Association between baseline hemoglobin level and early neurological deterioration after intravenous thrombolysis in patients with acute ischemic stroke.

OBJECTIVES: To investigate the association between baseline hemoglobin level and early neurologic deterioration (END) after intravenous thrombolysis in patients with acute ischemic stroke (AIS).

METHODS: Data of AIS patients who received intravenous thrombolytic therapy at multiple hospitals across the country between January 2017 and July 2020 were collected from the online database Acute Stroke Patients for stroke Management Quality Evaluation (CASE-Ⅱ, NCT04487340). Binary logistic regression analysis was used to study the factors affecting the occurrence of END after intravenous thrombolytic therapy, and the correlation between baseline hemoglobin level and END was investigated by limiting cubic spline curve.

RESULTS: A total of 8162 patients were included. Patients with END had lower baseline hemoglobin levels (136 and 140 g/L, P <0.01) and higher rates of anemia (24.2% and 16.9%, P <0.01) compared with non-END patients. Binary logistic regression analysis showed that baseline hemoglobin level ( OR =0.995, 95% CI : 0.991-0.999, P <0.05) and anemia ( OR =1.238, 95% CI : 1.055-1.454, P <0.01) were independently correlated with the occurrence of END after intravenous thrombolysis in AIS patients. Restricted cubic spline regression showed that there was a U-shaped relationship between hemoglobin level and the risk of END after intravenous thrombolysis in AIS patients ( P <0.01); while the relationship only existed in male patients ( P <0.05), not in female patients ( P >0.05).

CONCLUSIONS: There is a U-shaped correlation between baseline hemoglobin level and the risk of END in AIS patients after intravenous thrombolysis, that is, both lower and higher hemoglobin level may increase the risk of END.