Original ArticleAnemia on Admission Increases the Risk of Mortality at 6 Months and 1 Year in Hemorrhagic Stroke Patients in China
Introduction
Intracerebral hemorrhage (ICH) accounts for 10%-15% of all stroke cases1 and is associated with high rates of mortality and morbidity.2 Only 12%-33% among ICH patients have an independent life after 6 and 12 months.3, 4 This is particularly true in China where it accounts for between 17.1% and 55.4% of all strokes,5, 6 which show an higher rate than Western countries.7, 8
Anemia is considered a risk factor and common in patients with ICH. Anemia (definition of the World Health Organization is Hb < 12 g/dL in woman and <13 g/dL in men) is common in elderly patients (age-standardized prevalence of ≈8.5%) and associated with increased risk of hospitalization and mortality.9, 10 Several studies have demonstrated that low hemoglobin levels were associated with poor outcome or death after ischemic stroke.11, 12, 13, 14, 15, 16 Approximately 19% of patients with acute ischemic stroke have anemia on admission.12 However, the relationship between anemia and outcomes in ICH patients is inconclusive.12, 17, 18 Our study systematically analyzed the effect of anemia on admission and its effect on mortality or functional dependency in Chinese patients with ICH at discharge, 3 months, 6 months, and 1 year.
Section snippets
Methods
China National Stroke Registry (CNSR) is a multicenter, prospective, cohort study aimed at studying vascular risk factors, clinical characteristics, diagnosis, treatment, and prevention for patients with acute stroke. All patients were followed for outcome at 1 year.
ICH is diagnosed by brain axial computerized tomography (CT) according to the World Health Organization criteria.19 ICH patients were recruited by this registry who met the following criteria: (1) older than 18 years and (2) acute
Result
In CNSR, there were 22,216 patients with acute cerebrovascular events enrolled from September 2007 to August 2008. Among them, 5136 (23.1%) patients were diagnosed as having had acute ICH. Measured hemoglobin levels were available in 2513 (77.2%) patients (Fig 1). Among them, 484 patients (19%) had anemia and 282 (58.3%) were men. Mean age was 66.54 ± 13.6 years in the anemic group and 60.82 ± 12.51 years in control group. Table 1 shows the distribution of baseline characteristics and
Discussion
This study addressed the impact of anemia on the mortality and functional outcome in Chinese ICH patients. Our results confirmed the finding that anemia is common in elderly people and associated with increased mortality,9 poorer health-related quality of life, disability, and poorer physical function.12 As for patients with ICH, our study has found that anemia on admission was associated with increased risk of mortality after 6 months and 1 year. Such a phenomenon may be explained by the
Acknowledgment
We thank all participating colleagues contributed to this study.
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Author contributions: Research design: L.-P.L., G.-F.L., C.-X.W., and Y.-J.W.; study conception: X.-Q.Z- and Y.-J.W.; concept development: C.-X.W. and Y.-J.W.; literature review: YJZ, G.-F.L., and Y.-J.W.; data collection: Y.-J.Z., G.-F.L., L.-P.L., and C.-X.W.; data analysis: Y.-J.Z.; statistical consultation: G.-F.L.; drafting the article: Y.-J.Z. and Y.-J.W.; review of submitted versions: Y.-J.Z., G.-F.L., and Y.-J.W.; approval of submitted versions: Y.-J.W.; and draft revisions: Y.-J.W.
This study was funded by the Ministry of Science and Technology and the Ministry of health of the People's Republic of China. The grants include National Science and Technology Major Project of China (2008zx09312-008), The National Science Foundation (grant no. 7102050), The Research Special Fund For Public Welfare Industry of Health (200902004), Beijing Health System High Level Health Technology Talent Cultivation Plan (grant no.2001-3-023), and The Beijing Science and Technology Committee (grant no. D101107049310005 and Z121100005512016) and National Science and Technology Major Project of China (2011BA108B02).
Conflicts of interest: The authors declare no conflict of interest.
Disclosure: The financial sponsors of CNSR had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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Both authors contributed equally to this article.