Admission Hemoglobin Is Prognostic for In-Hospital Mortality in Oldest-Old Patients with Acute Ischemic Stroke

Li, Mingquan; Liu, Xiaoyun; Wang, Liumin; Shu, Lei; Luan, Liqin; Yin, Jie; Zhang, Jiudan; Wang, Qing; Xie, Tiantian; Liu, Ling; Geng, Tongchao

doi:10.1159/000514678

Cited by 5 publications

(8 citation statements)

References 24 publications

(30 reference statements)

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“…This was a longitudinal observational study. Data were collected prospectively between January 1, 2014, and January 31, 2020, for patients with AIS from two Nanjing Universityaffiliated hospitals, which have been described in detail elsewhere [19][20][21]. According to the definition put forth by the United Nations, the oldest-old patients were individuals aged ≥80 years [22].…”

Section: Methodsmentioning

confidence: 99%

“…As this study did not involve any intervention owing to its retrospective nature, the committee approved an exemption for individual informed consent. The specifics of the research design have already been covered elsewhere [19][20][21].…”

Section: Methodsmentioning

confidence: 99%

“…The baseline blood sample parameters and clinical information acquisition and processing were similar to those in our previous studies [19][20][21]. In brief, all data were extracted from the Electronic Medical Record System, including the patients' demographic and disease characteristics, such as stroke severity at baseline, cerebrovascular risk factors, and the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) categorization [24][25][26].…”

Section: Covariatesmentioning

confidence: 99%

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Dose-Response Relationship between C-Reactive Protein/Albumin Ratio and In-Hospital Mortality in Elderly Patients with Acute Ischemic Stroke

Li,

Chen,

Chen

et al. 2023

Gerontology

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Introduction: The C-reactive protein/albumin ratio is a reliable indicator of outcome risk in several diseases. This study aims to evaluate prognostic power of the C-reactive protein/albumin ratio for in-hospital mortality and the dose-response relationship between the two in the oldest-old patients with acute ischemic stroke. Methods: A longitudinal observational study was conducted including patients with acute ischemic stroke (aged ≥ 80 years) from two tertiary hospitals between January 1, 2014, and January 31, 2020. Based on the tertiles of the C-reactive protein/albumin ratio, the patients were divided into three groups. Restrictive cubic spline and robust locally weighted regression analysis were performed on continuous variables to examine the dose–response relationship between the C-reactive protein/albumin ratio and in-hospital mortality risk. All-cause mortality during hospitalization was the outcome for this study. Results: The study included 584 patients (mean age = 84.6 ± 3.1 years; 59.6% men). The C-reactive protein/albumin ratio was divided into three groups, namely, T1 of < 0.73, T2 of 0.73 – 2.03, and T3: > 2.03. After adjusting for demographic and clinical characteristics, a higher C-reactive protein/albumin ratio was independently associated with in-hospital mortality. The hazard ratio for this association was 2.01 (95% confidence interval: 1.12 – 3.60, P = 0.019). A dose–response relationship between the C-reactive protein/albumin ratio and in-hospital mortality risk was observed. Sensitivity analysis found no attenuation in the hazard ratio in uninfected individuals, whereas no difference in the hazard ratio was noted in individuals with infections. Conclusions: When predicting in–hospital mortality in the oldest-old patients with ischemic stroke, the C-reactive protein/albumin ratio might be a helpful and convenient metric.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Covariatesmentioning

confidence: 99%

See 1 more Smart Citation

Dose-Response Relationship between C-Reactive Protein/Albumin Ratio and In-Hospital Mortality in Elderly Patients with Acute Ischemic Stroke

Li,

Chen,

Chen

et al. 2023

Gerontology

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“…Individual informed consent exemption was granted from the committee for the retrospective nature of the data. The details of the study design have been described elsewhere [ 12 , 13 ].…”

Section: Methodsmentioning

confidence: 99%

“…All data were extracted from the electronic medical recording system, including the patients' background information (smoking habits, alcohol consumption, body mass index), cerebrovascular risk factors, Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification [ 15 ], infarct volume, and stroke severity at baseline [ 15 , 16 , 17 ]. The categorization of smoking or drinking patients was reported in our previous study [ 12 , 13 ]. Stroke severity at admission was assessed by the National Institute of Health Stroke Scale (NIHSS) score, and NIHSS score >14 was defined as severe stroke [ 12 ].…”

Section: Methodsmentioning

confidence: 99%

Dose-Response Relationship between Red Blood Cell Distribution Width and In-Hospital Mortality in Oldest Old Patients with Acute Ischemic Stroke

