Abe Arata, Sakamoto Yuki, Nishiyama Yasuhiro, Suda Satoshi, Suzuki Kentaro, Aoki Junya, Kimura Kazumi
Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
J Stroke Cerebrovasc Dis. 2018 Jun;27(6):1646-1652. doi: 10.1016/j.jstrokecerebrovasdis.2018.01.026. Epub 2018 Feb 22.
Anemia upon hospital admission is a known predictor of poor functional outcomes in patients with acute cerebral infarction. However, it remains unclear whether reductions in hemoglobin levels during hospitalization influence stroke outcomes. We investigated the association between in-hospital decline in hemoglobin and poor outcomes.
We retrospectively analyzed data from 480 consecutive patients who had experienced acute cerebral infarction and presented without anemia between January 2012 and March 2015. Decline in hemoglobin was taken as the difference between hemoglobin levels upon admission and nadir hemoglobin. Poor outcome was defined as a modified Rankin Scale score 3-6. A multivariate analysis of the relationship between decline in hemoglobin and poor outcome at discharge was conducted for various patient characteristics.
The mean hemoglobin level at admission was 14.3 ± 1.3 g/dL, whereas the mean nadir hemoglobin value was 13.1 ± 1.9 g/dL, with a mean decline in hemoglobin of 1.3 ± 1.5 g/dL. In patients with poor outcomes, mean decline in hemoglobin was significantly reduced to 3.1 g/dL (P < .001). The optimal cutoff decline in hemoglobin required to distinguish a poor outcome was 1.5 g/dL whereas the sensitivity and specificity were 62% and 82.3%, respectively, with an area under the curve of .77 (P < .0001). A decline in hemoglobin below 1.5 g/dL was found to be an independent predictor of poor outcome (odds ratio: 2.10; confidence interval: 1.10-3.99; P = .023).
Decline in hemoglobin in patients hospitalized with acute stroke may be associated with poor outcome.
入院时贫血是急性脑梗死患者功能预后不良的已知预测因素。然而，住院期间血红蛋白水平的降低是否会影响卒中预后仍不清楚。我们调查了住院期间血红蛋白下降与不良预后之间的关联。
我们回顾性分析了2012年1月至2015年3月期间连续480例发生急性脑梗死且入院时无贫血的患者的数据。血红蛋白下降定义为入院时血红蛋白水平与最低血红蛋白水平之差。不良预后定义为改良Rankin量表评分为3 - 6分。针对各种患者特征，对血红蛋白下降与出院时不良预后之间的关系进行了多因素分析。
入院时平均血红蛋白水平为14.3±1.3g/dL，而最低血红蛋白平均值为13.1±1.9g/dL，血红蛋白平均下降1.3±1.5g/dL。在预后不良的患者中，血红蛋白平均下降显著降至3.1g/dL（P <.001）。区分不良预后所需的血红蛋白最佳下降临界值为1.5g/dL，而敏感性和特异性分别为62%和82.3%，曲线下面积为0.77（P <.0001）。发现血红蛋白下降低于1.5g/dL是不良预后的独立预测因素（比值比：2.10；置信区间：1.10 - 3.99；P = 0.023）。
急性卒中住院患者血红蛋白下降可能与不良预后相关。
