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

Abstract

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.

Anemia Is a Risk Factor for the Development of Ischemic Stroke and Post-Stroke Mortality

“…Additionally, a recent study confirmed that patients who were anemic at the time of an ischemic stroke had a high risk for recurrence and development of cardiovascular disease and cardiovascular death within a year [2]. Furthermore, it was reported that delayed treatment of anemia during hospitalization with ischemic stroke was associated with poor outcome at 3 months [6]. Therefore, anemia is a risk factor for developing ischemic stroke and increases the chance of recurrence and mortality risk.…”

“…Anemia is a common disease in about 10% of people aged ≥65 years and its prevalence increase with age [1]. Ischemic stroke is frequently accompanied by anemia; previous studies have confirmed an average prevalence rate of 15-20% [2][3][4][5][6], and a maximum prevalence of 30% [7]. These prevalence rates of anemia are not significantly different from the 33% for diabetes or atrial fibrillation, which are known major risk factors for developing ischemic stroke [8,9].…”

Prevalence of Iron Deficiency Anaemia in Ischaemic Stroke

“…common disease in about 10% of people age ≥ 65 years 7 its prevalence increase with age.19 Ischemic stroke is frequently accompanied by anaemia, previous studies have confirmed an average prevalence rate of 15-20%. [20][21][22][23][24] and a maximum prevalence of 30%. 25 IDA is the most typical type of anaemia, accounting for nearly half of all anaemia cases worldwide.…”

Anemia and Optimal Transfusion Thresholds in Brain-Injured Patients: A Narrative Review of the Literature

“…148 Observational studies have likewise reported an inconsistent relationship between RBC transfusion and clinical outcomes, and this inconsistent finding may be, at least partially, attributable to differences in methodology. 33,129,149,150 The optimal transfusion trigger for AIS patients therefore remains unclear until more robust clinical data are available.…”