title: Anemia is associated with poor outcomes in patients with less severe ischemic stroke.
abstract: Anemia is a known predictor of in-hospital mortality among patients with such vascular conditions as acute myocardial infarction, congestive heart failure, and chronic kidney disease. The role of anemia in patients with acute ischemic stroke is less well understood. We sought to examine the association between anemia at hospital admission and the combined outcome of in-hospital mortality and discharge to hospice in patients with acute ischemic stroke. We evaluated data from a retrospective cohort of consecutive ischemic stroke patients presenting within 48 hours of symptom onset at 5 hospitals between 1998 and 2003. Anemia was defined as an admission hematocrit value of <30%. Less severe stroke was defined as an admission National Institutes of Health Stroke Scale score of <10. The outcome was the combined endpoint of in-hospital mortality or discharge to hospice. Among 1306 patients with stroke, anemia was present on admission in 6.4%, and the combined outcome of death or discharge to hospice was present in 10.1%. Anemia was not associated with outcome in patients with severe stroke (anemia, 17.2% [5 of 29] vs no anemia, 28,4% [98 of 345]; P = .20), but was associated with outcome in patients with less severe stroke (anemia, 13.0% [7 of 54] vs no anemia, 2.5% [22 of 878]; P < .0001). After adjustment for stroke severity, admission anemia was independently associated with outcome in patients with less severe stroke (adjusted odds ratio, 4.17; 95% confidence interval, 1.47-11.90), but not in patients with more severe strokes (adjusted odds ratio, 0.82; 95% confidence interval, 0.30-2.22). Our data indicate that anemia is associated with in-hospital mortality or discharge to hospice in patients with less severe ischemic stroke.
authors.affiliation: Department of Neurology, Yale University School of Medicine, New Haven, CT, USA. jason.sico@yale.edu
authors.forename: Jason J
authors.initials: JJ
authors.lastname: Sico
authors.forename: John
authors.initials: J
authors.lastname: Concato
authors.forename: Carolyn K
authors.initials: CK
authors.lastname: Wells
authors.forename: Albert C
authors.initials: AC
authors.lastname: Lo
authors.forename: Steven E
authors.initials: SE
authors.lastname: Nadeau
authors.forename: Linda S
authors.initials: LS
authors.lastname: Williams
authors.forename: Aldo J
authors.initials: AJ
authors.lastname: Peixoto
authors.forename: Mark
authors.initials: M
authors.lastname: Gorman
authors.forename: John L
authors.initials: JL
authors.lastname: Boice
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Bravata
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D002545:Brain Ischemia / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D016009:Chi-Square Distribution; D004185:Disability Evaluation; D005260:Female; D017051:Hospice Care; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010343:Patient Admission; D010351:Patient Discharge; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D014481:United States; D055815:Young Adult