Low hemoglobin is associated with poor functional outcome after non-traumatic, supratentorial intracerebral hemorrhage.
BACKGROUND
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.
Diedler
Jennifer
J
Department of Neurology, University of Heidelberg, Im Neuenheimer Feld 400, Heidelberg, Germany. jennifer.diedler@med.uni-heidelberg.de
Sykora
Marek
M
Hahn
Philipp
P
Heerlein
Kristin
K
Schölzke
Marion N
MN
Kellert
Lars
L
Bösel
Julian
J
Poli
Sven
S
Steiner
Thorsten
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications*; D002543:Cerebral Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000534:rehabilitation*; D005260:Female; D005858:Germany; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011859:Radiography; D020127:Recovery of Function / Q000502:physiology*; D016896:Treatment Outcome
D006454:Hemoglobins; C020622:hemoglobin B
Anesth Analg. 1996 Jan;82(1):61-7
8712427
Anesthesiology. 2002 Sep;97(3):660-70
12218534
Neurosurg Rev. 1995;18(4):237-45
8927239
Crit Care Med. 2008 Jul;36(7):2070-5
18552682
Eur J Neurol. 2007 May;14(5):477-82
17437604
J Cereb Blood Flow Metab. 2001 Jul;21(7):804-10
11435792
J Neurol Sci. 2001 Sep 15;190(1-2):3-10
11574099
Crit Care Med. 2007 Oct;35(10):2383-9
17717494
Neurology. 1998 Aug;51(2):447-51
9710017
Neurosurgery. 2006 Oct;59(4):767-73; discussion 773-4
17038942
Stroke. 1993 Jul;24(7):987-93
8322400
Neurocrit Care. 2007;6(1):22-9
17356187
J Neurol Sci. 1999 Apr 1;164(2):117-23
10402021
J Clin Neurosci. 2009 May;16(5):645-9
19285409
Stroke. 2009 May;40(5):1638-43
19286594
J Neurotrauma. 2007 Feb;24(2):315-28
17375996
Stroke. 1987 Jan-Feb;18(1):68-71
3810772
Br J Neurosurg. 2008 Apr;22(2):257-68
18348023
Stroke. 2006 Oct;37(10):2457-62
16960094
J Trauma. 2006 Sep;61(3):567-71
16966988
JAMA. 2002 Sep 25;288(12):1499-507
12243637
J Neurotrauma. 1994 Apr;11(2):149-60
7932795
Am J Physiol. 1999 Apr;276(4):H1190-6
10199842
Blood. 2006 Mar 1;107(5):1747-50
16189263
Crit Care Med. 2001 Mar;29(3):635-40
11373434
Neurology. 2001 Jul 10;57(1):18-24
11445622
Crit Care Med. 2009 Mar;37(3):1074-8
19237920
Crit Care Med. 2009 Apr;37(4):1442-7
19242340
Neurocrit Care. 2009;10(2):157-65
19116699
J Am Coll Surg. 2008 Sep;207(3):398-406
18722946
Stroke. 2009 Mar;40(3):815-9
19131652
Curr Opin Crit Care. 2006 Apr;12(2):119-23
16543786
Crit Care Med. 2004 Jan;32(1):39-52
14707558
Crit Care Med. 2006 Mar;34(3):617-23; quiz 624
16521258
Stroke. 2001 Apr;32(4):891-7
11283388
Stroke. 2009 May;40(5):1547-8
19286575