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Open AccessArticle

Timing of Transfusion, not Hemoglobin Variability, Is Associated with 3-Month Outcomes in Acute Ischemic Stroke

1
Department of Neurology, Chuncheon Sacred Heart Hospital, Chuncheon 24253, Korea
2
Chuncheon Translational Research Center, Hallym University College of Medicine, Chuncheon 24252, Korea
3
Department of Neurology, Hallym University Sacred Heart Hospital, Anyang 14068, Korea
4
Department of Neurology, Kangdong Sacred Heart Hospital, Seoul 05355, Korea
5
Department of Neurology, Dongtan Sacred Heart Hospital, Hwaseong 18450, Korea
6
Department of Neurology, Kangnam Sacred Heart Hospital, Seoul 07440, Korea
*
Authors to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(5), 1566; https://doi.org/10.3390/jcm9051566 (registering DOI)
Received: 5 May 2020 / Revised: 17 May 2020 / Accepted: 20 May 2020 / Published: 21 May 2020
(This article belongs to the Special Issue Diagnosis, Prevention and Treatment for Stroke)
Objectives: This study aimed to investigate whether transfusions and hemoglobin variability affects the outcome of stroke after an acute ischemic stroke (AIS). Methods: We studied consecutive patients with AIS admitted in three tertiary hospitals who received red blood cell (RBC) transfusion (RBCT) during admission. Hemoglobin variability was assessed by minimum, maximum, range, median absolute deviation, and mean absolute change in hemoglobin level. Timing of RBCT was grouped into two categories: admission to 48 h (early) or more than 48 h (late) after hospitalization. Late RBCT was entered into multivariable logistic regression model. Poor outcome at three months was defined as a modified Rankin Scale score ≥3. Results: Of 2698 patients, 132 patients (4.9%) received a median of 400 mL (interquartile range: 400–840 mL) of packed RBCs. One-hundred-and-two patients (77.3%) had poor outcomes. The most common cause of RBCT was gastrointestinal bleeding (27.3%). The type of anemia was not associated with the timing of RBCT. Late RBCT was associated with poor outcome (odd ratio (OR), 3.55; 95% confidence interval (CI), 1.43–8.79; p-value = 0.006) in the univariable model. After adjusting for age, sex, Charlson comorbidity index, and stroke severity, late RBCT was a significant predictor (OR, 3.37; 95% CI, 1.14–9.99; p-value = 0.028) of poor outcome at three months. In the area under the receiver operating characteristics curve comparison, addition of hemoglobin variability indices did not improve the performance of the multivariable logistic model. Conclusion: Late RBCT, rather than hemoglobin variability indices, is a predictor for poor outcome in patients with AIS. View Full-Text
Keywords: anemia; cerebral infarction; blood transfusion; red blood cells; outcome assessment anemia; cerebral infarction; blood transfusion; red blood cells; outcome assessment
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    Doi: 10.5281/zenodo.3786625
    Link: https://zenodo.org/record/3786625
    Description: Table S1: The comparison between patients with and without red blood cell transfusion during admission, Figure S1: The correlation between hemoglobin variability parameters.
MDPI and ACS Style

Kim, C.; Lee, S.-H.; Lim, J.-S.; Oh, M.S.; Yu, K.-H.; Kim, Y.; Lee, J.-H.; Jang, M.U.; Jung, S.; Lee, B.-C. Timing of Transfusion, not Hemoglobin Variability, Is Associated with 3-Month Outcomes in Acute Ischemic Stroke. J. Clin. Med. 2020, 9, 1566.

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