Impact of anaemia on acute stroke outcomes depends on the type of anaemia: Evidence from a UK stroke register

Raphae S. Barlas, Stephen J. McCall, Joao H. Bettencourt-Silva, Allan B Clark, Kristian M Bowles, Anthony K Metcalf, Mamas A Mamas, John F Potter, Phyo K. Myint

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Abstract

Background Previous research has demonstrated an association between anaemia and poor outcomes in acute stroke. This study aimed to assess the impact of anaemia on stroke by anaemia subtype. Methods Data from a prospective UK Regional Stroke Register were used to assess the association between hypochromic microcytic and normochromic normocytic anaemia on inpatient-mortality, length of stay (LOS) and discharge modified Rankin scale (mRS). Analysis was stratified by stroke subtypes and multivariable logistic regression, adjusting for potential confounders, was used to quantify this association. Patients who were not anaemic were the reference category. Results A total of 8167 stroke patients (admitted between 2003 and 2015) were included, mean age (SD) 77.39 ± 11.90 years. Of these, 3.4% (n = 281) had hypochromic microcytic anaemia and 15.5% (n = 1262) had normochromic normocytic anaemia on admission. Normochromic normocytic anaemia was associated with increased odds of in-patient mortality OR 1.48 (1.24–1.77), 90-day mortality OR 1.63 (1.38–1.92), longer LOS OR 1.21 (1.06–1.40), defined as > 7 days, and severe disability defined as discharge mRS ≥ 3 OR 1.31 (1.06–1.63), in patients with ischaemic stroke. Hypochromic microcytic anaemia was associated with 90-day mortality OR 1.90 (1.40–2.58) and a longer LOS OR 1.57 (1.20–2.05) in patients with ischaemic stroke. Conclusions Hypochromic microcytic and normochromic normocytic anaemia are associated with differing outcomes in terms of inpatient mortality and post stroke disability. While it is unclear if anaemia per se or another underlying cause is responsible for adverse outcomes, subtype of anaemia appears to be relevant in stroke prognosis.
Original languageEnglish
Pages (from-to)26-30
Number of pages5
JournalJournal of the Neurological Sciences
Volume383
Early online date30 Sep 2017
DOIs
Publication statusPublished - 15 Dec 2017

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Anemia
Stroke
Mortality
Length of Stay
Inpatients
Logistic Models
Research

Keywords

  • Stroke
  • Anaemia
  • Outcome
  • Prognosis

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Impact of anaemia on acute stroke outcomes depends on the type of anaemia : Evidence from a UK stroke register. / Barlas, Raphae S.; McCall, Stephen J.; Bettencourt-Silva, Joao H.; Clark, Allan B; Bowles, Kristian M; Metcalf, Anthony K; Mamas, Mamas A; Potter, John F; Myint, Phyo K.

In: Journal of the Neurological Sciences, Vol. 383, 15.12.2017, p. 26-30.

Research output: Contribution to journalArticle

Barlas, RS, McCall, SJ, Bettencourt-Silva, JH, Clark, AB, Bowles, KM, Metcalf, AK, Mamas, MA, Potter, JF & Myint, PK 2017, 'Impact of anaemia on acute stroke outcomes depends on the type of anaemia: Evidence from a UK stroke register' Journal of the Neurological Sciences, vol. 383, pp. 26-30. https://doi.org/10.1016/j.jns.2017.09.047
Barlas, Raphae S. ; McCall, Stephen J. ; Bettencourt-Silva, Joao H. ; Clark, Allan B ; Bowles, Kristian M ; Metcalf, Anthony K ; Mamas, Mamas A ; Potter, John F ; Myint, Phyo K. / Impact of anaemia on acute stroke outcomes depends on the type of anaemia : Evidence from a UK stroke register. In: Journal of the Neurological Sciences. 2017 ; Vol. 383. pp. 26-30.
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abstract = "Background Previous research has demonstrated an association between anaemia and poor outcomes in acute stroke. This study aimed to assess the impact of anaemia on stroke by anaemia subtype. Methods Data from a prospective UK Regional Stroke Register were used to assess the association between hypochromic microcytic and normochromic normocytic anaemia on inpatient-mortality, length of stay (LOS) and discharge modified Rankin scale (mRS). Analysis was stratified by stroke subtypes and multivariable logistic regression, adjusting for potential confounders, was used to quantify this association. Patients who were not anaemic were the reference category. Results A total of 8167 stroke patients (admitted between 2003 and 2015) were included, mean age (SD) 77.39 ± 11.90 years. Of these, 3.4{\%} (n = 281) had hypochromic microcytic anaemia and 15.5{\%} (n = 1262) had normochromic normocytic anaemia on admission. Normochromic normocytic anaemia was associated with increased odds of in-patient mortality OR 1.48 (1.24–1.77), 90-day mortality OR 1.63 (1.38–1.92), longer LOS OR 1.21 (1.06–1.40), defined as > 7 days, and severe disability defined as discharge mRS ≥ 3 OR 1.31 (1.06–1.63), in patients with ischaemic stroke. Hypochromic microcytic anaemia was associated with 90-day mortality OR 1.90 (1.40–2.58) and a longer LOS OR 1.57 (1.20–2.05) in patients with ischaemic stroke. Conclusions Hypochromic microcytic and normochromic normocytic anaemia are associated with differing outcomes in terms of inpatient mortality and post stroke disability. While it is unclear if anaemia per se or another underlying cause is responsible for adverse outcomes, subtype of anaemia appears to be relevant in stroke prognosis.",
keywords = "Stroke, Anaemia, Outcome, Prognosis",
author = "Barlas, {Raphae S.} and McCall, {Stephen J.} and Bettencourt-Silva, {Joao H.} and Clark, {Allan B} and Bowles, {Kristian M} and Metcalf, {Anthony K} and Mamas, {Mamas A} and Potter, {John F} and Myint, {Phyo K.}",
note = "Funding The NNUH Stroke and TIA Register is maintained by the NNUH NHS Foundation Trust Stroke Services and data management for this study is supported by the NNUH Research and Development Department through Research Capability Funds. Acknowledgments We thank the stroke data team for their contribution to maintain the NNUH stroke & TIA registers.",
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TY - JOUR

