Association of anemia and hemoglobin decrease during acute stroke treatment with infarct growth and clinical outcome.

Bellwald, Sebastian; Balasubramaniam, Rupashani; Nagler, Michael; Burri, Meret S; Fischer, Samuel D A; Hakim, Arsany; Dobrocky, Tomas; Yu, Yannan; Scalzo, Fabien; Heldner, Mirjam Rachel; Wiest, Roland; Mono, Marie-Luise; Sarikya, Hakan; El-Koussy, Marwan; Mordasini, Pasquale; Fischer, Urs; Schroth, Gerhard; Gralla, Jan; Mattle, Heinrich; Arnold, Marcel; ... (2018). Association of anemia and hemoglobin decrease during acute stroke treatment with infarct growth and clinical outcome. PLoS ONE, 13(9), e0203535. Public Library of Science 10.1371/journal.pone.0203535

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Anemia is associated with worse outcome in stroke, but the impact of anemia with intravenous thrombolysis or endovascular therapy has hardly been delineated. The aim of this study was to analyze the role of anemia on infarct evolution and outcome after acute stroke treatment.


1158 patients from Bern and 321 from Los Angeles were included. Baseline data and 3 months outcome assessed with the modified Rankin Scale were recorded prospectively. Baseline DWI lesion volumes were measured in 345 patients and both baseline and final infarct volumes in 180 patients using CT or MRI. Multivariable and linear regression analysis were used to determine predictors of outcome and infarct growth.


712 patients underwent endovascular treatment and 446 intravenous thrombolysis. Lower hemoglobin at baseline, at 24h, and nadir until day 5 predicted poor outcome (OR 1.150-1.279) and higher mortality (OR 1.131-1.237) independently of treatment. Decrease of hemoglobin after hospital arrival, mainly induced by hemodilution, predicted poor outcome and had a linear association with final infarct volumes and the amount and velocity of infarct growth. Infarcts of patients with newly observed anemia were twice as large as infarcts with normal hemoglobin levels.


Anemia at hospital admission and any hemoglobin decrease during acute stroke treatment affect outcome negatively, probably by enlarging and accelerating infarct growth. Our results indicate that hemodilution has an adverse effect on penumbral evolution. Whether hemoglobin decrease in acute stroke could be avoided and whether this would improve outcome would need to be studied prospectively.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Haematology and Central Haematological Laboratory
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > Unit Childrens Hospital > Forschungsgruppe Hämatologie (Erwachsene)

UniBE Contributor:

Bellwald, Sebastian, Balasubramaniam, Rupashani, Nagler, Michael, Hakim, Arsany, Dobrocky, Tomas, Heldner, Mirjam Rachel, Wiest, Roland Gerhard Rudi, Mono, Marie-Luise, El-Koussy, Marwan, Mordasini, Pasquale Ranato, Fischer, Urs Martin, Schroth, Gerhard, Gralla, Jan, Mattle, Heinrich, Arnold, Marcel, Jung, Simon


600 Technology > 610 Medicine & health




Public Library of Science




Pierrette Durand Lüthi

Date Deposited:

04 Oct 2018 07:45

Last Modified:

02 Mar 2023 23:31

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