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. 2010;14(2):R63.
doi: 10.1186/cc8961. Epub 2010 Apr 14.

Low hemoglobin is associated with poor functional outcome after non-traumatic, supratentorial intracerebral hemorrhage

Jennifer Diedler  1 , Marek Sykora, Philipp Hahn, Kristin Heerlein, Marion N Schölzke, Lars Kellert, Julian Bösel, Sven Poli, Thorsten Steiner
Affiliations

Low hemoglobin is associated with poor functional outcome after non-traumatic, supratentorial intracerebral hemorrhage

Jennifer Diedler et al. Crit Care. 2010.

Abstract

Introduction: The impact of anemia on functional outcome and mortality in patients suffering from non-traumatic intracerebral hemorrhage (ICH) has not been investigated. Here, we assessed the relationship between hemoglobin (HB) levels and clinical outcome after ICH.

Methods: One hundred and ninety six patients suffering from supratentorial, non-traumatic ICH were extracted from our local stroke database (June 2004 to June 2006). Clinical and radiologic computed tomography data, HB levels on admission, mean HB values and nadir during hospital stay were recorded. Outcome was assessed at discharge and 3 months using the modified Rankin score (mRS).

Results: Forty six (23.5%) patients achieved a favorable functional outcome (mRS <or= 3) and 150 (76.5%) had poor outcome (mRS 4 - 6) at discharge. Patients with poor functional outcome had a lower mean HB (12.3 versus 13.7 g/dl, P < 0.001) and nadir HB (11.5 versus 13.0 g/dl, P < 0.001). Ten patients (5.1%) received red blood cell (RBC) transfusions. In a multivariate logistic regression model, the mean HB was an independent predictor for poor functional outcome at three months (odds ratio (OR) 0.73, 95% confidence interval (CI) 0.58-0.92, P = 0.007), along with National Institute of Health Stroke Scale (NIHSS) at admission (OR 1.17, 95% CI 1.11 - 1.24, P < 0.001), and age (OR 1.08, 95% CI 1.04 - 1.12, P < 0.001).

Conclusions: We report an association between low HB and poor outcome in patients with non-traumatic, supratentorial ICH. While a causal relationship could not be proven, previous experimental studies and studies in brain injured patients provide evidence for detrimental effects of anemia on brain metabolism. However, the potential risk of anemia must be balanced against the risk of harm from red blood cell infusion.

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Figures

Figure 1
Figure 1
Cumulative hazard to develop anaemia during hospital stay for both outcome groups separately. During their hospital stay, patients with poor functional outcome (modified Rankin score (mRS) 4 to 6) had a higher risk to develop anemia compared with those with favorable outcome at discharge.
Figure 2
Figure 2
Mean hemoglobin values and outcome at discharge. Mean hemoglobin (HB) levels were significantly different between all groups (F (5,172) = 7.71, P < 0.001). Significant differences between group means are indicated by the bars (post-hoc analysis using Bonferroni adjustment for multiple comparisons). mRS, modified Rankin score.
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