Anemia on Admission Predicts Short- and Long-Term Outcomes in Patients with Acute Ischemic Stroke

Milionis, Haralampos; Papavasileiou, Vasileios; Eskandari, Ashraf; D'Ambrogio-Remillard, Suzette; Ntaios, George; Michel, Patrik

doi:10.1111/ijs.12397

Cited by 71 publications

(81 citation statements)

References 31 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%

“…Eleven studies used the World Health Organization definition of anemia as hemoglobin cutoffs,2, 8, 10, 16, 17, 18, 19, 20, 21, 22, 24 7 used prespecified values,1, 9, 23, 25, 26, 27, 28 and 2 did not specify the values used 6, 7. By using prespecified thresholds in constructing categorical comparisons for anemia, it is possible that cut points have been drawn up that favor statistically significant findings.…”

Section: Resultsmentioning

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: Resultsmentioning

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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Late‐onset aspirin‐related hemolysis and subsequent subdural hemorrhage in patient with glucose‐6‐phosphate dehydrogenase deficiency

Li,

Chen,

Deng

et al. 2024

Clinical Case Reports

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Key Clinical MessageAspirin‐related hemolysis in G6PD deficiency could be late‐onset during long‐term administration. Hemolytic anemia could continue for a relatively long time in elder patient with G6PD deficiency, which might be related to other adverse events.AbstractAspirin‐related hemolysis in G6PD‐deficient individuals was generally reported among patients who received high‐dose supplements within several days after ingestion. The safety of long‐term and low‐dose (50–325 mg/day) aspirin in patients coexist G6PD deficiency and cardiovascular disease is neglected in clinical practice. In this case, we observed a late‐onset hemolysis and subsequent fatal subdural hemorrhage in one G6PD‐deficient individual who had received long‐term and low‐dose aspirin. An 83‐year‐old male was diagnosed with acute ischemic stroke and treated with 100 mg/day aspirin at the emergency room. After admission, the patient was diagnosed with severe G6PD deficiency based on enzyme activity, but no hemolysis occurred within 10‐day aspirin therapy in the hospital. Hence, 100 mg/day aspirin was continued on discharge. Two months later, the patient presented acute hemolysis manifested as fatigue, dark urine, and moderate jaundice. Although hemolysis was self‐limit in a few days, hemoglobin decline continued for 20 days until a fatal subdural hemorrhage occurred. Our study indicated aspirin‐related hemolysis could be late‐onset in G6PD‐deficient individual even receiving low‐dose treatment and is probably linked to subsequent major bleeding events.

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The impacts of anemia burden on clinical outcomes in patients with out‐of‐hospital cardiac arrest

Ho,

Kuo,

Hsu

et al. 2023

Clinical Cardiology

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BackgroundOut‐of‐hospital cardiac arrest (OHCA) has low survival rates, and few patients achieve a desirable neurological outcome. Anemia is common among OHCA patients and has been linked to worse outcomes, but its impact following the return of spontaneous circulation (ROSC) is unclear. This study examines the relationship between anemia burden and clinical outcomes in OHCA patients.HypothesisHigher anemia burden after ROSC may be related to higher mortality and worse neurologic outcomes.MethodsPatients who experienced OHCA and had ROSC were enrolled retrospectively. Anemia burden was defined as the area under curve from the target hemoglobin level over a 72‐h period after OHCA. Hemoglobin level was measured at 12‐h intervals. The clinical outcomes of the study included mortality and neurological outcomes at Day 30.ResultsThe study enrolled 258 nontraumatic OHCA patients who achieved ROSC between January 2017 and December 2021. Among the 162 patients who survived more than 72 h, a higher anemia burden, specifically target hemoglobin levels below 7 (hazard ratio [HR]: 1.129, 95% confidence interval [CI]: 1.013–1.259, p = .029), 8 (HR: 1.099, 95% CI: 1.014–1.191, p = .021), and 9 g/dL (HR: 1.066, 95% CI: 1.001–1.134, p = .046) was associated with higher 30‐day mortality. Additionally, anemia burden with target hemoglobin levels below 7 (HR: 1.129, 95% CI: 1.016–1.248; p = .024) and 8 g/dL (HR: 1.088; 95% CI: 1.008–1.174, p = .031) was linked to worse neurological outcomes.ConclusionsAnemia burden predicts 30‐day mortality and neurological outcomes in OHCA patients who survive more than 72 h. Maintaining higher hemoglobin levels within the first 72 h after ROSC may improve short‐term outcomes.

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Anemia on Admission Predicts Short- and Long-Term Outcomes in Patients with Acute Ischemic Stroke

Abstract: Anemia is common among AIS patients and is associated with cardiovascular comorbidities. Low hemoglobin status independently predicts short and long-term mortality.

Cited by 71 publications

References 31 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

Late‐onset aspirin‐related hemolysis and subsequent subdural hemorrhage in patient with glucose‐6‐phosphate dehydrogenase deficiency

The impacts of anemia burden on clinical outcomes in patients with out‐of‐hospital cardiac arrest

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