T1 - Impact of anaemia on acute stroke outcomes depends on the type of anaemia

T2 - Evidence from a UK stroke register

AU - Barlas, Raphae S.

AU - McCall, Stephen J.

AU - Bettencourt-Silva, Joao H.

AU - Clark, Allan B

AU - Bowles, Kristian M

AU - Metcalf, Anthony K

AU - Mamas, Mamas A

AU - Potter, John F

AU - Myint, Phyo K.

N1 - Funding The NNUH Stroke and TIA Register is maintained by the NNUH NHS Foundation Trust Stroke Services and data management for this study is supported by the NNUH Research and Development Department through Research Capability Funds. Acknowledgments We thank the stroke data team for their contribution to maintain the NNUH stroke & TIA registers.

PY - 2017/12/15

Y1 - 2017/12/15

N2 - Background Previous research has demonstrated an association between anaemia and poor outcomes in acute stroke. This study aimed to assess the impact of anaemia on stroke by anaemia subtype. Methods Data from a prospective UK Regional Stroke Register were used to assess the association between hypochromic microcytic and normochromic normocytic anaemia on inpatient-mortality, length of stay (LOS) and discharge modified Rankin scale (mRS). Analysis was stratified by stroke subtypes and multivariable logistic regression, adjusting for potential confounders, was used to quantify this association. Patients who were not anaemic were the reference category. Results A total of 8167 stroke patients (admitted between 2003 and 2015) were included, mean age (SD) 77.39 ± 11.90 years. Of these, 3.4% (n = 281) had hypochromic microcytic anaemia and 15.5% (n = 1262) had normochromic normocytic anaemia on admission. Normochromic normocytic anaemia was associated with increased odds of in-patient mortality OR 1.48 (1.24–1.77), 90-day mortality OR 1.63 (1.38–1.92), longer LOS OR 1.21 (1.06–1.40), defined as > 7 days, and severe disability defined as discharge mRS ≥ 3 OR 1.31 (1.06–1.63), in patients with ischaemic stroke. Hypochromic microcytic anaemia was associated with 90-day mortality OR 1.90 (1.40–2.58) and a longer LOS OR 1.57 (1.20–2.05) in patients with ischaemic stroke. Conclusions Hypochromic microcytic and normochromic normocytic anaemia are associated with differing outcomes in terms of inpatient mortality and post stroke disability. While it is unclear if anaemia per se or another underlying cause is responsible for adverse outcomes, subtype of anaemia appears to be relevant in stroke prognosis.

AB - Background Previous research has demonstrated an association between anaemia and poor outcomes in acute stroke. This study aimed to assess the impact of anaemia on stroke by anaemia subtype. Methods Data from a prospective UK Regional Stroke Register were used to assess the association between hypochromic microcytic and normochromic normocytic anaemia on inpatient-mortality, length of stay (LOS) and discharge modified Rankin scale (mRS). Analysis was stratified by stroke subtypes and multivariable logistic regression, adjusting for potential confounders, was used to quantify this association. Patients who were not anaemic were the reference category. Results A total of 8167 stroke patients (admitted between 2003 and 2015) were included, mean age (SD) 77.39 ± 11.90 years. Of these, 3.4% (n = 281) had hypochromic microcytic anaemia and 15.5% (n = 1262) had normochromic normocytic anaemia on admission. Normochromic normocytic anaemia was associated with increased odds of in-patient mortality OR 1.48 (1.24–1.77), 90-day mortality OR 1.63 (1.38–1.92), longer LOS OR 1.21 (1.06–1.40), defined as > 7 days, and severe disability defined as discharge mRS ≥ 3 OR 1.31 (1.06–1.63), in patients with ischaemic stroke. Hypochromic microcytic anaemia was associated with 90-day mortality OR 1.90 (1.40–2.58) and a longer LOS OR 1.57 (1.20–2.05) in patients with ischaemic stroke. Conclusions Hypochromic microcytic and normochromic normocytic anaemia are associated with differing outcomes in terms of inpatient mortality and post stroke disability. While it is unclear if anaemia per se or another underlying cause is responsible for adverse outcomes, subtype of anaemia appears to be relevant in stroke prognosis.

KW - Stroke

KW - Anaemia

KW - Outcome

KW - Prognosis

U2 - 10.1016/j.jns.2017.09.047

DO - 10.1016/j.jns.2017.09.047

M3 - Article

VL - 383

SP - 26

EP - 30

JO - Journal of the Neurological Sciences

JF - Journal of the Neurological Sciences

SN - 0022-510X

ER -