Association of Anemia with Mortality and Functional Prognosis in Patients with First-Ever Ischemic Stroke: A Retrospective Cohort Study in Tunisia.

Introduction: There is significant debate surrounding whether anemia should be considered a prognostic factor for stroke. The aim of this study was to assess the impact of anemia on the outcomes after the first ischemic stroke (IS), based on the Hemoglobin (Hb) levels and IS etiology. Materials and Methods: We conducted a retrospective study in our department of Neurology including patients presenting with a first ever IS admitted in our Neurovascular unit between January 2023 and December 2023. Vascular risk factors and clinical presentations were documented. Mortality and outcomes (modified Rankin scores= mRS) were evaluated at three and six months. All parameters assessed were compared between anemic and non-anemic patients. Then, we examined the association between stroke outcomes, severity, etiology and type of anemia. Results: We included 549 patients with a mean age of 63.7±12 years. Anemic patients (27.9%) were older (p< 0.001) and were less likely to be smokers, consistent with the known effect of smoking on increasing Hb levels. On multivariate analysis, anemia was associated with more severe clinical presentations at onset (p=0.001) and with increased mRS during follow-up. Independent of the severity and type of anemia, patients diagnosed with anemia in both the acute phase and at six months had a significantly higher mortality rate, respectively, p=0.02 and p=0.04. Conclusion: Anemia is a common biological finding among IS patients and is associated with more severe clinical presentations, poorer functional outcomes, and increased mortality, suggesting a potential role as a prognostic marker that warrants further investigation.