Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
5-Year IF – 2.0, IF – 1.9, JCI (2024) – 0.43
Scopus CiteScore – 4.3
Q1 in SJR 2024, SJR score – 0.598, H-index: 49 (SJR)
ICV – 161.00; MNiSW – 70 pts
Initial editorial assessment and first decision within 24 h

ISSN 1899–5276 (print), ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2019, vol. 28, nr 10, October, p. 1419–1424

doi: 10.17219/acem/104540

Publication type: original article

Language: English

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Anemia on admission and long-term mortality risk in patients with acute ischemic stroke

Tanja Hojs Fabjan1,2,A,B,C,D,E,F, Meta Penko3,A,B,C,E,F, Radovan Hojs4,2,A,C,E,F

1 Department of Neurology, University Medical Centre, Maribor, Slovenia

2 Faculty of Medicine, University of Maribor, Slovenia

3 Clinic of Internal Medicine, Department of Cardiology, University Medical Centre, Maribor, Slovenia

4 Clinic of Internal Medicine, Department of Nephrology, University Medical Centre, Maribor, Slovenia

Abstract

Background. Anemia is associated with adverse outcomes in patients with acute myocardial infarction and congestive heart failure. Additionally, it has been shown that anemia increases the short-term mortality risk in patients with acute stroke.
Objectives. The aim of our study was to determine the importance of anemia as a long-term mortality risk factor by itself or in combination with other risk factors.
Material and Methods. We included 390 Caucasian patients with acute ischemic stroke in our study. Their progress was followed from the day of their admission until their death or a max. of 1,669 days. Stroke and anemia were defined according to the World Health Organization (WHO) criteria.
Results. Anemia was present in 57 (14.6%) patients. The patients with anemia were older (p < 0.01) and more likely to be female (p < 0.001). They had higher NIHSS scores on admission (p < 0.001) and discharge (p < 0.001), lower estimated glomerular filtration rates (eGFRs) (p < 0.001), lower serum LDL cholesterol (p < 0.01) and lower serum albumin levels (p < 0.001), while their serum C-reactive protein (CRP) levels were higher (p < 0.001). The Kaplan–Meier curves showed that patients with anemia had higher mortality (p < 0.001). Cox’s regression analysis revealed that anemia at admission was a predictor of long-term mortality in these patients (hazard ratio (HR) = 2.448, 95% confidence interval (95% CI) = 1.773–3.490; p < 0.001). Anemia remained a strong predictor of mortality after adjusting for other risk factors as well.
Conclusion. Anemia was frequent among our patients and was an independent predictor of long-term mortality even after adjusting for other risk factors.

Key words

risk factors, acute ischemic stroke, anemia, long-term mortality

References (30)

