Chang Thashi, Weeratunga Praveen, Vithanage Thamal, Wijewickrama Piumi, Kularathne Sithara, Fernando Sachie, Arambepola Carukshi
Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
Department of Clinical Medicine, University of Colombo, National Hospital of Sri Lanka, Colombo, Sri Lanka.
Ann Indian Acad Neurol. 2020 Jul-Aug;23(4):515-521. doi: 10.4103/aian.AIAN_357_19. Epub 2019 Sep 25.
Reduced hemoglobin concentration has an adverse impact on the ischemic penumbra in patients with ischemic stroke as it causes reduced oxygen delivery to neuronal tissue and predisposes to infarct expansion. There is a paucity of data on the impact of anemia on early functional outcomes.
To determine the association of anemia on early functional outcomes in a cohort of patients with ischemic stroke.
This prospective study was conducted among 190 participants with acute ischemic stroke presenting to the National Hospital of Sri Lanka. Data were collected on socio-demographic determinants, clinical presentation, co-morbidities, subtype of stroke, and stroke severity (NIHSS score). Early functional outcomes were assessed by the Modified-Rankin-Score (mRS) and Barthel index (BI) within 48 h of the onset. Anemia was defined as Hb <13 g/dl in males and <12 g/dl in females.
The mean age of the population was 62.4 years (SD = 11.8). Most participants (75.8%) were males. Anemia was noted in 56.4% of the total study population (59.0% males; 56.5% females) with a mean Hb of 11.7 g/dl. A total of 20% of patients had moderate to severe stroke severity as defined by an NIHSS of ≥16. Functional status assessment revealed that 67.9% had mRS <3 and 85.8% had BI <75. Furthermore, 85.8% had a composite MRS <3 and/or BI 75. Univariate analysis revealed that anemia was significantly associated with "moderate-severe" functional disability. On logistic regression analyses, this retained significance when the functional disability was assessed by mRS >3 (adjusted OR = 2.36; 95% CI = 1.1-5.1). Receiver operator characteristics (ROC) curves indicated a Hb% of 10.65 g/dl as the cut-off that would predict stroke-related disability assessed by mRS >3 [sensitivity = 86.7%; specificity = 34.2%; and AUC = 0.659 ( < 0.0001)].
Anemia is an independent determinant of poor functional disability in early acute ischemic stroke.
血红蛋白浓度降低会对缺血性中风患者的缺血半暗带产生不利影响，因为它会导致神经元组织的氧气输送减少，并易引发梗死灶扩大。关于贫血对早期功能结局影响的数据较少。
确定贫血与缺血性中风患者队列早期功能结局之间的关联。
这项前瞻性研究在斯里兰卡国立医院就诊的190例急性缺血性中风患者中进行。收集了社会人口学决定因素、临床表现、合并症、中风亚型和中风严重程度（美国国立卫生研究院卒中量表评分）的数据。在发病后48小时内通过改良Rankin量表（mRS）和Barthel指数（BI）评估早期功能结局。贫血定义为男性血红蛋白<13 g/dl，女性血红蛋白<12 g/dl。
研究人群的平均年龄为62.4岁（标准差=11.8）。大多数参与者（75.8%）为男性。在全部研究人群中，56.4%的人存在贫血（男性为59.0%；女性为56.5%），平均血红蛋白为11.7 g/dl。根据美国国立卫生研究院卒中量表≥16定义，共有20%的患者为中度至重度中风严重程度。功能状态评估显示，67.9%的患者mRS<3，85.8%的患者BI<75。此外，85.8%的患者综合MRS<3和/或BI 75。单因素分析显示，贫血与“中度-重度”功能残疾显著相关。在逻辑回归分析中，当通过mRS>3评估功能残疾时，这种相关性仍然显著（调整后的比值比=2.36；95%置信区间=1.1-5.1）。受试者工作特征（ROC）曲线表明，血红蛋白水平为10.65 g/dl可作为预测mRS>3评估的中风相关残疾的临界值[敏感性=86.7%；特异性=34.2%；曲线下面积=0.659（<0.0001）]。
贫血是早期急性缺血性中风功能残疾不良的独立决定因素。
