Barlas, RS, Honney, K, Loke, YK, McCall, SJ, Bettencourt-Silva, JH, Clark, AB, Bowles, KM, Metcalf, AK, Mamas, MA ORCID: 0000-0001-9241-8890, Potter, JF and Myint, PK (2016) Impact of hemoglobin levels and anemia on mortality in acute stroke: analysis of UK regional registry data, systematic review and meta-analysis. Journal of the American Heart Association, 5 (8). ISSN 2047-9980

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Abstract

Background: The impact of hemoglobin levels and anemia on stroke mortality remains controversial. We aimed to systematically assess this association and quantify the evidence. Methods and Results: We analysed data from a cohort of 8,013 stroke patients (mean (sd) 77.81±11.83 years) consecutively admitted over 11 years (January 2003–May 2015) using a UK Regional Stroke Register. The impact of hemoglobin levels and anemia on mortality was assessed by sex-specific values at different time points (7-day, 14-day, 1-month, 3-month, 6-month, 1 year), using multiple regression models controlling for confounders. Anemia was present in 24.5% of the cohort on admission and was associated with increased odds of mortality at most of the time points examined up to 1 year following stroke. The association was less consistent for males with hemorrhagic stroke. Elevated haemoglobin was also associated with increased mortality, mainly within the first month. We then conducted a systematic review using the EMBASE and Medline databases. Twenty studies met the inclusion criteria. When combined with the cohort from the current study, this gave a pooled population of 29,943 patients with stroke. The evidence base was quantified in a meta-analysis. Anemia on admission was found to be associated with an increased risk of mortality in both ischemic stroke (8 studies); OR 1.97(1.56– 2.47) and hemorrhagic stroke (4 studies); OR 1.46(1.23–1.74). Conclusions: There is strong evidence that patients with anemia have increased mortality in stroke. Targeted interventions in this patient population may improve outcomes and therefore require further evaluation.

Item Type: Article
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via American Heart Association at http://dx.doi.org/10.1161/JAHA.115.003019 Please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: Hemoglobin, mortality, prognosis, stroke
Subjects: R Medicine > R Medicine (General)
Divisions: Faculty of Medicine and Health Sciences > Institute for Science and Technology in Medicine
Depositing User: Symplectic
Date Deposited: 17 Jun 2016 12:51
Last Modified: 22 Jun 2018 15:08
URI: http://eprints.keele.ac.uk/id/eprint/1905

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