1
|
Desai A, Oh D, Rao EM, Sahoo S, Mahajan UV, Labak CM, Mauria R, Shah VS, Nguyen Q, Herring EZ, Elder T, Stout A, Shammassian BH. Impact of anemia on acute ischemic stroke outcomes: A systematic review of the literature. PLoS One 2023; 18:e0280025. [PMID: 36603022 DOI: 10.1371/journal.pone.0280025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/20/2022] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Anemia has been reported in nearly 40% of acute ischemic stroke (AIS) patients and is linked to significant morbidity and disability. The presence of anemia is associated with worse outcomes in AIS, specifically in the presence of large vessel occlusion (LVO). An optimal hemoglobin (Hb) target specific to this pathology has not yet been established. The goal of this review is to systematically review literature that observes the association that exists between AIS outcomes and hemoglobin (Hb) levels. METHODS A systematic review was performed in accordance with guidelines for the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) to identify studies from 2008-2022. The following inclusion and exclusion criteria were used: studies of adult patients with AIS; must describe outcomes with regard to Hb levels in AIS (not limited to LVO); must be written in English. The clinical variables extracted included Length of Stay (LOS), modified rankin score (mRS), Hb levels, and mortality. RESULTS A total of 1,154 studies were gathered, with 116 undergoing full text review. 31 studies were included in this review. The age of patients ranged from 61.4 to 77.8. The presence of anemia in AIS increased LOS by 1.7 days on average and these patients also have a 15.2% higher rate of mortality at one year, on average. DISCUSSION This data suggests that the contemporary thresholds for treating anemia in AIS patients may be inadequate because anemia is strongly associated with poor outcomes (e.g., mRS>2 or mortality) and increased LOS in AIS patients. The current generalized Hb threshold for transfusion (7 g/dL) is also used in AIS patients, however, a more aggressive transfusion parameter should be further explored based on these findings. Further studies are required to confirm these findings and to determine if a more liberal RBCT threshold will result in clinical benefits.
Collapse
Affiliation(s)
- Ansh Desai
- Case Western Reserve School of Medicine, Cleveland, OH, United States of America
| | - David Oh
- Case Western Reserve School of Medicine, Cleveland, OH, United States of America
| | - Elizabeth M Rao
- Case Western Reserve School of Medicine, Cleveland, OH, United States of America
| | - Saswat Sahoo
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, United States of America
| | - Uma V Mahajan
- Case Western Reserve School of Medicine, Cleveland, OH, United States of America
| | - Collin M Labak
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America
| | - Rohit Mauria
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America
| | - Varun S Shah
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America
| | - Quang Nguyen
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America
| | - Eric Z Herring
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America
| | - Theresa Elder
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America
| | - Amber Stout
- Case Western Reserve School of Medicine, Cleveland, OH, United States of America
| | - Berje H Shammassian
- Division of Neurocritical Care, Department Neurology, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| |
Collapse
|
2
|
Luvizutto GJ, Moliga AF, Rizzatti GRS, Fogaroli MO, de Moura E, Nunes HRDC, Resende LADL, Bazan R. Unilateral spatial neglect in the acute phase of ischemic stroke can predict long-term disability and functional capacity. Clinics (Sao Paulo) 2018; 73:e131. [PMID: 29791600 PMCID: PMC5952049 DOI: 10.6061/clinics/2018/e131] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/13/2017] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The aim of this study was to assess the relationship between the degree of unilateral spatial neglect during the acute phase of stroke and long-term functional independence. METHODS This was a prospective study of right ischemic stroke patients in which the independent variable was the degree of spatial neglect and the outcome that was measured was functional independence. The potential confounding factors included sex, age, stroke severity, topography of the lesion, risk factors, glycemia and the treatment received. Unilateral spatial neglect was measured using the line cancellation test, the star cancellation test and the line bisection test within 48 hours of the onset of symptoms. Functional independence was measured using the modified Rankin and Barthel scales at 90 days after discharge. The relationship between unilateral spatial neglect and functional independence was analyzed using multiple logistic regression that was corrected for confounding factors. RESULTS We studied 60 patients with a median age of 68 (34-89) years, 52% of whom were male and 74% of whom were Caucasian. The risk for moderate to severe disability increased with increasing star cancellation test scores (OR=1.14 [1.03-1.26], p=0.01) corrected for the stroke severity, which was a confounding factor that had a statistically positive association with disability (OR=1.63 [1.13-2.65], p=0.01). The best chance of functional independence decreased with increasing star cancellation test scores (OR=0.86 [0.78-0.96], p=0.006) corrected for the stroke severity, which was a confounding factor that had a statistically negative association with independence (OR=0.66 [0.48-0.92], p=0.017). CONCLUSION The severity of unilateral spatial neglect in acute stroke worsens the degree of long-term disability and functional independence.
Collapse
Affiliation(s)
- Gustavo José Luvizutto
- Departamento de Fisioterapia Aplicada, Universidade Federal do Triangulo Mineiro (UFTM), Uberaba, MG, BR
- *Corresponding author. E-mail:
| | - Augusta Fabiana Moliga
- Departamento de Reabilitacao, Faculdade de Medicina de Botucatu (UNESP), Botucatu, SP, BR
| | | | | | - Eduardo de Moura
- Departamento de Fisioterapia, Faculdade de Talentos Humanos (FACTHUS), Uberaba, MG, BR
| | | | | | - Rodrigo Bazan
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina de Botucatu (UNESP), Botucatu, SP, BR
| |
Collapse
|
3
|
Adapting the concepts of brain and cognitive reserve to post-stroke cognitive deficits: Implications for understanding neglect. Cortex 2017; 97:327-338. [DOI: 10.1016/j.cortex.2016.12.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 08/03/2016] [Accepted: 12/04/2016] [Indexed: 01/17/2023]
|