title: Ischemic Stroke Mortality Is More Strongly Associated with Anemia on Admission Than with Underweight Status.
abstract: BACKGROUND
  Underweight patients have recently been reported as a group with a high risk of poststroke death. Anemia also increases mortality rates in stroke patients. However, the causal associations between body weight and anemia resulting in stroke-related death remain unclear. We examined the association of weight status and hemoglobin levels with 3-month mortality after ischemic stroke.
  
  
  METHODS
  The study enrolled all consecutive patients with acute ischemic stroke and no history of stroke admitted to our hospital between January 2010 and December 2013. The patients were categorized into 4 body mass index (BMI) categories (underweight, normal-weight, overweight, and obese). Anemia was evaluated according to the World Health Organization criteria (men, <13 g/dL; women, <12 g/dL).
  
  
  RESULTS
  A total of 1733 acute ischemic stroke patients (149 underweight, BMI < 18.5 kg/m2; 1076 normal-weight, BMI = 18.5-24.9 kg/m2; 436 overweight, BMI = 25-29.9 kg/m2; and 72 obese, BMI > 30 kg/m2) were included. Death within 3 months occurred in 65 patients (underweight, 10.1%; normal-weight, 3.4%; overweight, 2.3%; and obese, 5.6%). Compared to nonanemic patients, those with anemia (n = 329, 19.0%) had lower BMI (21.8 kg/m2versus 23.7 kg/m2, P <.001) and higher mortality rates (9.1% versus 2.5%, P <.001). Underweight status was associated with 3-month mortality after adjusting for age, sex, comorbidities, and initial stroke severity. However, in the models that included laboratory findings, it was anemia status (odds ratio, 2.81; 95% confidence interval, 1.46-5.43), not underweight status, that was independently associated with 3-month mortality.
  
  
  CONCLUSIONS
  Anemia on admission was associated with stroke mortality independent of underweight status.
authors.affiliation: Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan; Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kubo
authors.affiliation: Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan. Electronic address: nhosomi@hiroshima-u.ac.jp.
authors.forename: Naohisa
authors.initials: N
authors.lastname: Hosomi
authors.affiliation: Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan; Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Hara
authors.affiliation: Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan; Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan.
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Neshige
authors.affiliation: Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Himeno
authors.affiliation: Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Takeshima
authors.affiliation: Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Takamatsu
authors.affiliation: Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Shimoe
authors.affiliation: Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan.
authors.forename: Taisei
authors.initials: T
authors.lastname: Ota
authors.affiliation: Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Maruyama
authors.affiliation: Stroke Center, Kinki University Hospital, Osaka, Japan.
authors.forename: Toshiho
authors.initials: T
authors.lastname: Ohtsuki
authors.affiliation: Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Kuriyama
authors.affiliation: Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
authors.forename: Masayasu
authors.initials: M
authors.lastname: Matsumoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood / Q000175:diagnosis / Q000401:mortality*; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002545:Brain Ischemia / Q000175:diagnosis / Q000401:mortality*; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D034141:Hypoalbuminemia / Q000097:blood / Q000175:diagnosis / Q000401:mortality; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D016017:Odds Ratio; D010343:Patient Admission; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000401:mortality*; D013851:Thinness / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D013997:Time Factors
chemical_list: D015415:Biomarkers; D006454:Hemoglobins
keywords: Anemia; ischemic stroke; mortality; underweight status