The prognostic role of iron deficiency in acute ischemic stroke patients: A prospective multicentric cohort study

Background and aims: Iron deficiency (ID) is a prognostic factor in heart failure and acute coronary syndrome. However, its role in cerebrovascular diseases is controversial. We aimed to determine the impact of ID on the functional outcome of acute ischemic stroke patients. Methods: This was an observational prospective multicentric cohort study. From January to December 2023, we enrolled acute ischemic stroke patients admitted to the stroke units of four comprehensive stroke centers. Venous blood samples were collected at admission to determine the iron status (serum iron, ferritin, transferrin). ID was defined as a serum ferritin concentration < 100 ng/mL or 100-299 ng/mL with transferrin saturation (TSAT) <20 %. The primary endpoint was the poor functional outcome at 90 days defined as modified Rankin Scale (mRS) 3-6. We used binary logistic regression models including confounding factors to test the association between ID and the primary outcome. Results: The analysis included 442 patients (mean age 73 +/- 13, 47.5 % female, median NIHSS 7 [IQR 3-15], 61.3 % treated with intravenous thrombolysis and/or endovascular treatment). ID prevalence was 65.6 %. In all binary logistic regression models, ID predicted poor functional outcome at 3 months irrespective from demographics, stroke severity and characteristics, anemia, risk factors, signs/symptoms of heart failure, glucose at admission, and inflammatory biomarkers (aOR 2.328, 95 % CI 1.272-4.263, p = 0.006). Conclusions: ID was strongly associated with poor functional outcome at 90 days in acute ischemic stroke patients. Further research is required to explore whether iron supplementation could be a potential therapeutic strategy to improve patient outcomes.