Hemoglobin Improvement is Positively Associated with Functional Outcomes in Stroke Patients with Anemia

The aim of this study was to evaluate the associations between hemoglobin improvement and functional outcomes in anemic patients after stroke.

This retrospective cohort study included consecutive hospitalized post-stroke patients with anemia. Data on serum hemoglobin level were extracted from medical records. The "change in hemoglobin levels" was defined as the pre-discharge hemoglobin level minus the baseline hemoglobin level. Study outcomes included the Functional Independence Measure-motor (FIM-motor) efficacy, and length of stay. Multivariate analyses were used to determine whether the change in hemoglobin levels was independently associated with study outcomes, after adjusting for potential confounders.

Of the 637 patients admitted, 194 stroke patients (mean age 75.4 years; 53.6% women) presented anemia at baseline and were included in the analysis. The mean (SD) baseline hemoglobin level was 11.2 (0.9) g/dL and the median (IQR) change was 0.4 (0.1-1.1) g/dL. In multivariate analyses, the change in hemoglobin levels was positively associated with the FIM-motor efficacy (β = 0.114, p = 0.031), and negatively associated with length of stay (β = -0.059, p = 0.039). Moreover, the baseline hemoglobin level was independently associated with the FIM-motor efficacy (β = 0.267, p = 0.001).

A lower baseline hemoglobin level is negatively associated with functional recovery, and hemoglobin improvement is positively associated with functional recovery and shorter hospital stay in stroke patients with anemia. Anemia should be assessed at baseline as a prognostic indicator and, if treatable, treated appropriately to maximize outcomes in these patients.