Anemia on Admission Predicts Short- and Long-Term Outcomes in Patients with Acute Ischemic Stroke
Abstract
Background
It is still debatable whether anemia predicts stroke outcome.
Aim
To describe the characteristics of patients with acute ischemic stroke (AIS) and anemia and identify whether hemoglobin status on admission is a prognostic factor of AIS outcome.
Methods
All 2439 patients of the Acute Stroke Registry and Analysis of Lausanne (ASTRAL) between January 2003 and June 2011 were selected. Demographics, risk factors, prestroke treatment, clinical, radiological and metabolic variables in patients with and without anemia according to the definition of the World Health Organization were compared. Functional disability and mortality were recorded up to 12 months from admission.
Results
Anemic patients (17·5%) were older, had lower body mass index, higher rates of coronary artery disease (CAD), atrial fibrillation, diabetes mellitus and peripheral artery disease. Anemia was associated with more severe stroke manifestations, lower systolic and diastolic blood pressure measurements, worse estimated glomerular filtration rate and elevated C-reactive protein concentrations upon admission and with increased modified Rankin scores during the follow-up. Anemic patients had higher 7-day, 3-month and 12-month mortality, which was associated with hemoglobin status and other factors, including age, CAD, stroke severity, and baseline C-reactive levels. Hemoglobin levels were inversely associated with recurrent stroke and mortality throughout the 12-month follow-up.
Conclusion
Anemia is common among AIS patients and is associated with cardiovascular comorbidities. Low hemoglobin status independently predicts short and long-term mortality.
Get full access to this article
View all access and purchase options for this article.
References
1. Culleton BF, Manns BJ, Zhang J, Tonelli M, Klarenbach S, Hemmelgarn BR. Impact of anemia on hospitalization and mortality in older adults. Blood 2006; 107:3841–6.
2. Penninx BW, Pahor M, Cesari M, et al. Anemia is associated with disability and decreased physical performance and muscle strength in the elderly. J Am Geriatr Soc 2004; 52:719–24.
3. Salisbury AC, Alexander KP, Reid KJ, et al. Incidence, correlates, and outcomes of acute, hospital-acquired anemia in patients with acute myocardial infarction. Circ Cardiovasc Qual Outcomes 2010; 3:337–46.
4. Younge JO, Nauta ST, Akkerhuis KM, Deckers JW, Van Domburg RT. Effect of anemia on short- and long-term outcome in patients hospitalized for acute coronary syndromes. Am J Cardiol 2012; 109:506–10.
5. Kosiborod M, Smith GL, Radford MJ, Foody JM, Krumholz HM. The prognostic importance of anemia in patients with heart failure. Am J Med 2003; 114:112–9.
6. McMurray JJ, Uno H, Jarolim P, et al. Predictors of fatal and nonfatal cardiovascular events in patients with type 2 diabetes mellitus, chronic kidney disease, and anemia: an analysis of the Trial to Reduce cardiovascular Events with Aranesp (darbepoetin-alfa) Therapy (TREAT). Am Heart J 2011; 162:748–755.e3.
7. Kulier A, Levin J, Moser R, et al. Impact of preoperative anemia on outcome in patients undergoing coronary artery bypass graft surgery. Circulation 2007; 116:471–9.
8. Tanne D, Molshatzki N, Merzeliak O, Tsabari R, Toashi M, Schwammenthal Y. Anemia status, hemoglobin concentration and outcome after acute stroke: a cohort study. BMC Neurol 2010; 10:22.
9. Ferrucci L, Guralnik JM, Woodman RC, et al. Proinflammatory state and circulating erythropoietin in persons with and without anemia. Am J Med 2005; 118:1288.
10. Vila N, Castillo J, Davalos A, Chamorro A. Proinflammatory cytokines and early neurological worsening in ischemic stroke. Stroke 2000; 31:2325–9.
11. Hao Z, Wu B, Wang D, Lin S, Tao W, Liu M. A cohort study of patients with anemia on admission and fatality after acute ischemic stroke. J Clin Neurosci 2013; 20:37–42.
12. Bertoli AM, Vila LM, Alarcon GS, et al. Factors associated with arterial vascular events in PROFILE: a Multiethnic Lupus Cohort. Lupus 2009; 18:958–65.
13. Sico JJ, Concato J, Wells CK, et al. Anemia is associated with poor outcomes in patients with less severe ischemic stroke. J Stroke Cerebrovasc Dis 2011; 22:271–8.
14. Platt OS. Prevention and management of stroke in sickle cell anemia. Hematology Am Soc Hematol Educ Program 2006; 1:54–7.
