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Anemia impacts short-term and long-term mortality risk after acute ischemic stroke
Chen Ee Low1, Hon Jen Wong1, Chun En Yau1
1Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Background:
The relationship between hemoglobin concentration and all-cause mortality in acute ischemic stroke (AIS) patients remains unclear due to conflicting findings. This study aims to evaluate the impact of hemoglobin concentration on the risk of both short-term and long-term all-cause mortality in AIS patients from a nationwide stroke registry.
Method:
We utilized data from the Singapore Stroke Registry (SSR), including patients >18years old at first AIS onset, and received treatment at a local hospital between 2005 and 2020. Patients were stratified according to sex-specific hemoglobin concentration cut-offs on anemia severity and polycythemia from the World Health Organization. Multivariate logistic regression and Cox proportional hazards modeling were performed, adjusting for demographics and cardiovascular risk factors.
Results:
A total of 56,884 ischemic stroke patients were included, of which 66.8% had no anemia, 15.7% had mild anemia, 12.2% had severe anemia, and 5.3% had polycythemia. The cohort was predominantly male (57%), with a median age of 68 years. The median follow-up duration was 10-years (IQR 7-13). Compared to patients with normal-range hemoglobin, both mild and severe anemia was associated with elevated short-term and long-term risks of all-cause mortality. Severe anemia was associated with the highest risk of all-cause mortality, with hazard ratios of 1.99 (95%CI:1.92-2.06) at 30-days, 1.73 (95%CI:1.66-1.81) at 1-year, and 1.52 (95%CI:1.41-1.64) at 5-years. However, the excess risk associated with severe anemia appeared to attenuate at 10-years, whilst the elevated risk persisted among patients with mild anemia.
Conclusion:
In this nationwide stroke registry, anemia is prevalent among AIS patients and is significantly associated with both short-term and long-term mortality.
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