ORIGINAL RESEARCH article
Front. Neurosci.
Sec. Translational Neuroscience
This article is part of the Research TopicResearch on the Correlative Mechanisms and Clinical Exploration of Headache and Cerebrovascular DiseasesView all 12 articles
The Association of Hemoglobin Levels and Balance Function in Patients with Stroke: A Multicenter Study in China
Provisionally accepted
- 1Huashan Hospital, Fudan University, Shanghai, China
- 2Department of Rehabilitation Medicine, Shanghai East Hospital, Shanghai, China
- 3The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- 4Fujian University of Traditional Chinese Medicine, Fuzhou, China
- 5Huashan Hospital Fudan University National Clinical Research Center for Aging and Medicine, Shanghai, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background Balance impairment following stroke is a leading cause of disability and falls. Hemoglobin (Hb) affects systemic and cerebral oxygen delivery and may influence neuromuscular function and post-stroke balance, but evidence from large multicenter clinical samples is limited. We investigated the association between hemoglobin concentration and balance performance in a Chinese multicenter cross-sectional study of stroke patients. Methods We studied 2,006 neuroimaging‑confirmed stroke patients from 26 hospitals. Balance impairment was defined as BBS ≤40. Admission Hb (g/dL) was analyzed per 1 g/dL and by tertiles (<12.6 g/dL, 12.6–14.0 g/dL, ≥14.0 g/dL). Multivariable logistic regression with sequential adjustment, restricted cubic splines, and prespecified subgroup and sensitivity analyses evaluated associations. Results Balance impairment occurred in 70.5% (1,414/2,006). Each 1 g/dL higher Hb was associated with lower odds of impairment in unadjusted (OR 0.83, 95% CI 0.78–0.87; p < 0.001) and fully adjusted models (OR 0.89, 95% CI 0.83–0.96; p = 0.002). This association remained robust after comprehensive adjustment for demographic, lifestyle, comorbidity, stroke characteristics, and lesion location factors. Compared with the lowest tertile, adjusted ORs were 0.72 (95% CI 0.53–0.99; p = 0.042) for the middle tertile and 0.62 (95% CI 0.45–0.85; p = 0.003) for the highest tertile. Spline analyses suggested a broadly linear inverse association; results were consistent across subgroups and sensitivity checks. Conclusion Higher admission hemoglobin was independently associated with better balance after stroke. Prospective studies should test whether Hb optimization improves rehabilitation outcomes.
Keywords: Balance Impairment3, Berg Balance Scale2, hemoglobin1, multicenter5, Stroke4
Received: 02 Dec 2025; Accepted: 17 Dec 2025.
Copyright: © 2025 Zhu, Bi, Zhang, Lin, Lin, Zhao, Lin and Jia. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jie Jia
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.