Liu Qi, Wang Xianwei, Wang Yilong, Wang Chunxue, Zhao Xingquan, Liu Liping, Li Zixiao, Meng Xia, Guo Li, Wang Yongjun
Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China,
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Cerebrovasc Dis. 2022;51(1):36-44. doi: 10.1159/000517868. Epub 2021 Aug 18.
Existing studies on the association between hemoglobin values and stroke outcomes mostly focus on the lower side and mortality, often the only and primary endpoint. The current study was conducted to assess the association between hemoglobin concentration and a variety of poor stroke outcomes in patients with acute ischemic stroke.
We studied 8,321 patients enrolled in the China National Stroke Registry (CNSR) between 2007 and 2008. Patients were divided into 7 groups, and a logistic regression model was used to evaluate the association. Endpoints of interest included 1-year all-cause mortality, stroke recurrence, combined endpoint, and stroke disability. Stroke disability was defined as a modified Rankin Scale of 2-6.
Patients with low and high hemoglobin values (≤11.6 g/dL and >16.1 g/dL) had higher proportion of poststroke adverse events than those in other groups. As compared with the fourth group of hemoglobin values of 13.5-14.2 g/dL, the adjusted odds ratios (ORs) with 95% confidence interval (CI) of low hemoglobin values (≤11.6 g/dL) were 2.25 (1.72-2.93) for all-cause mortality, 1.30 (1.04-1.61) for stroke recurrence, 1.63 (1.33-2.01) for combined endpoint, and 1.37 (1.12-1.67) for stroke disability, respectively. And, the ORs of high hemoglobin values (>16.1 g/dL) for adverse stroke outcomes were 1.72 (1.25-2.37), 1.43 (1.13-1.82), 1.43 (1.13-1.81), and 1.31 (1.06-1.63), respectively. Stratified analysis showed significant interactions between sex and categories of hemoglobin values for all-cause mortality (p = 0.05), stroke recurrence (p = 0.03), and combined endpoint (p = 0.01) but not for stroke disability (p = 0.24).
Our study found both low and high hemoglobin values were associated with adverse stroke outcomes including all-cause mortality, stroke recurrence, combined endpoint, and stroke disability, which showed a U-shaped association. And, significant interactions between sex and hemoglobin concentration on all-cause mortality and stroke recurrence were also identified.
现有关于血红蛋白值与卒中结局之间关联的研究大多聚焦于较低水平及死亡率，而死亡率往往是唯一的主要终点。本研究旨在评估急性缺血性卒中患者血红蛋白浓度与多种不良卒中结局之间的关联。
我们研究了2007年至2008年期间纳入中国国家卒中登记系统（CNSR）的8321例患者。患者被分为7组，并使用逻辑回归模型评估关联。感兴趣的终点包括1年全因死亡率、卒中复发、联合终点和卒中残疾。卒中残疾定义为改良Rankin量表评分为2 - 6分。
血红蛋白值低（≤11.6 g/dL）和高（>16.1 g/dL）的患者发生卒中后不良事件的比例高于其他组。与血红蛋白值第四组（13.5 - 14.2 g/dL）相比，血红蛋白值低（≤11.6 g/dL）时，全因死亡率的校正比值比（OR）及95%置信区间（CI）为2.25（1.72 - 2.93），卒中复发为1.30（1.04 - 1.61），联合终点为1.63（1.33 - 2.01），卒中残疾为1.37（1.12 - 1.67）。并且，血红蛋白值高（>16.1 g/dL）时不良卒中结局的OR分别为1.72（1.25 - 2.37）、1.43（1.13 - 1.82）、1.43（1.13 - 1.81）和1.31（1.06 - 1.63）。分层分析显示，在全因死亡率（p = 0.05）、卒中复发（p = 0.03）和联合终点（p = 0.01）方面，性别与血红蛋白值类别之间存在显著交互作用，但在卒中残疾方面无显著交互作用（p = 0.24）。
我们的研究发现，血红蛋白值低和高均与不良卒中结局相关，包括全因死亡率、卒中复发、联合终点和卒中残疾，呈现U形关联。并且，还发现性别与血红蛋白浓度在全因死亡率和卒中复发方面存在显著交互作用。