15. Michel P, Odier C, Rutgers M, et al. The Acute STroke Registry and Analysis of Lausanne (ASTRAL): design and baseline analysis of an ischemic stroke registry including acute multimodal imaging. Stroke 2010; 41:2491–8.
16. European Stroke Organisation (ESO) Executive Committee, ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis 2008; 25:457–507.
17. Anonymous. Nutritional anaemias. Report of a WHO scientific group. World Health Organ Tech Rep Ser 1968; 405:5–37.
18. Levey AS, Coresh J, Greene T, et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 2006; 145:247–54.
19. Del Fabbro P, Luthi JC, Carrera E, Michel P, Burnier M, Burnand B. Anemia and chronic kidney disease are potential risk factors for mortality in stroke patients: a historic cohort study. BMC Nephrol 2010; 11:27.
20. Huang WY, Chen IC, Meng L, Weng WC, Peng TI. The influence of anemia on clinical presentation and outcome of patients with first-ever atherosclerosis-related ischemic stroke. J Clin Neurosci 2009; 16:645–9.
21. Kannel WB, Gordon T, Wolf PA, McNamara P. Hemoglobin and the risk of cerebral infarction: the Framingham Study. Stroke 1972; 3:409–20.
22. Herold S, Brozovic M, Gibbs J, et al. Measurement of regional cerebral blood flow, blood volume and oxygen metabolism in patients with sickle cell disease using positron emission tomography. Stroke 1986; 17:692–8.
23. Shahar A, Sadeh M. Severe anemia associated with transient neurological deficits. Stroke 1991; 22:1201–2.
24. Dexter F, Hindman BJ. Effect of haemoglobin concentration on brain oxygenation in focal stroke: a mathematical modelling study. Br J Anaesth 1997; 79:346–51.
25. Kim JS, Kang SY. Bleeding and subsequent anemia: a precipitant for cerebral infarction. Eur Neurol 2000; 43:201–8.
26. Leal-Noval SR, Munoz-Gomez M, Murillo-Cabezas F. Optimal hemoglobin concentration in patients with subarachnoid hemorrhage, acute ischemic stroke and traumatic brain injury. Curr Opin Crit Care 2008; 14:156–62.
27. Nybo M, Kristensen SR, Mickley H, Jensen JK. The influence of anaemia on stroke prognosis and its relation to N-terminal pro-brain natriuretic peptide. Eur J Neurol 2007; 14:477–82.
28. Bhatia RS, Garg RK, Gaur SP, et al. Predictive value of routine hematological and biochemical parameters on 30-day fatality in acute stroke. Neurol India 2004; 52:220–3.
29. Wade JP, Taylor DW, Barnett HJ, Hachinski VC. Hemoglobin concentration and prognosis in symptomatic obstructive cerebrovascular disease. Stroke 1987; 18:68–71.
30. Kellert L, Martin E, Sykora M, et al. Cerebral oxygen transport failure?: decreasing hemoglobin and hematocrit levels after ischemic stroke predict poor outcome and mortality: STroke: RelevAnt Impact of hemoGlobin, Hematocrit and Transfusion (STRAIGHT) – an observational study. Stroke 2011; 42:2832–7.
31. Kellert L, Herweh C, Sykora M, et al. Loss of penumbra by impaired oxygen supply? Decreasing hemoglobin levels predict infarct growth after acute ischemic stroke: STroke: RelevAnt Impact of hemoGlobin, Hematocrit and Transfusion (STRAIGHT) – an observational study. Cerebrovasc Dis Extra 2012; 2:99–107.
32. Diamond PT, Gale SD, Evans BA. Relationship of initial hematocrit level to discharge destination and resource utilization after ischemic stroke: a pilot study. Arch Phys Med Rehabil 2003; 84:964–7.
33. Pfeffer MA, Burdmann EA, Chen CY, et al. A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease. N Engl J Med 2009; 361:2019–32.
Cite article
Cite article
Cite article
OR
Download to reference manager
If you have citation software installed, you can download article citation data to the citation manager of your choice
Information, rights and permissions
Information
Published In
Article first published online: November 26, 2014
Issue published: February 2015
Keywords
PubMed: 25427291
Authors
Metrics and citations
Metrics
Journals metrics
This article was published in International Journal of Stroke.
VIEW ALL JOURNAL METRICSArticle usage*
Total views and downloads: 217
*Article usage tracking started in December 2016
Altmetric
See the impact this article is making through the number of times it’s been read, and the Altmetric Score.
