Predictive value of hemoglobin level on early neurological outcomes in acute ischemic stroke

ABSTRACT

Background

Few studies have examined the association between hemoglobin (Hb) levels and early neurological changes following acute ischemic stroke (AIS). The present research investigated whether higher or lower Hb level on admission was associated with early neurological deterioration (END) in AIS patients. Furthermore, we evaluated the predictive effect of Hb concentration on stable or improving outcome.

Methods

In this prospective cohort study, a total of 1330 patients admitted within 24 hours after AIS onset were finally involved in the analysis. We classified participants into four groups according to baseline Hb levels: ≤120, 121–140, 141–160, and >160 g/L. The risk of END was accessed by means of logistic regression analysis, and tendency of improvement and stability by multinomial logit analysis. We further evaluated the pattern and magnitude of association of Hb as a continuous variable and END by multivariate logistic regression analysis of restricted cubic spline.

Results

Compared with the reference group, hemoglobin >160 g/L was associated with END (OR, 95%CI; 2.149, 1.314–3.512) and severe END (OR, 95% CI as 2.317, 1.351–3.976 and 2.810,1.589–4.968, respectively). Comparatively, higher Hb level also independently predicted improving (OR, 95% CI; 0.322, 0.170–0.609) and stable (OR, 95% CI; 0.371, 0.205–0.673) outcome. Similar results were found when restricted to anterior circulation ischemic stroke after adjustment of variables including large vessel disease.

Conclusions

We concluded that patients with higher baseline Hb level are at significantly higher risk for END, and less likely to reach stable or improving status at the early stage of stroke.

KEYWORDS:

• Early neurological deterioration
• hemoglobin
• outcome
• stroke

Notes on contributors

Yue Liu is a PhD candidate at the Department of Neurology, The First Affiliated Hospital of Harbin Medical University (Harbin, China). Jingbo Zhao is a professor of Epidemiology in Harbin Medical University. Fang Li is an associate chief physician at the Department of Neurology, The First Affiliated Hospital of Harbin Medical University. Hongwei Sun, Yanyan Sun, Hongwei Sun, Fan Yang work as attending doctors at the Department of Neurology, The First Affiliated Hospital of Harbin Medical University. Yu Zhao is an associate chief physician at the Department of Laboratory Diagnosis, The First Affiliated Hospital of Harbin Medical University. Zijun Liang is on the staff at the Department of health insurance management, The First Affiliated Hospital of Harbin Medical University. Ying Tang is a professor of Neurology in The First Affiliated Hospital of Harbin Medical University.

Abbreviations

AIS, acute ischemic stroke; AF, atrial fibrillation; CI, confidence interval; CT, computed tomography; CHD, coronary heart disease; DBP, diastolic blood pressure; END, early neurological deterioration; FBG, fasting blood glucose; Hb, hemoglobin; HCY, homocysteine; HDL-C, high-density lipoprotein cholesterol; ICA, Internal carotid artery; LDL-C, low-density lipoprotein cholesterol; MRI, magnetic resonance imaging; MI, myocardial infarction; NIHSS, National Institutes of Health Stroke Scale; OR, odds ratio; rt-PA, recombinant tissue plasminogen activator; SBP, systolic blood pressure; TC, total cholesterol; TG, triglyceride; TOAST, Trial of ORG 10172 in Acute Stroke Treatment

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

Ying Tang designed and supervised the study. Yue Liu drafted the manuscript and performed statistical analyses. Jingbo Zhao performed statistical analyses and reviewed the manuscript. Hongwei Sun, Fan Yang, Yu Zhao, Zijun Liang participated in data collection, data interpretation and reviewing the manuscript. Fang Li, Hongwei Sun, Yanyan Sun contributed to data management, quality control and reviewing the manuscript. All co-authors have read and approved the final manuscript.

Data accessibility statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

The work was supported by grants from the National Natural Science Foundation of China (81771508), the Department of Education, Heilongjiang Province (12521291), and the Natural Science Foundation of Heilongjiang Province (D201235) to Prof. Tang.