Contributions
Abstract: PB2528
Type: Publication Only
Background
There exists conflicting reports on the impact of hemoglobin in stroke. Physiological data suggest an adverse impact of anaemia on stroke. Also, it is noted that in Polycythemia; thrombotic events, in particular arterial thrombosis are increased and may contribute to a heightened mortality risk in patients with PV. Available guidance based on observational data suggests maintaining a hemoglobin level above 90g/L in patients with ischaemic stroke admitted to the ICU. However such recommendations are based on evaluation of specific patient populations and carry the potential risk to harm unexplored patient subsets if generalized. The best practice in patients with stroke is unclear and the impact of hemoglobin in stroke needs to be explored.
Aims
We attempted to determine the level of hemoglobin in patients with severe acute ischaemic stroke in our tertiary care centre.
Methods
We determined the impact of hemoglobin in a discovery case-control cohort in our hospital. We also performed a validation of the findings in an independent cohort of prospectively collected dataset of the Indo-US stroke registry and add to the evidence. The discovery cohort consisted of 570 patients with acute stroke who were admitted consecutively between January, 2012 to March, 2014 to our regional tertiary center in India, with a catchment population of ≈10, 00,000. The validation cohort consisted of patient enrolled into the prospective U.S. NIH and Indian Government funded Indo-US Stroke Registry and Infrastructure Development Project register; the methods of which have been detailed previously. Briefly, this registry enrolled consecutive adult patients admitted with imaging-confirmed ischemic stroke and at two weeks after symptom onset to five academic hospitals in geographically diverse centers across India. Data was entered into a central web-based electronic database. From January, 2012 to August, 2014, data was prospectively collected for 2066 patients.
Results
The patients in the discovery cohort were matched for gender, level of hemoglobin and proportion of anemics. In this cohort on a binary logistic regression analysis of stroke severity with hemoglobin quintiles in men we did not detect any significant relation. There was a trend noted with increasing severity of stroke with lower hemoglobin quintiles in women. We then explored this trend in the validation cohort. There was a significant association with increasing severity of stroke in both men ( Hb <12) and women (Hb <12.7) based on the quintiles (Table 1).
Conclusion
In our analysis there appears to be a trend towards increasing severity of stroke with lower levels of hemoglobin. This is more significant in women. Current strategy of transfusion of red cells to maintain hemoglobin above 9g/dL in patients with acute ischaemic stroke might need to be revised to higher thresholds.
Session topic: 32. Transfusion medicine
Keyword(s): Hemoglobin, Stroke
Abstract: PB2528
Type: Publication Only
Background
There exists conflicting reports on the impact of hemoglobin in stroke. Physiological data suggest an adverse impact of anaemia on stroke. Also, it is noted that in Polycythemia; thrombotic events, in particular arterial thrombosis are increased and may contribute to a heightened mortality risk in patients with PV. Available guidance based on observational data suggests maintaining a hemoglobin level above 90g/L in patients with ischaemic stroke admitted to the ICU. However such recommendations are based on evaluation of specific patient populations and carry the potential risk to harm unexplored patient subsets if generalized. The best practice in patients with stroke is unclear and the impact of hemoglobin in stroke needs to be explored.
Aims
We attempted to determine the level of hemoglobin in patients with severe acute ischaemic stroke in our tertiary care centre.
Methods
We determined the impact of hemoglobin in a discovery case-control cohort in our hospital. We also performed a validation of the findings in an independent cohort of prospectively collected dataset of the Indo-US stroke registry and add to the evidence. The discovery cohort consisted of 570 patients with acute stroke who were admitted consecutively between January, 2012 to March, 2014 to our regional tertiary center in India, with a catchment population of ≈10, 00,000. The validation cohort consisted of patient enrolled into the prospective U.S. NIH and Indian Government funded Indo-US Stroke Registry and Infrastructure Development Project register; the methods of which have been detailed previously. Briefly, this registry enrolled consecutive adult patients admitted with imaging-confirmed ischemic stroke and at two weeks after symptom onset to five academic hospitals in geographically diverse centers across India. Data was entered into a central web-based electronic database. From January, 2012 to August, 2014, data was prospectively collected for 2066 patients.
Results
The patients in the discovery cohort were matched for gender, level of hemoglobin and proportion of anemics. In this cohort on a binary logistic regression analysis of stroke severity with hemoglobin quintiles in men we did not detect any significant relation. There was a trend noted with increasing severity of stroke with lower hemoglobin quintiles in women. We then explored this trend in the validation cohort. There was a significant association with increasing severity of stroke in both men ( Hb <12) and women (Hb <12.7) based on the quintiles (Table 1).
Conclusion
In our analysis there appears to be a trend towards increasing severity of stroke with lower levels of hemoglobin. This is more significant in women. Current strategy of transfusion of red cells to maintain hemoglobin above 9g/dL in patients with acute ischaemic stroke might need to be revised to higher thresholds.
Session topic: 32. Transfusion medicine
Keyword(s): Hemoglobin, Stroke