Does Mild Anemia Associate With 3-Month Vascular Outcomes in Severe Acute Ischemic Stroke?

초록

Background: Anemia has been shown to be independently associated with poor outcomes in critically ill patients. Despite this, the impact of hemoglobin (Hb) levels on prognosis among patients with severe acute ischemic stroke (AIS) requiring neurocritical care has not been well established. We therefore sought to evaluate the relationship between Hb levels and clinical outcomes in this population. Methods: This study was an analysis of a prospective, multicenter, nationwide stroke registry between January 2011 and April 2023. We included patients within 7 days of onset AIS whose severity of National Institutes of Health Stroke Scale more than 16 scores. Hb levels were categorized into 4 groups; 1) moderate to severe anemia (Hb < 11 g/dL), 2) mild anemia(men: 11.0-12.9 g/dL, women: 11.0-11.9 g/dL), 3) normal (men: 13.0-17.0 g/dL, women: 12.0-15.5 g/ dL), 4) polycythemia (men > 17.0 g/dL, women> 15.6 g/dL).The primary outcome is defined as a composite of recurrent stroke, myocardial infarction (MI), and all-cause mortality within 3-month. Results: A total of 8,615 patients with severe AIS were included in the final analysis (mean age, 74.3 ± 12.1 years; 47.8% male). The prevalence of moderate-to-severe anemia was 15.9%, mild anemia 17.0%, normal Hb levels 62.4%, and polycythemia 4.6%. Compared with patients with normal Hb levels, those with mild or moderate-to-severe anemia exhibited higher 3-month rates of the composite outcome of recurrent stroke, MI, and all-cause mortality. After multivariable adjustment, both mild and moderate-to-severe anemia remained independently associated with an increased risk of the 3-month composite outcome (adjusted hazard ratio, 1.15; 1.04-1.28; P = 0.009). Conclusion: In patients with severe AIS requiring neurocritical care, lower Hb levels were independently associated with an increased risk of 3-month composite vascular outcomes, even at the level of mild anemia. © 2026 The Korean Academy of Medical Sciences.

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