Association of anemia and hemoglobin decrease during acute stroke treatment with infarct growth and clinical outcome

Bellwald, Sebastian; Balasubramaniam, Rupashani; Nagler, Michael; Burri, Melchior; Fischer, Samuel D A; Hakim, Arsany; Dobrocky, Tomas; Yu, Yannan; Scalzo, Fabien; Heldner, Mirjam Rachel; Wiest, Roland; Mono, Marie‐Luise; Sarikya, Hakan; El-Koussy, Marwan; Mordasini, Pasquale; Fischer, Urs; Schroth, Gerhard; Gralla, Jan; Mattle, Heinrich; Arnold, Marcel; Liebeskind, David S; Jung, Simon

doi:10.1371/journal.pone.0203535

Cited by 30 publications

(25 citation statements)

References 32 publications

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“…As mentioned earlier, anemia or low hemoglobin levels were frequently observed in patients with ischemic stroke after excessive fluid replacement, and low hemoglobin levels were also associated with higher morbidity and mortality in both short‐ and long‐term follow‐up . The low hemoglobin levels after stroke may accelerate the ischemic status of penumbral lesions through the decline of oxygen‐delivery capacity of blood .…”

Section: Discussionmentioning

confidence: 78%

“…18 Anemia or low hemoglobin levels induced by hemodilution were common in stroke patients, especially in those with ischemic stroke after the excessive fluid replacement. 19 Accumulating studies have indicated that low hemoglobin levels were correlated with poor functional outcome and increased mortality in stroke patients. 20 However, no study has investigated the relationship between hemoglobin and PSCI.…”

Section: Introductionmentioning

confidence: 99%

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Hemoglobin, anemia, and poststroke cognitive impairment: A cohort study

Ruan

Yuan

et al. 2020

Int J Geriat Psychiatry

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Objectives Several studies have demonstrated that anemia was associated with cognitive impairment. The aim of this study was to explore the relationship between hemoglobin and cognitive impairment in patient with acute ischemic stroke. Methods In total, 326 patients with acute ischemic stroke were followed up for 1 month. The main outcome was the incidence and severity of poststroke cognitive impairment (PSCI) assessed by Mini‐Mental State Examination (MMSE). The impact of hemoglobin levels and anemia on PSCI was assessed by multiple regression models controlling for potential confounders. Results During the 1‐month follow‐up, 193 (59.2%) patients developed PSCI. Anemia was independently associated with PSCI (OR = 3.637; 95% CI, 1.216‐10.881; P = .021) after adjusting for demographics, vascular risk factors, stroke severity, and functional outcome. When the hemoglobin levels stratified into tertiles, higher hemoglobin levels were associated with better cognitive function. This result was however not significant after adjusting for the same confounders above. Conclusions Low hemoglobin levels are associated with an increased risk of PSCI. Targeted interventions in this population may reduce the incidence of PSCI and require further evaluation.

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Section: Discussionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Hemoglobin, anemia, and poststroke cognitive impairment: A cohort study

Ruan

Yuan

et al. 2020

Int J Geriat Psychiatry

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“…A recent study, including IVT and endovascular treated patients, found that anaemia at hospital admission and any decrease of haemoglobin were associated with poor functional outcome and higher mortality. 8 The large sample size in the present study allowed a subgroup analysis of patients with mild and moderate/ severe anaemia. Data on anaemia subgroups are scarce.…”

Section: Discussionmentioning

confidence: 94%

“…7 A second study, including both IVT (n ¼ 466) and endovascular treated patients (n ¼ 712), found anaemia on admission being an independent predictor of poor functional outcome and mortality. 8 From a pathophysiological point of view, low HL at stroke onset is likely to impair outcomes due to a mismatch between increased metabolic requirements of the penumbral brain tissue and lowered oxygen transport capacity and reduced blood perfusion. Furthermore, HL might also affect outcomes via alterations in cerebrovascular autoregulation, blood coagulation and inflammatory mediators.…”

Section: Introductionmentioning

confidence: 99%

Effect of haemoglobin levels on outcome in intravenous thrombolysis-treated stroke patients

