Hemoglobin level and three-month clinical outcomes among ischemic stroke patients with elevated systolic blood pressure

  • Daoxia Guo
    Affiliations
    Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China
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  • Zhengbao Zhu
    Affiliations
    Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China

    Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
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  • Chongke Zhong
    Affiliations
    Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China

    Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
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  • Hao Peng
    Affiliations
    Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China
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  • Tian Xu
    Affiliations
    Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China

    Department of Neurology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
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  • Aili Wang
    Affiliations
    Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China
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  • Yanbo Peng
    Affiliations
    Department of Neurology, Affiliated Hospital of Hebei United University, Hebei, China
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  • Tan Xu
    Affiliations
    Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China
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  • Chung-Shiuan Chen
    Affiliations
    Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
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  • Yongqiu Li
    Affiliations
    Department of Neurology, Tangshan Worker's Hospital, Hebei, China
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  • Zhong Ju
    Affiliations
    Department of Neurology, Kerqin District First People's Hospital of Tongliao City, Inner Mongolia, China
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  • Jing Chen
    Affiliations
    Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States

    Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
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  • Yonghong Zhang
    Correspondence
    Corresponding author at: School of Public Health, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou 215123, China.
    Affiliations
    Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China
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  • Jiang He
    Affiliations
    Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States

    Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
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Published:November 27, 2018DOI:https://doi.org/10.1016/j.jns.2018.11.030

      Highlights

      • •Elevated hemoglobin was associated with poor outcomes at 3 months after stroke onset.
      • •This study included 3883 ischemic stroke patients with an elevated SBP.
      • •Patients with high hemoglobin level should be aggressively monitored.
      • •Hemoglobin is simple and easy to test and evaluate at acute phase or admission.

      Abstract

      Background

      Previous studies have reported that extreme low and high hemoglobin levels are positively associated with the risk of ischemic stroke. However, there are few reports on the relationship between hemoglobin at acute phase and clinical outcomes after ischemic stroke and the results of their association to date are inconsistent. We aimed to investigate the association between them in a large prospective cohort of ischemic stroke patients.

      Methods

      Baseline hemoglobin levels were measured in 3881 patients with acute ischemic stroke. The primary outcome was defined as composite outcome of major disability and death (modified Rankin Scale score ≥ 3) at 3 months after stroke onset. Secondary outcomes were separately those of major disability and death.

      Results

      Compared with the lowest quartile of hemoglobin, the multivariate adjusted odds ratios (95% confidence intervals) associated with the highest quartile were 1.38 (1.03–1.86), 1.49 (1.11–1.99), 0.79 (0.41–1.52) for primary outcome, major disability and death, respectively. Multiple-adjusted spline regression model showed linear associations of hemoglobin levels with primary outcome (P for linearity =0.037) and major disability (P for linearity =0.004). Subgroup analyses further confirmed the positive association between high hemoglobin and poor prognosis of ischemic stroke.

      Conclusions

      Elevated hemoglobin levels in the acute phase were associated with poor prognosis at 3 months after ischemic stroke. Further prospective studies from other samples of ischemic stroke patients are needed to validate our findings.

      Keywords

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