Association Between Hemoglobin Levels and Hemorrhagic Stroke Outcomes: A Cross-sectional Study on Recovery and Prognosis
Ayesha Johar1, Ayesha Ahmad2, Javeria Akhter3, Huzaifa Nawaz4, Wajiha Aftab5, Dhyey Sidhpura6, Maham Jawad7, Syeda Unzila Tirmizi8, Soma Khalid8, Sameen Fida4
1Khyber Medical University Peshawar, 2Khyber medical university, 3Indus Hospital and Health network, 4Services Institute of Medical Sciences (SIMS), Ghaus-ul-Azam Jail Road, Lahore, Pakistan 54000, 5Dow International Medical College, 6Carle foundation Hospital Urbana Illinois, 7Fatima memorial hospital and college of medicine and dentistry, 8Shaheed Mohtarma Benazir Bhutto Medical College Lyari
Objective:
The objective is to evaluate the association between hemoglobin levels and hemorrhagic stroke outcomes in order to evaluate recovery and prognosis in these patients.
Background:
Abnormal hemoglobin may influence cerebral blood flow and oxygen delivery, which is a risk factor for stroke recovery. Although anemia and polycythemia are associated with outcomes, no evidence is clear on the subject. We assessed the correlation of Hb, HS severity and outcomes.
Design/Methods:
A cross-sectional study was conducted among adults with acute hemorrhagic stroke. Hemoglobin within 24 h was classified as low (<12 g/dL females, <13 g/dL males), normal, or high. Stroke severity was measured by NIHSS and outcomes by mRS at discharge. Baseline traits were summarized descriptively. Group differences used Pearson χ² with Cramér’s V, Mann–Whitney U, or Kruskal–Wallis. Multivariable logistic regression identified predictors of favorable outcome (mRS 0–2) and mortality. Model fit used Hosmer–Lemeshow and Nagelkerke R².
Results:
A total of 445 patients (Hb-low 330 [74.2%], normal 114 [25.6%], high 1) were included; Baseline severity and outcomes were similar by Hb group (NIHSS 9.74 ± 7.02 vs 10.64 ± 6.25; mRS 2.15 ± 2.20 vs 2.25 ±1.78) with deaths [32/330 (9.7%) vs.C >4/114 (3.5%]. Higher mRS(p<0.0001) and mortality were related to later arrival (p=0.013). Diabetes(p<0.001), hypertension (p=0.0001) and age (p = 0.0049) predicted poorer outcomes. There was no difference in mRS(p=0.257) or NIHSS (p=0.245) according to Hb category. In multivariable models, Hb was not an independent predictor of outcome/death; NIHSS remained the dominant predictor (favorable outcome:aOR 0.77 per point, p<0.001; mortality: aOR 1.07 per point, p=0.019), with diabetes also increasing death risk (aOR 2.58, p=0.014).
Conclusions:
Hemoglobin was not independently correlated with hemorrhagic stroke recovery, prognosis or mortality. Stroke severity and history of diabetes were independent predictors of poor outcome. Routine hemoglobin screening is still clinically relevant, but trageted correction may not translate to better recovery.
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