Anemia at admission is associated with poor clinical outcome in cerebral venous thrombosis.

Silvis, Suzanne M; Reinstra, Elza; Hiltunen, Sini; Lindgren, Erik; Heldner, Mirjam R.; Mansour, Maryam; Ghiasian, Masoud; Jood, Katarina; Zuurbier, Susanna M; Groot, Adrien E; Arnold, Marcel; Barboza, Miguel A; Arauz, Antonio; Putaala, Jukka; Tatlisumak, Turgut; Coutinho, Jonathan M (2020). Anemia at admission is associated with poor clinical outcome in cerebral venous thrombosis. European journal of neurology, 27(4), pp. 716-722. Wiley 10.1111/ene.14148

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BACKGROUND

Anemia is associated with poor clinical outcome after ischemic and hemorrhagic stroke. We examined the association between anemia and outcome in patients with cerebral venous thrombosis (CVT).

METHODS

Consecutive adult patients with CVT were included from seven centers. Anemia at admission was scored according to World Health Organization definitions. Poor clinical outcome was defined as a modified Rankin Scale (mRS) score 3-6 at last follow-up. A multiple imputation procedure was applied for handling missing data in the multivariable analysis. Using binary logistic regression analysis, we adjusted for age, sex, cancer, and center of recruitment (model 1). In a secondary analysis we additionally adjusted for coma, intracerebral hemorrhage, non-hemorrhagic lesion, and deep venous system thrombosis (model 2). In a sensitivity analysis we excluded patients with cancer.

RESULTS

Data of 952 patients with CVT were included, 22% of whom had anemia at admission. Patients with anemia more often had a history of cancer (17% vs. 7%, p<0.001) than patients without anemia. Poor clinical outcome (21% vs. 11%, p<0.001) and mortality (11% vs. 6%, p=0.07) were more common among patients with anemia. After adjustment, anemia at admission increased the risk of poor outcome (adjusted odds ratio [aOR]: 2.4, 95% confidence interval [CI] 1.5-3.7, model 1). Model 2 revealed comparable results (aOR 1.9, 95% CI 1.2-3.2), as did the sensitivity analysis excluding patients with cancer (aOR 2.3, 95% CI 1.3-3.8, model 1).

CONCLUSION

The risk of poor clinical outcome is doubled in CVT patients presenting with anemia at admission.

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