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.
Highlights
Anemia is an independent predictor for mortality and cardiovascular disease in the general population [1]
Low hemoglobin status was associated with poor outcomes in patients with acute ischemic stroke (AIS); these studies focused on admission hemoglobin level and did not assess whether red blood cell transfusion (RBCT) was performed during the admission [1]
The number of patients taking anticoagulants was higher in the RBCT group, but there was no difference in the previous use of antiplatelet agents before the index stroke between the two groups
Summary
Anemia is an independent predictor for mortality and cardiovascular disease in the general population [1]. Moman et al have reported that RBCT is associated with a longer hospital stay in patients with AIS with no difference in mortality [9]. They used propensity score matching to evaluate the impact of transfusion; they did not assess the hemoglobin status in all participants. Kellert et al studied the association between RBCT and mortality and 3-month outcomes in patients with AIS admitted to a neurologic intensive care unit [10]. One systematic review has suggested that anemia increases the mortality rate in patients with acute stroke; the association between RBCT and change in hemoglobin level were not evaluated [1]. Our aim is to assess the effect of type of anemia, timing of RBCT, and hemoglobin variability index during admission on the 3-month outcomes in patients with AIS, who received RBCT
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