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Stroke Vasc Neurol. 2018 Apr 24;3(3):160-168. doi: 10.1136/svn-2018-000149. eCollection 2018 Sep.

Association between admission haematocrit and mortality among men with acute ischaemic stroke.

Sico JJ1,2,3,4,5, Myers LJ6,7, Fenton BJ5,8, Concato J3,4,9, Williams LS6,7,10,11, Bravata DM6,7,10,11,12.

Author information

1
Neurology Service, VA Connecticut Healthcare System, West Haven, Connecticut, USA.
2
Department of Neurology, Center for NeuroEpidemiological and Clinical Neurological Research, Yale University School of Medicine, New Haven, Connecticut, USA.
3
Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
4
Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, Connecticut, USA.
5
Pain Research, Informatics, Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut, USA.
6
Communication and the HSR&D Stroke Quality Enhancement Research Initiative (QUERI), Richard L Roudebush VA Medical Center, Indianapolis, Indiana, USA.
7
VA Health Services Research and Development (HSR&D), Center for Healthcare Informatics, Richard L Roudebush VA Medical Center, Indianapolis, Indiana, USA.
8
Division of Chronic Disease Epidemiology, Yale School of Public Health, West Haven, Connecticut, USA.
9
Medical Service, VA Connecticut Healthcare System, West Haven, Connecticut, USA.
10
Regenstrief Institute, Indianapolis, Indiana, USA.
11
Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
12
Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.

Abstract

Objective:

Anaemia is associated with higher mortality among patients with non-stroke cardiovascular conditions; less is known regarding the relationship between anaemia and mortality among patients with acute ischaemic stroke.

Methods:

Medical records were abstracted for n=3965 veterans from 131 Veterans Health Administration facilities who were admitted with ischaemic stroke in fiscal year 2007. Haematocrit values within 24 hours of admission were classified as ≤27%, 28%-32%, 33%-37%, 38%-42%, 43%-47% or ≥48%. Multivariate logistic regression was used to examine the relationship between anaemia and in-hospital, 30-day, 6-month and 1-year mortality, adjusting for age, medical comorbidities, modified Acute Physiology and Chronic Health Evaluation-III and stroke severity. Impact factors were calculated to standardise comparisons between haematocrit tier and other covariates.

Results:

Among n=3750 patients included in the analysis, the haematocrit values were ≤27% in 2.1% (n=78), 28%-32% in 6.2% (n=234), 33%-37% in 17.9% (n=670), 38%-42% in 36.4% (n=1366), 43%-47% in 28.2% (n=1059) and ≥48% in 9.1% (n=343). Patients with haematocrit ≤27%, compared with patients in the 38%-42% range, were more likely to have died across all follow-up intervals, with statistically significant adjusted ORs (aORs) ranging from 2.5 to 3.5. Patients with polycythaemia (ie, haematocrit ≥48%) were at increased risk of in-hospital mortality (aOR=2.9; 95% CI 1.4 to 6.0), compared with patients with mid-range admission haematocrits. Pronounced differences between patients receiving and not receiving blood transfusion limited our ability to perform a propensity analysis. Impact factors in the 1-year mortality model were 0.46 (severe anaemia), 0.06 (cancer) and 0.018 (heart disease).

Conclusions:

Anaemia is independently associated with an increased risk of death throughout the first year post stroke; high haematocrit is associated with early poststroke mortality. Severe anaemia is associated with 1-year mortality to a greater degree than cancer or heart disease. These data cannot address the question of whether interventions targeting anaemia might improve patient outcomes.

KEYWORDS:

anemia; hematocrit; ischemic stroke; mortality; polycythemia

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