Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2021 May 1;49(5):828-837.
doi: 10.1097/CCM.0000000000004891.

Admission Hemoglobin Levels Are Associated With Functional Outcome in Spontaneous Intracerebral Hemorrhage

Julián N Acosta  1 , Audrey C Leasure  1 , Lindsey R Kuohn  1 , Cameron P Both  1 , Nils H Petersen  1   2 , Lauren H Sansing  2 , Charles C Matouk  3 , Fernando Testai  4 , Carl D Langefeld  1   2   3   4   5   6   7   8   9   10 , Daniel Woo  8 , Hooman Kamel  7 , Santosh B Murthy  7 , Adnan Qureshi  8   9 , Stephan A Mayer  10 , Kevin N Sheth  1 , Guido J Falcone  1
Affiliations
Meta-Analysis

Admission Hemoglobin Levels Are Associated With Functional Outcome in Spontaneous Intracerebral Hemorrhage

Julián N Acosta et al. Crit Care Med. .

Abstract

Objectives: To test the hypothesis that admission hemoglobin levels are associated with outcome in primary, nontraumatic intracerebral hemorrhage.

Design: Individual patient data meta-analysis of three studies of intracerebral hemorrhage.

Setting: Two randomized clinical trials and one multiethnic observational study.

Patients: Patients with spontaneous, nontraumatic intracerebral hemorrhage.

Interventions: None.

Measurements and main results: Our exposure of interest was admission hemoglobin levels and the primary outcome was 3-month postintracerebral hemorrhage-dichotomized modified Rankin Scale (0-3 vs 4-6). Intermediate outcomes were admission hematoma volume and hematoma expansion defined as 6 mL or 33% increase in hemorrhage size on repeat CT. A total of 4,172 intracerebral hemorrhage patients were included in the study (mean age 63 [sd = 14]; female sex 1,668 [40%]). Each additional g/dL of admission hemoglobin was associated with 14% (odds ratio, 0.86; 95% CI, 0.82-0.91) and 7% (odds ratio, 0.93; 95% CI, 0.88-0.98) reductions in the risk of poor outcome in unadjusted and adjusted analyses, respectively. Dose-response analyses indicated a linear relationship between admission hemoglobin levels and poor outcome across the entire evaluated range (test-for-trend p < 0.001). No consistent associations were found between the admission hemoglobin levels and hematoma volume or hematoma expansion.

Conclusions: Higher hemoglobin levels are associated with better outcome in intracerebral hemorrhage. Further research is needed to evaluate admission hemoglobin levels as both a therapeutic target and predictor of outcome.

PubMed Disclaimer

Conflict of interest statement

Ms. Leasure is supported by the National Institutes of Health (NIH) (R03NS112859). Dr. Sansing is supported by the NIH (R01NS095993, R01NS097728, U01NS113445). Dr. Kamel is supported by the NIH (R01NS097443, U01NS095869, R01HL144541, U01NS106513). Dr. Murthy is supported by the NIH (K23NS105948) and the Leon Levy Foundation. Dr. Sheth is supported by the NIH (U24NS107136, U24NS107215, R01NR018335, U01NS106513, R03NS112859) and the American Heart Association (18TPA34170180,17CSA33550004). Dr. Falcone is supported by the National Institute on Aging (K76AG59992), the National Institute of Neurological Disorders and Stroke (R03NS112859), the American Heart Association (18IDDG34280056), a Yale Pepper Scholar Award (P30AG021342), and the Neurocritical Care Society Research Fellowship. Drs. Acosta, Sansing, Langefeld, Woo, Sheth, and Falcone received support for article research from the NIH. Drs. Langefeld’s and Woo’s institutions received funding from the NIH. Dr. Kamel serves as a principal investigator for the NIH-funded AtRial Cardiopathy and Antithrombotic Drugs In Prevention After Cryptogenic Stroke (ARCADIA) trial (National Institute of Nuerological Disoders and Stroke U01NS095869), which receives in-kind study drug from the Bristol-Myers-Squibb-Pfizer Alliance for Eliquis and ancillary study support from Roche Diagnostics, serves as Deputy Editor for JAMA Neurology, serves as a steering committee member of Medtronic’s Stroke atrial fibrillation trial (uncompensated), serves on an end point adjudication committee for a trial of empagliflozin for Boehringer-Ingelheim, and has served on an advisory board for Roivant Sciences related to Factor XI inhibition. Dr. Mayer recieved funding from Idorsia, MaxQ AI, Bayer, Brain Cool, Biogen, and Nestle. Dr. Sheth’s institution received funding from Biogen, Novartis, and Bard, and he recieved funding from Hyperfine and Zoll. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Dose response analysis. Proportion of patients with poor outcome in each hemoglobin level subgroup.
See this image and copyright information in PMC

Comment in

  • [Neurosurgical intensive care medicine : Intensive medical care studies from 2020/2021].
    Beynon C, Bernhard M, Brenner T, Dietrich M, Fiedler MO, Nusshag C, Weigand MA, Reuß CJ, Michalski D, Jungk C. Beynon C, et al. Anaesthesist. 2021 Sep;70(9):789-794. doi: 10.1007/s00101-021-00978-9. Epub 2021 Aug 10. Anaesthesist. 2021. PMID: 34378066 German. No abstract available.
  • Hemoglobin Level at Admission Is Less Important.
    Ye T, Du K. Ye T, et al. Crit Care Med. 2022 Feb 1;50(2):e214-e215. doi: 10.1097/CCM.0000000000005323. Crit Care Med. 2022. PMID: 35100203 No abstract available.
  • The authors reply.
    Acosta JN, Leasure AC, Sheth KN, Falcone GJ. Acosta JN, et al. Crit Care Med. 2022 Feb 1;50(2):e215-e216. doi: 10.1097/CCM.0000000000005388. Crit Care Med. 2022. PMID: 35100204 Free PMC article. No abstract available.

References

    1. Gross BA, Jankowitz BT, Friedlander RM. Cerebral Intraparenchymal Hemorrhage: A Review. JAMA - J Am Med Assoc. 2019;321(13):1295–1303. doi: 10.1001/jama.2019.2413 - DOI - PubMed
    1. Cordonnier C, Demchuk A, Ziai W, et al. Intracerebral haemorrhage: current approaches to acute management. Lancet. 2018;392(10154):1257–1268. doi: 10.1016/S0140-6736(18)31878-6 - DOI - PubMed
    1. Mei H, Xia T, Feng G, et al. Opportunities in systems biology to discover mechanisms and repurpose drugs for CNS diseases. Drug Discov Today. 2012;17(21–22):1208–1216. doi: 10.1016/j.drudis.2012.06.015 - DOI - PubMed
    1. Fagan SC. Drug repurposing for drug development in stroke. Pharmacotherapy. 2010;30(7 PART 2). doi: 10.1592/phco.30.pt2.51S - DOI - PubMed
    1. Stucchi M, Cantoni S, Piccinelli E, et al. Anemia and acute coronary syndrome: current perspectives. Vasc Health Risk Manag. 2018:14–109. doi: 10.2147/VHRM.S140951 - DOI - PMC - PubMed

Publication types