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February 19, 2013; 80 (8) Article

Sex differences and hemoglobin levels in relation to stroke outcomes

W. Taylor Kimberly, Fabricio O. Lima, Sydney O’Connor, Karen L. Furie
First published January 30, 2013, DOI: https://doi.org/10.1212/WNL.0b013e31828250ff
W. Taylor Kimberly
From the Stroke Service (W.T.K., F.O.L., K.L.F.) and Division of Neurocritical Care and Emergency Neurology (W.T.K., S.O.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston. K.L.F. is currently with the Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI.
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Fabricio O. Lima
From the Stroke Service (W.T.K., F.O.L., K.L.F.) and Division of Neurocritical Care and Emergency Neurology (W.T.K., S.O.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston. K.L.F. is currently with the Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI.
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Sydney O’Connor
From the Stroke Service (W.T.K., F.O.L., K.L.F.) and Division of Neurocritical Care and Emergency Neurology (W.T.K., S.O.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston. K.L.F. is currently with the Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI.
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Karen L. Furie
From the Stroke Service (W.T.K., F.O.L., K.L.F.) and Division of Neurocritical Care and Emergency Neurology (W.T.K., S.O.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston. K.L.F. is currently with the Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI.
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Citation
Sex differences and hemoglobin levels in relation to stroke outcomes
W. Taylor Kimberly, Fabricio O. Lima, Sydney O’Connor, Karen L. Furie
Neurology Feb 2013, 80 (8) 719-724; DOI: 10.1212/WNL.0b013e31828250ff

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Abstract

Objective: Women have worse outcomes after stroke compared to men. Since women have lower hemoglobin values, we examined whether hemoglobin levels may associate with worse stroke outcomes in women.

Methods: We retrospectively studied 274 patients enrolled in a prospective multicenter study. We explored the relationship of hemoglobin with clinical outcome at 6 months, as measured by the modified Rankin Scale (mRS). Ordinal logistic regression was used to evaluate the independent effect of hemoglobin on clinical outcome, and to explore the influence of sex on that association.

Results: Women had a lower mean hemoglobin level (11.7 ± 1.8 g/dL) compared to men (13.3 ± 1.7 g/dL). Low hemoglobin was associated with worse 6-month mRS outcomes in univariate analysis (p < 0.001). Lower hemoglobin remained independently associated with poor outcome after adjustment for comorbid disease, stroke severity, age, and sex. The inclusion of hemoglobin in the model attenuated the independent effect of sex on outcome.

Conclusions: Sex differences in stroke outcome are linked to lower hemoglobin level, which is more prevalent in women. Further examination of this potentially modifiable predictor is warranted.

GLOSSARY

CI=
confidence interval;
IQR=
interquartile range;
mRS=
modified Rankin Scale;
OR=
odds ratio;
SNP=
single nucleotide polymorphism;
STOPStroke=
Screening Technology and Outcome Project in Stroke;
YSS=
yield shear stress

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Received June 21, 2012.
  • Accepted October 29, 2012.
  • © 2013 American Academy of Neurology
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