title: Cerebral oxygen transport failure?: decreasing hemoglobin and hematocrit levels after ischemic stroke predict poor outcome and mortality: STroke: RelevAnt Impact of hemoGlobin, Hematocrit and Transfusion (STRAIGHT)--an observational study.
abstract: OBJECTIVE
  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.affiliation: Department of Neurology, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. Lars.Kellert@med.uni-heidelberg.de
authors.forename: Lars
authors.initials: L
authors.lastname: Kellert
authors.forename: Evgenia
authors.initials: E
authors.lastname: Martin
authors.forename: Marek
authors.initials: M
authors.lastname: Sykora
authors.forename: Harald
authors.initials: H
authors.lastname: Bauer
authors.forename: Philipp
authors.initials: P
authors.lastname: Gussmann
authors.forename: Jennifer
authors.initials: J
authors.lastname: Diedler
authors.forename: Christian
authors.initials: C
authors.lastname: Herweh
authors.forename: Peter A
authors.initials: PA
authors.lastname: Ringleb
authors.forename: Werner
authors.initials: W
authors.lastname: Hacke
authors.forename: Thorsten
authors.initials: T
authors.lastname: Steiner
authors.forename: Julian
authors.initials: J
authors.lastname: Bösel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000097:blood* / Q000188:drug therapy / Q000401:mortality; D016208:Databases, Factual; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006400:Hematocrit; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D020521:Stroke / Q000097:blood* / Q000188:drug therapy / Q000401:mortality; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D006454:Hemoglobins; D010959:Tissue Plasminogen Activator