Ciacciarelli Antonio, Falcou Anne, Nicolini Ettore, Broccolini Aldobrando, Frisullo Giovanni, Abruzzese Serena, Scala Irene, Anticoli Sabrina, Testani Elisa, Montinaro Ennio, Ranchicchio Cristina, De Michele Manuela, Toni Danilo
Emergency Department, Stroke Unit, Sapienza University of Rome, Rome, Italy.
Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome, Italy.
J Neurol Sci. 2025 Feb 15;469:123371. doi: 10.1016/j.jns.2024.123371. Epub 2024 Dec 27.
Iron deficiency (ID) is a prognostic factor in heart failure and acute coronary syndrome. However, its role in cerebrovascular diseases is controversial. We aimed to determine the impact of ID on the functional outcome of acute ischemic stroke patients.
This was an observational prospective multicentric cohort study. From January to December 2023, we enrolled acute ischemic stroke patients admitted to the stroke units of four comprehensive stroke centers. Venous blood samples were collected at admission to determine the iron status (serum iron, ferritin, transferrin). ID was defined as a serum ferritin concentration < 100 ng/mL or 100-299 ng/mL with transferrin saturation (TSAT) <20 %. The primary endpoint was the poor functional outcome at 90 days defined as modified Rankin Scale (mRS) 3-6. We used binary logistic regression models including confounding factors to test the association between ID and the primary outcome.
The analysis included 442 patients (mean age 73 ± 13, 47.5 % female, median NIHSS 7 [IQR 3-15], 61.3 % treated with intravenous thrombolysis and/or endovascular treatment). ID prevalence was 65.6 %. In all binary logistic regression models, ID predicted poor functional outcome at 3 months irrespective from demographics, stroke severity and characteristics, anemia, risk factors, signs/symptoms of heart failure, glucose at admission, and inflammatory biomarkers (aOR 2.328, 95 % CI 1.272-4.263, p = 0.006).
ID was strongly associated with poor functional outcome at 90 days in acute ischemic stroke patients. Further research is required to explore whether iron supplementation could be a potential therapeutic strategy to improve patient outcomes.
缺铁（ID）是心力衰竭和急性冠状动脉综合征的一个预后因素。然而，其在脑血管疾病中的作用存在争议。我们旨在确定缺铁对急性缺血性脑卒中患者功能结局的影响。
这是一项观察性前瞻性多中心队列研究。在2023年1月至12月期间，我们纳入了入住四个综合性卒中中心卒中单元的急性缺血性脑卒中患者。入院时采集静脉血样以确定铁状态（血清铁、铁蛋白、转铁蛋白）。缺铁定义为血清铁蛋白浓度<100 ng/mL或100 - 299 ng/mL且转铁蛋白饱和度（TSAT）<20%。主要终点是90天时功能结局不良，定义为改良Rankin量表（mRS）评分为3 - 6分。我们使用包括混杂因素的二元逻辑回归模型来检验缺铁与主要结局之间的关联。
分析纳入了442例患者（平均年龄73±13岁，47.5%为女性，美国国立卫生研究院卒中量表[NIHSS]中位数为7分[四分位间距3 - 15分]，61.3%接受了静脉溶栓和/或血管内治疗）。缺铁患病率为65.6%。在所有二元逻辑回归模型中，无论人口统计学、卒中严重程度和特征、贫血、危险因素、心力衰竭的体征/症状、入院时血糖以及炎症生物标志物如何，缺铁均预测3个月时功能结局不良（调整优势比2.328，95%置信区间1.272 - 4.263，p = 0.006）。
缺铁与急性缺血性脑卒中患者90天时功能结局不良密切相关。需要进一步研究以探讨补充铁剂是否可能是改善患者结局的一种潜在治疗策略。
