title: Short term stroke outcome is worse among indiv1iduals with sickle cell trait.
abstract: BACKGROUND
  Most (86%) of the global stroke mortality are from low- and middle-income countries (LMIC) including African countries which have the highest prevalence of the sickle cell trait (Hb AS). The effects of this trait on stroke occurrence and outcome are poorly understood. We aimed to investigate the effects of the sickle cell trait on the 30-day stroke mortality in Nigerian-Africans.
  
  
  METHODS
  This was a prospective study of 35 stroke patients with sickle cell trait (Haemoglobin AS) and 35 age and sex-matched controls without haemoglobinopathy (Haemoglobin AA). Haemoglobin electrophoresis was performed for all before recruitment and they all had neuroimaging done. Patients with haemoglobin AS were used as cases and those with haemoglobin AA as controls. The National Institute of Health Stroke Scale (NIHSS) was used to assess the severity of stroke at presentation and the Modified Rankin Scale for 30-day stroke outcome.
  
  
  RESULTS
  There was no significant difference in the baseline stroke severity between the two groups (p = 0.21). Univariate analysis of the factors predicting the 30-day stroke outcome revealed that NIHSS score > 20 (p < 0.001), haemorrhagic stroke (p = 0.01) and the presence of Hb AS (p < 0.001) were significantly associated with 30-day mortality. Haemorrhagic stroke type was strongly associated with HbAS (OR = 2.9, 95% CI = 1.10-7.99, p-value = 0.02). With multiple logistic regression model, the presence of Hb AS (p = 0.01) and NIHSS score > 20 (p = 0.05) emerged as independent risk factors for 30-day mortality. The cases had worse stroke outcome at 30 days.
  
  
  CONCLUSIONS
  Stroke had1 a worse 30-day mortality and outcome in patients with sickle cell trait (HbAS) than in patients with normal adult haemoglobin (HbAA).
authors.affiliation: Department of Medicine, Neurology Unit, Federal Teaching Hospital, Ido-Ekiti, Nigeria.
authors.forename: P
authors.initials: P
authors.lastname: Olowoyo
authors.affiliation: Department of Medicine, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria.
authors.forename: M O
authors.initials: MO
authors.lastname: Owolabi
authors.affiliation: Neurology Unit, Medicine Department, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria.
authors.forename: B
authors.initials: B
authors.lastname: Fawale
authors.affiliation: Department of Medicine, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria.
authors.forename: A
authors.initials: A
authors.lastname: Ogunniyi
keywords: Sickle cell trait; Stroke mortality; Stroke outcome