Kim Chulho, Lee Sang-Hwa, Lim Jae-Sung, Oh Mi Sun, Yu Kyung-Ho, Kim Yerim, Lee Ju-Hun, Jang Min Uk, Jung San, Lee Byung-Chul
Department of Neurology, Chuncheon Sacred Heart Hospital, Chuncheon 24253, Korea.
Chuncheon Translational Research Center, Hallym University College of Medicine, Chuncheon 24252, Korea.
J Clin Med. 2020 May 21;9(5):1566. doi: 10.3390/jcm9051566.
This study aimed to investigate whether transfusions and hemoglobin variability affects the outcome of stroke after an acute ischemic stroke (AIS).
We studied consecutive patients with AIS admitted in three tertiary hospitals who received red blood cell (RBC) transfusion (RBCT) during admission. Hemoglobin variability was assessed by minimum, maximum, range, median absolute deviation, and mean absolute change in hemoglobin level. Timing of RBCT was grouped into two categories: admission to 48 h (early) or more than 48 h (late) after hospitalization. Late RBCT was entered into multivariable logistic regression model. Poor outcome at three months was defined as a modified Rankin Scale score ≥3.
Of 2698 patients, 132 patients (4.9%) received a median of 400 mL (interquartile range: 400-840 mL) of packed RBCs. One-hundred-and-two patients (77.3%) had poor outcomes. The most common cause of RBCT was gastrointestinal bleeding (27.3%). The type of anemia was not associated with the timing of RBCT. Late RBCT was associated with poor outcome (odd ratio (OR), 3.55; 95% confidence interval (CI), 1.43-8.79; -value = 0.006) in the univariable model. After adjusting for age, sex, Charlson comorbidity index, and stroke severity, late RBCT was a significant predictor (OR, 3.37; 95% CI, 1.14-9.99; -value = 0.028) of poor outcome at three months. In the area under the receiver operating characteristics curve comparison, addition of hemoglobin variability indices did not improve the performance of the multivariable logistic model.
Late RBCT, rather than hemoglobin variability indices, is a predictor for poor outcome in patients with AIS.
本研究旨在调查输血及血红蛋白变异性是否会影响急性缺血性卒中（AIS）后卒中的预后。
我们研究了在三家三级医院连续收治的急性缺血性卒中患者，这些患者在住院期间接受了红细胞（RBC）输血（RBCT）。通过血红蛋白水平的最小值、最大值、范围、中位数绝对偏差和平均绝对变化来评估血红蛋白变异性。RBCT的时间分为两类：住院后0至48小时（早期）或超过48小时（晚期）。晚期RBCT被纳入多变量逻辑回归模型。三个月时预后不良定义为改良Rankin量表评分≥3分。
在2698例患者中，132例（4.9%）接受了中位数为400 mL（四分位间距：400 - 840 mL）的浓缩红细胞。102例（77.3%）患者预后不良。RBCT最常见的原因是胃肠道出血（27.3%）。贫血类型与RBCT的时间无关。在单变量模型中，晚期RBCT与预后不良相关（比值比（OR），3.55；95%置信区间（CI），1.43 - 8.79；P值 = 0.006）。在调整年龄、性别、Charlson合并症指数和卒中严重程度后，晚期RBCT是三个月时预后不良的显著预测因素（OR，3.37；95% CI，1.14 - 9.99；P值 = 0.028）。在受试者工作特征曲线下面积比较中，添加血红蛋白变异性指标并未改善多变量逻辑模型的性能。
晚期RBCT而非血红蛋白变异性指标是急性缺血性卒中患者预后不良的预测因素。
