title: Low hemoglobin is associated with poor functional outcome after non-traumatic, supratentorial intracerebral hemorrhage.
abstract: 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.
authors.affiliation: Department of Neurology, University of Heidelberg, Im Neuenheimer Feld 400, Heidelberg, Germany. jennifer.diedler@med.uni-heidelberg.de
authors.forename: Jennifer
authors.initials: J
authors.lastname: Diedler
authors.forename: Marek
authors.initials: M
authors.lastname: Sykora
authors.forename: Philipp
authors.initials: P
authors.lastname: Hahn
authors.forename: Kristin
authors.initials: K
authors.lastname: Heerlein
authors.forename: Marion N
authors.initials: MN
authors.lastname: Schölzke
authors.forename: Lars
authors.initials: L
authors.lastname: Kellert
authors.forename: Julian
authors.initials: J
authors.lastname: Bösel
authors.forename: Sven
authors.initials: S
authors.lastname: Poli
authors.forename: Thorsten
authors.initials: T
authors.lastname: Steiner
mesh_terms: 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
chemical_list: D006454:Hemoglobins; C020622:hemoglobin B
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