and men had comparable crude mortality rates at 3 years. After multivariable Scrutinio et al.Sex Differences in Severe Stroke adjustment, however, women had lower mortality risk. No sex-differences in the risk of being transferred to acute care or dying within 90 days from admission to rehabilitation or in responsiveness to rehabilitation were observed.

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Section: Covariatesmentioning

confidence: 99%

Sex Differences in Long-Term Mortality and Functional Outcome After Rehabilitation in Patients With Severe Stroke

et al. 2020

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“…The presence of anemia is also independently associated with increased mortality in several nonsurgical subgroups including stroke, chronic obstructive pulmonary disease, chronic kidney disease, chronic heart diseases, and ischemic heart diseases . It has been estimated that anemia increases the cost of health care delivery by 50% .…”

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confidence: 99%

Anemia in hospitalized patients: an overlooked risk in medical care

Krishnasivam¹,

Trentino

Burrows³

et al. 2018

Transfusion

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BACKGROUND This study investigated the association between nadir anemia and mortality and length of stay (LOS) in a general population of hospitalized patients. STUDY DESIGN AND METHODS A retrospective cohort study of tertiary hospital admissions in Western Australia between July 2010 and June 2015. Outcome measures were in‐hospital mortality and LOS. RESULTS Of 80,765 inpatients, 45,675 (56.55%) had anemia during admission. Mild and moderate/severe anemia were independently associated with increased in‐hospital mortality (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.36‐1.86, p = 0.001; OR 2.77, 95% CI 2.32‐3.30, p < 0.001, respectively). Anemia was also associated with increased LOS, demonstrating a larger effect in emergency (mild anemia—incident rate ratio [IRR] 1.52, 95% CI 1.48‐1.56, p < 0.001; moderate/severe anemia—IRR 2.18, 95% CI 2.11‐2.26, p < 0.001) compared to elective admissions (mild anemia—IRR 1.30, 95% CI 1.21‐1.41, p < 0.001; moderate/severe anemia—IRR 1.69, 95% CI 1.55‐1.83, p < 0.001). LOS was longer in patients who developed anemia during admission compared to those who had anemia on admission (IRR 1.13, 95% CI 1.10‐1.17, p < 0.001). Red cell transfusion was independently associated with 2.23 times higher odds of in‐hospital mortality (95% CI 1.89‐2.64, p < 0.001) and 1.31 times longer LOS (95% CI 1.25‐1.37, p < 0.001). CONCLUSION More than one‐third of patients not anemic on admission developed anemia during admission. Even mild anemia is independently associated with increased mortality and LOS; however, transfusion to treat anemia is an independent and additive risk factor.

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“…In different series, anemia was reported in 6-40% of this patients group [2,3,4,6]. Moreover it is widely suggested to be related with poor functional outcome and even with increased mortality [5,6,7,8,9,10,11,12,13,14].…”

Section: Discussionmentioning

confidence: 99%

“…For this reason, toleration of anemia becomes much more difficult particularly in AIS patients [10,11]. This autoregulation process is more complicated in AIS patients with anemia compared with healthy anemic patients, and the tolerable cutoff level of Hb may likely be different in this patient group [6,8]. However, the effects of anemia on clinical and functional outcomes in ischemic stroke patients undergoing mechanical thrombectomy had not been studied previously.…”

Section: Introductionmentioning

confidence: 99%

“…Recent clinical studies revealed that anemia seems to be significantly related with poor clinical outcome and mortality in AIS patients. Moreover, anemia has been suggested to be an independent risk factor for stroke [3,5,6,7,8]. Although anemia is not widely accepted as a traditional risk factor like hypertension, diabetes, hyperlipidemia, and smoking for ischemic stroke, it is generally evaluated as an additional and modifiable risk factor [8].…”

Section: Introductionmentioning

confidence: 99%

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Moderate to Severe Anemia Is Associated with Poor Functional Outcome in Acute Stroke Patients Treated with Mechanical Thrombectomy

2017

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Background: Anemia will negatively affect cerebral collaterals and penumbra. Eventually, it may cause worse clinical outcomes and even increase mortality rates in stroke patients. Anemia has recently been suggested to be an independent risk factor for ischemic stroke. Therefore, we aimed to investigate the effects of the presence of anemia on clinical outcomes in ischemic stroke patients undergoing mechanical thrombectomy. Methods: This was a retrospective study involving the prospectively and consecutively collected data of 90 adult patients between January 2015 and August 2016. Hemoglobin (Hb) cutoff levels were accepted as 12 g/dL for women and 13 g/dL for men. Patients having anemia were further divided into three subgroups as severe anemia (Hb <8 g/dL for both genders), moderate anemia (Hb <10 g/dL for both genders), and mild anemia (Hb <13 g/dL for men and Hb <12 g/dL for women). Results: Forty of the subjects (44.4%) had anemia. Moderate anemia was detected in 14 out of 90 patients (15.5%) and severe anemia was found in only four of them (4.4%). Poor functional outcome (mRS 3-6) was similar in both anemic and non-anemic patients (37.5% vs. 38%, respectively, p = 0.08), but poor functional outcome was found to be statistically significant with severe anemic group (Hb <8 mg/dL) (p = 0.003). In multiple logistic regression analysis, moderate and severe anemia has been found to increase the mortality (p = 0.032). Conclusions: Our study demonstrated a poor functional outcome only in moderate to severe anemic patients. Clinicians should keep in mind the negative effect of moderate to severe anemia in the clinical course of acute stroke patients treated with mechanical thrombectomy.

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Anemia increases the mortality risk in patients with stroke: A meta-analysis of cohort studies

Cited by 68 publications

References 42 publications

Sex Differences in Long-Term Mortality and Functional Outcome After Rehabilitation in Patients With Severe Stroke

Sex Differences in Long-Term Mortality and Functional Outcome After Rehabilitation in Patients With Severe Stroke

Anemia in hospitalized patients: an overlooked risk in medical care

Moderate to Severe Anemia Is Associated with Poor Functional Outcome in Acute Stroke Patients Treated with Mechanical Thrombectomy

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