Background: Single small subcortical infarction (SSSI) is prone to progressive neurological deterioration, associated with poor outcomes. We investigated the association between admission hematocrit (HCT) levels and risk of progressive stroke in SSSI patients.
Methods: A retrospective cohort study using data from the China National Stroke Registry III included 2,457 SSSI patients. Progressive stroke was defined as ≥1 point increase in National Institutes of Health Stroke Scale (NIHSS) score during hospitalization. Logistic regression models assessed the association between HCT and progressive stroke risk, adjusting for confounders.
Results: 249 (10.13%) patients experienced progressive stroke. Higher HCT levels were independently associated with lower risk of NIHSS worsening ≥1 point (adjusted odds ratio [OR] 0.988, 95% CI 0.980-0.996, P=0.005) and ≥2 points (adjusted OR 0.983, 95% CI 0.973-0.994, P=0.002). Patients with HCT ≥41.3% had 37.9% lower risk of NIHSS worsening ≥1 point compared to HCT <41.3% (adjusted OR 0.621, 95% CI 0.411-0.939, P=0.024). The protective effect of HCT was more pronounced in severe sensory deficit patients, with each 1% HCT increase associated with 7.1% reduced NIHSS worsening ≥2 points risk among sensory subscale score ≥2 patients (adjusted OR 0.929, 95% CI 0.878-0.983, P=0.010). However, this association was attenuated in mild motor deficit patients.
Conclusions: Higher admission HCT levels independently associated with lower progressive stroke risk in SSSI patients, particularly those with severe sensory deficits. Monitoring and optimizing HCT may prevent neurological deterioration in SSSI. Further mechanistic studies and therapeutic implications warrant investigation.