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

Media type: E-Article
Title: Effect of haemoglobin levels on outcome in intravenous thrombolysis-treated stroke patients
Contributor: Altersberger, Valerian L; Kellert, Lars; Al Sultan, Abdulaziz S; Martinez-Majander, Nicolas; Hametner, Christian; Eskandari, Ashraf; Heldner, Mirjam R; van den Berg, Sophie A; Zini, Andrea; Padjen, Visnja; Kägi, Georg; Pezzini, Alessandro; Polymeris, Alexandros; DeMarchis, Gian M; Tiainen, Marjaana; Räty, Silja; Nannoni, Stefania; Jung, Simon; Zonneveld, Thomas P; Maffei, Stefania; Bonati, Leo; Lyrer, Philippe; Sibolt, Gerli; Ringleb, Peter A; [...]
imprint: SAGE Publications, 2020
Published in: European Stroke Journal
Language: English
DOI: 10.1177/2396987319889468
ISSN: 2396-9873; 2396-9881
Origination:
Footnote:
Description: <jats:sec><jats:title>Introduction</jats:title><jats:p> 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. </jats:p></jats:sec><jats:sec><jats:title>Patients and methods</jats:title><jats:p> 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. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> 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 (OR<jats:sub>adjusted</jats:sub> 1.25 (1.05–1.48)) and mortality (OR<jats:sub>adjusted</jats:sub> 1.58 (1.27–1.95)). In anaemia subgroups, both mild and moderate/severe anaemia independently predicted poor outcome (OR<jats:sub>adjusted</jats:sub> 1.29 (1.07–1.55) and 1.48 (1.09–2.02)) and mortality (OR<jats:sub>adjusted</jats:sub> 1.45 (1.15–1.84) and OR<jats:sub>adjusted</jats:sub> 2.00 (1.46–2.75)). Each haemoglobin level decrease by 1 g/dl independently increased the risk of poor outcome (OR<jats:sub>adjusted</jats:sub> 1.07 (1.02–1.11)) and mortality (OR<jats:sub>adjusted</jats:sub> 1.08 (1.02–1.15)). Anaemia was not associated with occurrence of symptomatic intracranial haemorrhage. Polyglobulia did not change any outcome. </jats:p></jats:sec><jats:sec><jats:title>Discussion</jats:title><jats:p> 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. </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> Anaemia on admission, but not polyglobulia, is a strong and independent predictor of poor outcome and mortality in intravenous thrombolysis-treated stroke patients. </jats:p></jats:sec>
Access State: Open Access

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