Beyond Hemoglobin Levels: Integrating Anemia Phenotyping Into Prognostic Models for Patients With Stroke Following...

Area of Science:

• Neurology
• Hematology
• Internal Medicine

Background:

• Anemia is a known predictor of adverse outcomes following intravenous thrombolysis for acute ischemic stroke.
• The differential prognostic impact of various anemia morphological subtypes remains incompletely understood.

Purpose of the Study:

• To investigate the distinct effects of microcytic, normocytic, and macrocytic anemia on patient outcomes after acute ischemic stroke treated with intravenous thrombolysis.

Main Methods:

• A multicenter, prospective cohort study involving 1367 patients treated with intravenous thrombolysis for acute ischemic stroke.
• Anemia was classified based on World Health Organization criteria and mean corpuscular volume.
• Multivariable logistic regression and mediation analyses were employed to assess outcomes.

Main Results:

• Anemia was present in 27.7% of patients (14.7% normocytic, 8.9% microcytic, 3.9% macrocytic).
• Microcytic and normocytic anemia were independently linked to increased risks of 3-month mortality and severe disability.
• Normocytic anemia also correlated with in-hospital neurological deterioration, stroke-associated pneumonia, and gastrointestinal bleeding, with pneumonia mediating a significant portion of the risk.

Conclusions:

• Morphological anemia subtypes possess distinct prognostic implications in patients receiving intravenous thrombolysis for acute ischemic stroke.
• Microcytic and normocytic anemia are associated with poor prognosis and mortality.
• In-hospital complications, especially stroke-associated pneumonia, play a mediating role in the adverse outcomes associated with normocytic anemia.