title: Anaemia on admission is associated with more severe intracerebral haemorrhage and worse outcomes.
abstract: BACKGROUND
  Lower haemoglobin levels may impair cerebral oxygen delivery and threaten tissue viability in the setting of acute brain injury. Few studies have examined the association between haemoglobin levels and outcomes after spontaneous intracerebral haemorrhage.
  
  
  OBJECTIVE
  We evaluated whether anaemia on admission was associated with greater intracerebral haemorrhage severity and worse outcome.
  
  
  METHODS
  Consecutive patients with spontaneous intracerebral haemorrhage were analyzed from the Registry of the Canadian Stroke Network. Admission haemoglobin was related to stroke severity (using the Canadian Neurological Scale), modified Rankin score at discharge, and one-year mortality. Adjustment was made for potential confounders including age, gender, medical history, warfarin use, glucose, creatinine, blood pressure, and intraventricular haemorrhage.
  
  
  RESULTS
  Two thousand four hundred six patients with intracerebral haemorrhage were studied of whom 23% had anaemia (haemoglobin <120 g/l) on admission, including 4% with haemoglobin <100 g/l. Patients with anaemia were more likely to have severe neurological deficits at presentation [haemoglobin ≤ 100 g/l, adjusted odds ratio 4.04 (95% confidence interval 2.39, 6.84); haemoglobin 101-120 g/l, adjusted odds ratio 1.93 (95% confidence interval 1.43, 2.59), both P < 0.0001]. In nonanticoagulated patients, severe anaemia was also associated with poor outcome (modified Rankin score 4-6) at discharge [haemoglobin ≤ 100 g/l, adjusted odds ratio 2.42 (95% confidence interval 1.07-5.47), P = 0.034] and increased mortality at one-year [haemoglobin ≤ 100 g/l, adjusted hazard ratio 1.73 (95% confidence interval 1.22-2.45), P = 0.002].
  
  
  CONCLUSIONS
  Anaemia on admission is associated with greater intracerebral haemorrhage severity and worse outcomes. The utility of transfusion remains unclear in this setting.
authors: Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada.
authors: Miguel
authors: M
authors: Bussière
authors: Meera
authors: M
authors: Gupta
authors: Mukul
authors: M
authors: Sharma
authors: Dar
authors: D
authors: Dowlatshahi
authors: Jiming
authors: J
authors: Fang
authors: Rajat
authors: R
authors: Dhar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000453:epidemiology* / Q000209:etiology*; D002170:Canada; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010343:Patient Admission / Q000706:statistics & numerical data*; D010351:Patient Discharge; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins; C057506:hemoglobin L
keywords: anaemia; haemoglobin; intracerebral haemorrhage; outcomes