Anemia status, hemoglobin concentration and outcome after acute stroke: a cohort study
TLDR
WHO-defined anemia was common in both men and women among patients with acute stroke and predicted poor outcome and the association between admission hemoglobin and mortality was not linear; risk for death increased at both extremes of hemoglobin.Abstract:
In the setting of an acute stroke, anemia has the potential to worsen brain ischemia, however, the relationship between the entire range of hemoglobin to long-term outcome is not well understood. We examined the association between World Health Organization-defined admission anemia status (hemoglobin<13 in males, <12 g/dl in women) and hemoglobin concentration and 1-year outcome among 859 consecutive patients with acute stroke (ischemic or intracerebral hemorrhage). The mean baseline hemoglobin concentration was 13.8 ± 1.7 g/dl (range 8.1 - 18.7). WHO-defined anemia was present in 19% of patients among both women and men. After adjustment for differences in baseline characteristics, patients with admission anemia had an adjusted OR for all-cause death at 1-month of 1.90 (95% CI, 1.05 to 3.43) and at 1-year of 1.72 (95% CI, 1.00 to 2.93) and for the combined end-point of disability, nursing facility care or death of 2.09 (95% CI, 1.13 to 3.84) and 1.83 (95% CI, 1.02 to 3.27) respectively. The relationship between hemoglobin quartiles and all-cause death revealed a non-linear association with increased risk at extremes of both low and high concentrations. In logistic regression models developed to estimate the linear and quadratic relation between hemoglobin and outcomes of interest, each unit increment in hemoglobin squared was associated with increased adjusted odds of all-cause death [at 1-month 1.06 (1.01 to 1.12; p = 0.03); at 1-year 1.09 (1.04 to 1.15; p < 0.01)], confirming that extremes of both low and high levels of hemoglobin were associated with increased mortality. WHO-defined anemia was common in both men and women among patients with acute stroke and predicted poor outcome. Moreover, the association between admission hemoglobin and mortality was not linear; risk for death increased at both extremes of hemoglobin.read more
Citations
More filters
Journal ArticleDOI
What is really dangerous: anaemia or transfusion?
TL;DR: The risks of anaemia and transfusion in the light of substantial variations in transfusion practices, increasing costs, shrinking pool of donated resources, and ambiguity about actual clinical benefits of banked allogeneic blood demand better management strategies targeted at improving patient outcomes.
Journal ArticleDOI
Evidence-Based Guidelines for the Management of Large Hemispheric Infarction: A Statement for Health Care Professionals from the Neurocritical Care Society and the German Society for Neuro-Intensive Care and Emergency Medicine
Michel T. Torbey,Julian Bösel,Denise H. Rhoney,Fred Rincon,Dimitre Staykov,Arun P. Amar,Panayiotis N. Varelas,Eric Jüttler,DaiWai W. Olson,Hagen B. Huttner,Klaus Zweckberger,Kevin N. Sheth,Christian Dohmen,Ansgar M. Brambrink,Stephan A. Mayer,Osama O. Zaidat,Werner Hacke,Stefan Schwab +17 more
TL;DR: Experts from neurocritical care, neurosurgery, neurology, interventional neuroradiology, and neuroanesthesiology from Europe and North America were recruited and recommendations were developed based on the quality of evidence and the balance of benefits and harms.
Journal ArticleDOI
Incidence of Stroke Before and After Dialysis Initiation in Older Patients
Anne M. Murray,Stephen L. Seliger,Stephen L. Seliger,Kamakshi Lakshminarayan,Kamakshi Lakshminarayan,Charles A. Herzog,Craig A. Solid +6 more
TL;DR: The process of initiating dialysis may cause strokes, and further studies should evaluate methods to mitigate the risk for stroke during this high-risk period.
Journal ArticleDOI
Impact of Hemoglobin Levels and Anemia on Mortality in Acute Stroke: Analysis of UK Regional Registry Data, Systematic Review, and Meta‐Analysis
Raphae S. Barlas,K Honney,Yoon K. Loke,Stephen J. McCall,Joao H. Bettencourt-Silva,Allan Clark,Kristian M. Bowles,Anthony K. Metcalf,Mamas A. Mamas,John F. Potter,Phyo K. Myint +10 more
TL;DR: Strong evidence suggests that patients with anemia have increased mortality with stroke, and targeted interventions in this patient population may improve outcomes and require further evaluation.
Journal ArticleDOI
Iron deficiency anemia--bridging the knowledge and practice gap.
Aryeh Shander,Aryeh Shander,Lawrence T. Goodnough,Mazyar Javidroozi,Michael Auerbach,Jeffrey L. Carson,William B. Ershler,Mary Ghiglione,John A. Glaspy,Indu Lew +9 more
TL;DR: An algorithm for detection and management of anemia was discussed, which incorporated iron study (with primary emphasis on transferrin saturation), serum creatinine and glomerular filtration rate, and vitamin B12 and folic acid measurements, and management strategies included iron therapy, erythropoiesis-stimulating agents, and referral as needed.
References
More filters
Journal ArticleDOI
Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment
Harold P. Adams,Birgitte H. Bendixen,L J Kappelle,José Biller,Betsy B. Love,David Lee Gordon,E. Eugene Marsh +6 more
TL;DR: The TOAST stroke subtype classification system is easy to use and has good interobserver agreement and should allow investigators to report responses to treatment among important subgroups of patients with ischemic stroke.
Journal ArticleDOI
Locally Weighted Regression: An Approach to Regression Analysis by Local Fitting
TL;DR: Locally weighted regression as discussed by the authors is a way of estimating a regression surface through a multivariate smoothing procedure, fitting a function of the independent variables locally and in a moving fashion analogous to how a moving average is computed for a time series.
Journal ArticleDOI
Measurements of acute cerebral infarction: a clinical examination scale.
Thomas Brott,Harold P. Adams,Charles P. Olinger,John R. Marler,William G. Barsan,José Biller,Judith Spilker,R Holleran,Robert Eberle,Vicki S. Hertzberg +9 more
TL;DR: A 15-item neurologic examination stroke scale for use in acute stroke therapy trials was designed and interrater reliability for the scale was found to be high, and test-retest reliability was also high, suggesting acceptable examination and scale validity.
Journal ArticleDOI
Correction of Anemia with Epoetin Alfa in Chronic Kidney Disease
Ajay K. Singh,Lynda A. Szczech,Kezhen L. Tang,Huiman X. Barnhart,Shelly Sapp,Marsha Wolfson,Donal N. Reddan,Abstr Act +7 more
TL;DR: The use of a target hemoglobin level of 13.5 g per deciliter (as compared with 11.3 g perDeciliter) was associated with increased risk and no incremental improvement in the quality of life and the use of epoetin alfa targeted to achieve a level of 11.4 g perdeciliter was not associated with an increased risk.
Journal ArticleDOI
Smoothing parameter selection in nonparametric regression using an improved Akaike information criterion
TL;DR: In this paper, an improved version of a criterion based on the Akaike information criterion (AIC), termed AICc, is derived and examined as a way to choose the smoothing parameter.