Wang

Zhu

et al. 2022

Gerontology

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Introduction: It is crucial to identify predictors of mortality in the early stage of acute ischemic stroke for the oldest old (aged ≥80 years) because of their poor overall survival outcomes. However, limited data are available as the oldest old have often been excluded from previous clinical studies. Hence, we aimed to assess the predictive effect of red blood cell distribution width on in-hospital mortality and the dose-response relationship between the red blood cell distribution width and in-hospital mortality in oldest old with acute ischemic stroke. Methods: A retrospective cohort study was performed in two tertiary hospitals. Patients aged ≥80 years admitted due to acute ischemic stroke from January 1, 2014, to January 31, 2020, were included in the study. We divided the eligible patients into 3 groups with tertiles of red blood cell distribution width. Restrictive cubic spline and robust locally weighted regression analysis were performed to test the dose-response relationship between red blood cell distribution width and the in-hospital mortality risk. All-cause in-hospital mortality was the main study outcome. Results: Overall, 606 patients were included in the final analysis. Red blood cell distribution width was categorized into 3 groups (T1: <13.7%, T2: 13.8–15.7%, and T3: >15.7%). The rationality of this categorization was then validated with restricted cubic spline and robust locally regression smoothing scatterplot, respectively. After adjusting for demographic and clinical features, a higher red blood cell distribution width was independently associated with in-hospital mortality and the hazard ratio (HR) was 3.31 (95% CI 2.47–4.45, p < 0.001). There was a positive dose-response relationship between red blood cell distribution width and mortality risk. Sensitivity analysis identified no conspicuous change in the HR. Conclusions: Red blood cell distribution width may be a valuable and simple measure for predicting in-hospital mortality in oldest old patients with acute ischemic stroke.

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Causal Association Between Anemia and Cardiovascular Disease: A 2‐Sample Bidirectional Mendelian Randomization Study

Gan

Liu

et al. 2023

JAHA

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Background Although previous observational studies have shown an association between anemia and cardiovascular disease (CVD), the underlying causal relationship between anemia and CVD remains uncertain. Methods and Results We conducted a 2‐sample bidirectional Mendelian randomization (MR) study to assess the causal association between anemia and CVD. We extracted summary statistics data for anemia, heart failure (HF), coronary artery disease (CAD), atrial fibrillation, any stroke, and any ischemic stroke (AIS) from relevant published genome‐wide association studies. After rigorous quality control steps, independent single‐nucleotide polymorphisms for each disease were selected as instrumental variables. Inverse‐variance weighting was used as the primary method to estimate the causal association between anemia and CVD in the 2‐sample MR analysis. Simultaneously, we performed a series of multiple methods analyses (median weighting, maximum likelihood [MR robust adjusted profile score]), sensitivity analyses (Cochran's Q test and MR‐Egger intercept, leave‐one‐out test [MR pleiotropy residual sum and outlier]), instrumental variable strength evaluations ( F statistic), and statistic power estimates to verify the robustness and reliability of our results. Furthermore, the associations between anemia and CVD from different studies, including the UK Biobank and FinnGen studies, were combined by meta‐analysis. The MR analysis showed that genetically predicted anemia was significantly associated with HF risk at the Bonferroni‐corrected significance level (odds ratio [OR], 1.11 [95% CI, 1.04–1.18]; P =0.002) and was suggestively associated with CAD risk (OR, 1.11 [95% CI, 1.02–1.22]; P =0.020). However, the associations between anemia and atrial fibrillation, any stroke, or AIS were not statistically significant. In the reverse MR analysis, we found that genetic susceptibility to HF, CAD, and AIS was significantly associated with anemia risk. The ORs of HF, CAD, and AIS were 1.64 (95% CI, 1.39–1.94; P =7.60E‐09), 1.16 (95% CI, 1.08–1.24; P =2.32E‐05), and 1.30 (95% CI, 1.11–1.52; P =0.001), respectively. Genetically predicted atrial fibrillation was suggestively associated with anemia (OR, 1.06 [95% CI, 1.01–1.12]; P =0.015). Sensitivity analyses found weak evidence of horizontal pleiotropy and heterogeneity, which ensured the robustness and reliability of the results. Meta‐analysis also showed the statistically significant association between anemia and HF risk. Conclusions Our study supports bidirectional causality between anemia and HF and significant associations between genetic predisposition to CAD and AIS with anemia, which contributes to the clinical management of both diseases.

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Admission Hemoglobin Is Prognostic for In-Hospital Mortality in Oldest-Old Patients with Acute Ischemic Stroke

Cited by 5 publications

References 24 publications

Dose-Response Relationship between C-Reactive Protein/Albumin Ratio and In-Hospital Mortality in Elderly Patients with Acute Ischemic Stroke

Dose-Response Relationship between C-Reactive Protein/Albumin Ratio and In-Hospital Mortality in Elderly Patients with Acute Ischemic Stroke

Dose-Response Relationship between Red Blood Cell Distribution Width and In-Hospital Mortality in Oldest Old Patients with Acute Ischemic Stroke

Causal Association Between Anemia and Cardiovascular Disease: A 2‐Sample Bidirectional Mendelian Randomization Study

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