Learn more about the Altmetric Scores
Articles citing this one
Receive email alerts when this article is cited
Web of Science: 54 view articles Opens in new tab
Crossref: 52
- Renal function as risk factor for diabetic foot ulcers: A meta‐analysi...
- Late‐onset aspirin‐related hemolysis and subsequent subdural hemorrhag...
- Prediction of Death in Intracerebral Hemorrhage Patients After Minimal...
- Anemia and Optimal Transfusion Thresholds in Brain-Injured Patients: A...
- The impacts of anemia burden on clinical outcomes in patients with out...
- Machine learning-based prediction of cerebral hemorrhage in patients w...
- Association between magnesium intake and the risk of anemia among adul...
- Relationship between hemoglobin, albumin, lymphocyte, and platelet (HA...
- Impact of anemia on acute ischemic stroke outcomes: A systematic revie...
- Relationship between baseline haemoglobin content and poststroke cogni...
- Both Ends of Values in the Hemoglobin Spectrum Are Associated with Adv...
- Six degrees head-down tilt bed rest caused low-grade hemolysis: a pros...
- Association between aspirin‐induced hemoglobin decline and outcome aft...
- Nutritional Supplements and Neuroprotective Diets and Their Potential ...
- Safety and efficacy of low-dose aspirin in ischemic stroke patients wi...
- Non-vascular contributing factors of diabetic foot ulcer severity in n...
- Anemia Is a Risk Factor for the Development of Ischemic Stroke and Pos...
- Perioperative Neurological Evaluation and Management to Lower the Risk...
- Relationship between Self-Reported Sleep Duration and Risk of Anemia: ...
- Is there an association between anemia and diabetic foot ulcers? A sys...
- The Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) Score Is Asso...
- Growth Hormone and Neuronal Hemoglobin in the Brain—Roles in Neuroprot...
- Liberal vs. Conservative Blood Strategies
- Blood Transfusion Strategies in Neurocritical Care
- Admission Hemoglobin Is Prognostic for In-Hospital Mortality in Oldest...
- Anemia Predicts Poor Clinical Outcome in Mechanical Thrombectomy Patie...
- Does Anemia Have a Potential Effect on Type 2 Hepatorenal Syndrome?
- Impact pronostic du taux d’hémoglobine de la phase aiguë des accidents...
- Hemoglobin, anemia, and poststroke cognitive impairment: A cohort stud...
- Influence of Hemoglobin Concentration on Stroke Recurrence and Composi...
- Anemia in patients with diabetic foot ulcer and its impact on disease ...
- Anemia in Patients with Diabetic Foot Ulcer: Effects on Diabetic Micro...
- A Systems Analysis of the Relationships Between Anemia and Ischemic St...
- Associations of Anemia With Outcomes in Patients With Spontaneous Intr...
- Effect of Glyceryl Trinitrate on Hemodynamics in Acute Stroke
- Long-Term Outcomes in Patients with Anemia And Cerebral Venous Thrombo...
- Mechanisms responsible for reduced erythropoiesis during androgen depr...
- Hemoglobin concentration does not impact 3-month outcome following acu...
- Decline in Hemoglobin during Hospitalization May Be Associated with Po...
- The alliance with expanding blood volume and correcting anemia is an e...
- Impact of anemia on in‐hospital complications after ischemic stroke
- Moderate to Severe Anemia Is Associated with Poor Functional Outcome i...
- Prognostic role of hypochloremia in acute ischemic stroke patients
- Changing reference intervals for haemoglobin in Denmark: Clinical and ...
- Ischemic Stroke Mortality Is More Strongly Associated with Anemia on A...
- Anemia and stroke: Where do we stand?
- Anemia management after acute brain injury
- Anemia in Patients With Diabetic Foot Ulcer...
- Impact of Hemoglobin Levels and Anemia on Mortality in Acute Stroke: A...
- Anemia increases the mortality risk in patients with stroke: A meta-an...
- Admission Heart Rate Predicts Poor Outcomes in Acute Intracerebral Hem...
- Long-Term Mortality and Its Risk Factors in Stroke Survivors
Figures and tables
Figures & Media
Tables
View Options
Get access
Access options
If you have access to journal content via a personal subscription, university, library, employer or society, select from the options below:
loading institutional access options
WSO members can access this journal content using society membership credentials.
WSO members can access this journal content using society membership credentials.
Alternatively, view purchase options below:
Purchase 24 hour online access to view and download content.
Access journal content via a DeepDyve subscription or find out more about this option.
