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Sico J, Bravata DM. Anemia Predicts In-hospital Mortality Among Patients With Mild Stroke Severity. Paper presented at: American Heart Association / American Stroke Association State-of-the-Art Annual Nursing Symposium; 2010 Feb 23; San Antonio, TX.
Background: Anemia has been described as a potent predictor of in-hospital mortality among patients with acute myocardial infarction, congestive heart failure and chronic kidney disease. The role of anemia in patients with acute ischemic stroke is less well understood. Objective: We examined the association between anemia and patient outcomes among patients with acute ischemic stroke. Methods: We used data from a retrospective cohort of ischemic stroke patients within 48 hours of symptom onset at five hospitals (1998-2003). Anemia was defined as an admission hematocrit of less than 30 mg/dL. Mild stroke was defined as an admission NIH Stroke Scale (NIHSS) _ 10. The outcome was the combined endpoint of in-hospital mortality and discharge to hospice. Results: Among 1306 stroke patients, the rate of anemia was 6.4%, and 10.1% died or were discharged to hospice. In unadjusted analyses: anemia was not associated with in-hospital mortality among patients with severe strokes (anemia, 5/29 [17.2%] versus no anemia, 98/345 [28.4%; p_0.20]) but was associated with in-hospital mortality among patients with mild strokes (anemia, 7/54 [13.0%] versus no anemia, 22/878 [2.5%; p_0.0001]). Similarly, among patients with mild stroke, multivariate analysis demonstrated that admission anemia was independently associated with the combined endpoint even after adjustment for NIHSS 4.09 (95%CI: 1.44-11.57). Conclusion: Anemia is a robust predictor of in-hospital mortality and discharge to hospice among patients presenting with mild acute ischemic strokes. Further characterization of anemia in ischemic stroke patients and the role of blood transfusions warrant further investigation.