BACKGROUND AND PURPOSE: Although conceivably relevant for penumbra oxygenation, the optimal levels of hemoglobin (Hb) and hematocrit (Hct) in patients with acute ischemic stroke are unknown. METHODS: We identified patients from our prospective local stroke database who received intravenous thrombolysis based on multimodal magnet resonance imaging during the years 1998 to 2009. A favorable outcome at 3 months was defined as a modified Rankin Scale score≤2 and a poor outcome as a modified Rankin Scale score≥3. The dynamics of Hemoglobin (Hb), Hematocrit (Hct), and other relevant laboratory parameters as well as cardiovascular risk factors were retrospectively assessed and analyzed between these 2 groups. RESULTS: Of 217 patients, 114 had a favorable and 103 a poor outcome. In a multivariable regression model, anemia until day 5 after admission (odds ratio [OR]=2.61; 95% CI, 1.33 to 5.11; P=0.005), Hb nadir (OR=0.81; 95% CI, 0.67 to 0.99; P=0.038), and Hct nadir (OR=0.93; 95% CI, 0.87 to 0.99; P=0.038) remained independent predictors for poor outcome at 3 months. Mortality after 3 months was independently associated with Hb nadir (OR=0.80; 95% CI, 0.65 to 0.98; P=0.028) and Hb decrease (OR=1.34; 95% CI, 1.01 to 1.76; P=0.04) as well as Hct decrease (OR=1.12; 95% CI, 1.01 to 1.23; P=0.027). CONCLUSIONS: Poor outcome and mortality after ischemic stroke are strongly associated with low and further decreasing Hb and Hct levels. This decrease of Hb and Hct levels after admission might be more relevant and accessible to treatment than are baseline levels.
BACKGROUND AND PURPOSE: Although conceivably relevant for penumbra oxygenation, the optimal levels of hemoglobin (Hb) and hematocrit (Hct) in patients with acute ischemic stroke are unknown. METHODS: We identified patients from our prospective local stroke database who received intravenous thrombolysis based on multimodal magnet resonance imaging during the years 1998 to 2009. A favorable outcome at 3 months was defined as a modified Rankin Scale score≤2 and a poor outcome as a modified Rankin Scale score≥3. The dynamics of Hemoglobin (Hb), Hematocrit (Hct), and other relevant laboratory parameters as well as cardiovascular risk factors were retrospectively assessed and analyzed between these 2 groups. RESULTS: Of 217 patients, 114 had a favorable and 103 a poor outcome. In a multivariable regression model, anemia until day 5 after admission (odds ratio [OR]=2.61; 95% CI, 1.33 to 5.11; P=0.005), Hb nadir (OR=0.81; 95% CI, 0.67 to 0.99; P=0.038), and Hct nadir (OR=0.93; 95% CI, 0.87 to 0.99; P=0.038) remained independent predictors for poor outcome at 3 months. Mortality after 3 months was independently associated with Hb nadir (OR=0.80; 95% CI, 0.65 to 0.98; P=0.028) and Hb decrease (OR=1.34; 95% CI, 1.01 to 1.76; P=0.04) as well as Hct decrease (OR=1.12; 95% CI, 1.01 to 1.23; P=0.027). CONCLUSIONS: Poor outcome and mortality after ischemic stroke are strongly associated with low and further decreasing Hb and Hct levels. This decrease of Hb and Hct levels after admission might be more relevant and accessible to treatment than are baseline levels.
Authors: Michel T Torbey; Julian Bösel; Denise H Rhoney; Fred Rincon; Dimitre Staykov; Arun P Amar; Panayiotis N Varelas; Eric Jüttler; DaiWai Olson; Hagen B Huttner; Klaus Zweckberger; Kevin N Sheth; Christian Dohmen; Ansgar M Brambrink; Stephan A Mayer; Osama O Zaidat; Werner Hacke; Stefan Schwab Journal: Neurocrit Care Date: 2015-02 Impact factor: 3.210
Authors: Rajat N Moman; Daryl J Kor; Arun Chandran; Andrew C Hanson; Darrell R Schroeder; Alejandro A Rabinstein; Matthew A Warner Journal: J Crit Care Date: 2018-11-11 Impact factor: 3.425
Authors: Joseph B Miller; Christopher Lewandowski; Charles R Wira; Andrew Taylor; Charlotte Burmeister; Robert Welch Journal: Neurocrit Care Date: 2017-04 Impact factor: 3.210
Authors: Valerian L Altersberger; Lars Kellert; Abdulaziz S Al Sultan; Nicolas Martinez-Majander; Christian Hametner; Ashraf Eskandari; Mirjam R Heldner; Sophie A van den Berg; Andrea Zini; Visnja Padjen; Georg Kägi; Alessandro Pezzini; Alexandros Polymeris; Gian M DeMarchis; Marjaana Tiainen; Silja Räty; Stefania Nannoni; Simon Jung; Thomas P Zonneveld; Stefania Maffei; Leo Bonati; Philippe Lyrer; Gerli Sibolt; Peter A Ringleb; Marcel Arnold; Patrik Michel; Sami Curtze; Paul J Nederkoorn; Stefan T Engelter; Henrik Gensicke Journal: Eur Stroke J Date: 2019-11-13