Altersberger

Kellert

Sultan

et al. 2019

European Stroke Journal

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Introduction Alterations in haemoglobin levels are frequent in stroke patients. The prognostic meaning of anaemia and polyglobulia on outcomes in patients treated with intravenous thrombolysis is ambiguous. Patients and methods In this prospective multicentre, intravenous thrombolysis register-based study, we compared haemoglobin levels on hospital admission with three-month poor outcome (modified Rankin Scale 3–6), mortality and symptomatic intracranial haemorrhage (European Cooperative Acute Stroke Study II-criteria (ECASS-II-criteria)). Haemoglobin level was used as continuous and categorical variable distinguishing anaemia (female: <12 g/dl; male: <13 g/dl) and polyglobulia (female: >15.5 g/dl; male: >17 g/dl). Anaemia was subdivided into mild and moderate/severe (female/male: <11 g/dl). Normal haemoglobin level (female: 12.0–15.5 g/dl, male: 13.0–17.0 g/dl) served as reference group. Unadjusted and adjusted odds ratios with 95% confidence intervals were calculated with logistic regression models. Results Among 6866 intravenous thrombolysis-treated stroke patients, 5448 (79.3%) had normal haemoglobin level, 1232 (17.9%) anaemia – of those 903 (13.2%) had mild and 329 (4.8%) moderate/severe anaemia – and 186 (2.7%) polyglobulia. Anaemia was associated with poor outcome (ORadjusted 1.25 (1.05–1.48)) and mortality (ORadjusted 1.58 (1.27–1.95)). In anaemia subgroups, both mild and moderate/severe anaemia independently predicted poor outcome (ORadjusted 1.29 (1.07–1.55) and 1.48 (1.09–2.02)) and mortality (ORadjusted 1.45 (1.15–1.84) and ORadjusted 2.00 (1.46–2.75)). Each haemoglobin level decrease by 1 g/dl independently increased the risk of poor outcome (ORadjusted 1.07 (1.02–1.11)) and mortality (ORadjusted 1.08 (1.02–1.15)). Anaemia was not associated with occurrence of symptomatic intracranial haemorrhage. Polyglobulia did not change any outcome. Discussion The more severe the anaemia, the higher the probability of poor outcome and death. Severe anaemia might be a target for interventions in hyperacute stroke. Conclusion Anaemia on admission, but not polyglobulia, is a strong and independent predictor of poor outcome and mortality in intravenous thrombolysis-treated stroke patients.

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“…In general population, history of RBCT is associated with 1.6-fold increase in the risk of ischemic stroke [26]. This association is explained by the fact that stored RBC increases blood viscosity, and decreases nitric oxide concentration, vasoconstriction, and platelet activation [1].…”

Section: Discussionmentioning

confidence: 99%

Timing of Transfusion, not Hemoglobin Variability, Is Associated with 3-Month Outcomes in Acute Ischemic Stroke

Kim

Lee

Lim

et al. 2020

JCM

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Objectives: This study aimed to investigate whether transfusions and hemoglobin variability affects the outcome of stroke after an acute ischemic stroke (AIS). Methods: We studied consecutive patients with AIS admitted in three tertiary hospitals who received red blood cell (RBC) transfusion (RBCT) during admission. Hemoglobin variability was assessed by minimum, maximum, range, median absolute deviation, and mean absolute change in hemoglobin level. Timing of RBCT was grouped into two categories: admission to 48 h (early) or more than 48 h (late) after hospitalization. Late RBCT was entered into multivariable logistic regression model. Poor outcome at three months was defined as a modified Rankin Scale score ≥3. Results: Of 2698 patients, 132 patients (4.9%) received a median of 400 mL (interquartile range: 400–840 mL) of packed RBCs. One-hundred-and-two patients (77.3%) had poor outcomes. The most common cause of RBCT was gastrointestinal bleeding (27.3%). The type of anemia was not associated with the timing of RBCT. Late RBCT was associated with poor outcome (odd ratio (OR), 3.55; 95% confidence interval (CI), 1.43–8.79; p-value = 0.006) in the univariable model. After adjusting for age, sex, Charlson comorbidity index, and stroke severity, late RBCT was a significant predictor (OR, 3.37; 95% CI, 1.14–9.99; p-value = 0.028) of poor outcome at three months. In the area under the receiver operating characteristics curve comparison, addition of hemoglobin variability indices did not improve the performance of the multivariable logistic model. Conclusion: Late RBCT, rather than hemoglobin variability indices, is a predictor for poor outcome in patients with AIS.

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Association of anemia and hemoglobin decrease during acute stroke treatment with infarct growth and clinical outcome

Cited by 30 publications

References 32 publications

Hemoglobin, anemia, and poststroke cognitive impairment: A cohort study

Hemoglobin, anemia, and poststroke cognitive impairment: A cohort study

Effect of haemoglobin levels on outcome in intravenous thrombolysis-treated stroke patients

Timing of Transfusion, not Hemoglobin Variability, Is Associated with 3-Month Outcomes in Acute Ischemic Stroke

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