Low hemoglobin and hematoma expansion after intracerebral hemorrhage.

TitleLow hemoglobin and hematoma expansion after intracerebral hemorrhage.
Publication TypeJournal Article
Year of Publication2019
AuthorsRoh DJ, Albers DJ, Magid-Bernstein J, Doyle K, Hod E, Eisenberger A, Murthy S, Witsch J, Park S, Agarwal S, E Connolly S, Elkind MSV, Claassen J
Date Published2019 07 23
KeywordsAged, Aged, 80 and over, Anemia, Brain, Cerebral Hemorrhage, Disease Progression, Female, Hematoma, Hemoglobins, Humans, Logistic Models, Male, Middle Aged, Multivariate Analysis, Prognosis, Tomography, X-Ray Computed

OBJECTIVE: Studies have independently shown associations of lower hemoglobin levels with larger admission intracerebral hemorrhage (ICH) volumes and worse outcomes. We investigated whether lower admission hemoglobin levels are associated with more hematoma expansion (HE) after ICH and whether this mediates lower hemoglobin levels' association with worse outcomes.

METHODS: Consecutive patients enrolled between 2009 and 2016 to a single-center prospective ICH cohort study with admission hemoglobin and neuroimaging data to calculate HE (>33% or >6 mL) were evaluated. The association of admission hemoglobin levels with HE and poor clinical outcomes using modified Rankin Scale (mRS 4-6) were assessed using separate multivariable logistic regression models. Mediation analysis investigated causal associations among hemoglobin, HE, and outcome.

RESULTS: Of 256 patients with ICH meeting inclusion criteria, 63 (25%) had HE. Lower hemoglobin levels were associated with increased odds of HE (odds ratio [OR] 0.80 per 1.0 g/dL change of hemoglobin; 95% confidence interval [CI] 0.67-0.97) after adjusting for previously identified covariates of HE (admission hematoma volume, antithrombotic medication use, symptom onset to admission CT time) and hemoglobin (age, sex). Lower hemoglobin was also associated with worse 3-month outcomes (OR 0.76 per 1.0 g/dL change of hemoglobin; 95% CI 0.62-0.94) after adjusting for ICH score. Mediation analysis revealed that associations of lower hemoglobin with poor outcomes were mediated by HE ( = 0.01).

CONCLUSIONS: Further work is required to replicate the associations of lower admission hemoglobin levels with increased odds of HE mediating worse outcomes after ICH. If confirmed, an investigation into whether hemoglobin levels can be a modifiable target of treatment to improve ICH outcomes may be warranted.

Alternate JournalNeurology
PubMed ID31209179
PubMed Central IDPMC6669932
Grant ListUL1 TR001873 / TR / NCATS NIH HHS / United States

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