title: Loss of Penumbra by Impaired Oxygen Supply? Decreasing Hemoglobin Levels Predict Infarct Growth after Acute Ischemic Stroke: Stroke: Relevant Impact of Hemoglobin, Hematocrit and Transfusion (STRAIGHT) - An Observational Study.
abstract: BACKGROUND
  The association of mortality and poor outcome with reduced levels of hemoglobin (Hb) and hematocrit (Hct) in patients admitted for ischemic stroke was recently demonstrated. The mechanisms behind this have remained unclear.
  
  
  OBJECTIVE
  Here, we aimed to investigate a putative association between low Hb and Hct levels and infarct growth.
  
  
  METHODS
  All consecutive patients who received intravenous thrombolysis based on multimodal magnetic resonance imaging during the years 1998-2009 were screened. Laboratory data as well as admission magnetic resonance images and follow-up computed tomography scans of 257 patients were assessed. Overall, data of 100 patients were of sufficient quality and further analyzed.
  
  
  RESULTS
  Decrease in Hb and Hct as well as perfusion-weighted imaging volume, mismatch volume, and final infarct size on follow-up computed tomography were associated with infarct growth. A linear regression model revealed Hb decrease (β = 0.23, p = 0.02) to be a predictor of infarct growth, independent of mismatch volume (β = 0.27, p = 0.004) and minimum sodium (β = -0.21, p = 0.03), and adjusted to the non-predicting variables age, National Institute of Health Stroke Scale score, maximum leucocytes and C-reactive protein, blood glucose, and Hct decrease.
  
  
  CONCLUSIONS
  Hb levels that decrease after admission independently predict infarct growth in thrombolyzed stroke patients. The clinical implications of this relationship remain to be investigated.
authors.affiliation: Department of Neurology, University of Heidelberg, Heidelberg, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Kellert
authors.forename: C
authors.initials: C
authors.lastname: Herweh
authors.forename: M
authors.initials: M
authors.lastname: Sykora
authors.forename: P
authors.initials: P
authors.lastname: Gussmann
authors.forename: E
authors.initials: E
authors.lastname: Martin
authors.forename: P A
authors.initials: PA
authors.lastname: Ringleb
authors.forename: T
authors.initials: T
authors.lastname: Steiner
authors.forename: J
authors.initials: J
authors.lastname: Bösel
keywords: Acute stroke; Anemia; Computed tomography; Hemoglobin; Magnetic resonance imaging; Stroke; Thrombolysis