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Journal article

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

  • Altersberger VL Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland.
  • Kellert L Department of Neurology, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany.
  • Al Sultan AS Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.
  • Martinez-Majander N Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
  • Hametner C Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany.
  • Eskandari A Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
  • Heldner MR Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
  • van den Berg SA Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
  • Zini A Stroke Unit, Department of Neuroscience, Ospedale Civile S. Agostino-Estense, Modena University Hospital, Modena, Italy.
  • Padjen V Neurology Clinic, Clinical Centre of Serbia, Beograd, Serbia.
  • Kägi G Department of Neurology, Kantonsspital St Gallen, St Gallen, Switzerland.
  • Pezzini A Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy.
  • Polymeris A Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland.
  • DeMarchis GM Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland.
  • Tiainen M Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
  • Räty S Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
  • Nannoni S Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
  • Jung S Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
  • Zonneveld TP Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
  • Maffei S Stroke Unit, Department of Neuroscience, Ospedale Civile S. Agostino-Estense, Modena University Hospital, Modena, Italy.
  • Bonati L Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland.
  • Lyrer P Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland.
  • Sibolt G Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
  • Ringleb PA Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany.
  • Arnold M Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
  • Michel P Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
  • Curtze S Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
  • Nederkoorn PJ Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
  • Engelter ST Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland.
  • Gensicke H Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland.
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  • 2020-07-09
Published in:
  • European stroke journal. - 2020
English Introduction
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.


Patients and methods
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.


Results
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 (ORadjusted 1.25 (1.05-1.48)) and mortality (ORadjusted 1.58 (1.27-1.95)). In anaemia subgroups, both mild and moderate/severe anaemia independently predicted poor outcome (ORadjusted 1.29 (1.07-1.55) and 1.48 (1.09-2.02)) and mortality (ORadjusted 1.45 (1.15-1.84) and ORadjusted 2.00 (1.46-2.75)). Each haemoglobin level decrease by 1 g/dl independently increased the risk of poor outcome (ORadjusted 1.07 (1.02-1.11)) and mortality (ORadjusted 1.08 (1.02-1.15)). Anaemia was not associated with occurrence of symptomatic intracranial haemorrhage. Polyglobulia did not change any outcome.


Discussion
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.


Conclusion
Anaemia on admission, but not polyglobulia, is a strong and independent predictor of poor outcome and mortality in intravenous thrombolysis-treated stroke patients.
Language
  • English
Open access status
gold
Identifiers
Persistent URL
https://sonar.ch/global/documents/39
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