  1. Dhar R, Zazulia AR, Videen TO, Zipfel GJ, Derdeyn CP, Diringer MN. Red blood cell transfusion increases cerebral oxygen delivery in anemic patients with subarachnoid hemorrhage. Stroke. 2009;40(9):3039–3044.
  2. Ferrucci L, Guralnik JM, Woodman RC, et al. Proinflammatory state and circulating erythropoietin in persons with and without anemia. Am J Med. 2005;118(11):1288.
  3. Culleton BF, Manns BJ, Zhang J, Tonelli M, Klarenbach S, Hemmelgarn BR. Impact of anemia on hospitalization and mortality in older adults. Blood. 2006;107(10):3841–3846.
  4. Penninx BW, Pahor M, Cesari M, et al. Anemia is associated with disability and decreased physical performance and muscle strength in the elderly. J Am Geriatr Soc. 2004;52(5):719–724.
  5. Salisbury AC, Alexander KP, Reid KJ, et al. Incidence, correlates, and outcomes of acute, hospital-acquired anemia in patients with acute myocardial infarction. Circ Cardiovasc Qual Outcomes. 2010;3(4):337–346.
  6. Younge JO, Nauta ST, Akkerhuis KM, Deckers JW, van Domburg RT. Effect of anemia on short- and long-term outcome in patients hospitalized for acute coronary syndromes. Am J Cardiol. 2012;109(4):506–510.
  7. Kosiborod M, Smith GL, Radford MJ, Foody JM, Krumholz HM. The prognostic importance of anemia in patients with heart failure. Am J Med. 2003;114(2):112–119.
  8. Li Z, Zhou T, Li Y, Chen P, Chen L. Anemia increases the mortality risk in patients with stroke: A meta-analysis of cohort studies. Sci Rep. 2016;6:26636.
  9. Huang WY, Weng WC, Chien YY, Wu CL, Peng TI, Chen KH. Predictive factors of outcome and stroke recurrence in patients with unilateral atherosclerosis-related internal carotid artery occlusion. Neurol India. 2008;56(2):173–178.
  10. Huang WY, Chen IC, Meng L, Weng WC, Peng TI. The influence of anemia on clinical presentation and outcome of patients with first-ever atherosclerosis-related ischemic stroke. J Clin Neurosci. 2009;16(5):645–649.
  11. Thorvaldsen P, Asplund K, Kuulasmaa K, Rajakangas AM, Schroll M. Stroke incidence, case fatality, and mortality in the WHO MONICA Project. Stroke. 1995;26(3):361–367.
  12. Muir KW, Weir CJ, Murray GD, Povey C, Lees KR. Comparison of neurological scales and scoring systems for acute stroke prognosis. Stroke. 1996;27(10):1817–1820.
  13. Nutritional anemias. Report of a WHO scientific group. World Health Organ Tech Rep Ser. 1968;405:5–37.
  14. Levey AS, Stevens LA, Schmid CH, et al; CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604–612.
  15. Ryden L, Grant PJ, Anker SD, et al. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: The Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J. 2013;34(39):3035–3087.
  16. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34(28):2159–2219.
  17. Del Fabbro P, Luthi JC, Carrera E, Michel P, Burnier M, Burnand B. Anemia and chronic kidney disease are potential risk factors for mortality in stroke patients: A historic cohort study. BMC Nephrol. 2010;11:27.
  18. Nybo M, Kristensen SR, Mickley H, Jensen JK. The influence of anemia on stroke prognosis and its relation to N-terminal pro-brain natriuretic peptide. Eur J Neurol. 2007;14(5):477–482.
  19. Sico JJ, Concato J, Wells CK, et al. Anemia is associated with poor outcomes in patients with less severe ischemic stroke. J Stroke Cerebrovasc Dis. 2013;22(3):271–278.
  20. Hao Z, Wu B, Wang D, Lin S, Tao W, Liu M. A cohort study of patients with anemia on admission and fatality after acute ischemic stroke. J Clin Neurosci. 2013;20(1):37–42.
  21. Barlas RS, Honney K, Loke YK, et al. Impact of hemoglobin levels and anemia on mortality in acute stroke: Analysis of UK regional registry data, systemic review, and meta-analysis. J Am Heart Assoc. 2016;5(8):pii: e003019.
  22. Corona LP, Duarte YA, Lebrao ML. Prevalence of anemia and associated factors in older adults: Evidence from the SABE Study. Rev Saude Publica. 2014;48(5):723–731.
  23. Milionis H, Papavasileiou V, Eskandari A, D’Ambrogio-Remillard S, Ntaios G, Michel P. Anemia on admission predicts short- and long-term outcomes in patients with acute ischemic stroke. Int J Stroke. 2015;10(2):224–230.
  24. Stenvinkel P, Heimbürger O, Paultre F, et al. Strong association between malnutrition, inflammation and atherosclerosis in chronic renal failure. Kidney Int. 1999;55(5):1899–1911.
  25. Hojs Fabjan T, Hojs R, Tetickovic E, Pecovnik Balon B. Ischaemic stroke – impact of renal dysfunction on in-hospital mortality. Eur J Neurol. 2007;14(12):1351–1356.
  26. MacWalter RS, Wong SYS, Wong KYK. Does renal dysfunction predict mortality after acute stroke? A 7-year follow-up study. Stroke. 2002;33(6):130–135.
  27. Tsagalis G, Akrivos T, Alevizaki M, et al. Renal dysfunction in acute stroke: An independent predictor of long-term all combined vascular events and overall mortality. Nephrol Dial Transplant. 2009;24(1):194–200.
  28. Dexter F, Hindman BJ. Effect of haemoglobin concentration on brain oxygenation in focal stroke: A mathematical modelling study. Br J Anaesth. 1997;79(3):346–351.
  29. Kim JS, Kang SY. Bleeding and subsequent anemia: A precipitant for cerebral infarction. Eur Neurol. 2000;43(4):201–208.
  30. Barles RS, McCall SJ, Bettencourt-Silva JH, et al. Impact of anemia on acute stroke outcomes depends on the type of anemia: Evidence from a UK stroke register. J Neurol Sci. 2017;383:26–30.
© Wroclaw Medical University