title: Nadir hemoglobin is associated with poor outcome from intracerebral hemorrhage.
abstract: OBJECTIVE
  Examine the relationship between anemia and outcomes from intracerebral hemorrhage (ICH).
  
  
  METHODS
  Patients admitted with spontaneous ICH between July 2008 and December 2010 were identified from our prospective stroke registry. Patients were divided into two groups based on admission hemoglobin (low vs. normal based on laboratory reference range for gender). Baseline characteristics were compared between groups using Chi-square, t-tests and Wilcoxon Rank Sum tests. Primary outcome was functional status at discharge, with modified Rankin Scale (mRS) 5-6 considered a poor outcome. Cumulative logit and logistic regression models were used to assess the relationships between baseline hemoglobin, nadir hemoglobin, and transfusion with outcomes.
  
  
  RESULTS
  Of the 109 patients, 28% (n = 30) were anemic on admission. Baseline anemia did not predict the primary outcome. Nadir hemoglobin was associated with poor functional outcome at discharge (OR = 1.58, 95% CI 1.31-1.90, p < 0.0001) and remained significant after adjusting for age, baseline NIHSS, transfusion, and length of stay (OR = 1.43, 95% CI 1.06-1.94, p = 0.02). Patients who received a transfusion had 9 times greater odds of having a discharge mRS 5-6 (OR 9.37, 95% CI 2.84-30.88, p = 0.0002) compared with patients who did not receive transfusion. This was no longer statistically significant after adjusting for other factors impacting outcome (OR 4.01, 95% CI 0.64-25.32, p = 0.1392). Neither nadir hemoglobin nor transfusion was found to be independent predictors of in-hospital mortality.
  
  
  CONCLUSIONS
  This study suggests that nadir hemoglobin, not admission hemoglobin, can be used to predict poor functional outcome. Transfusion was not an independent predictor of poor outcome from ICH.
authors.affiliation: Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, 35294 Birmingham, England ; Health Services and Outcomes Research Center for Outcome, Effectiveness Research and Education (COERE), Birmingham, England.
authors.forename: Tiffany R
authors.initials: TR
authors.lastname: Chang
authors.forename: Amelia K
authors.initials: AK
authors.lastname: Boehme
authors.forename: Aimee
authors.initials: A
authors.lastname: Aysenne
authors.forename: Karen C
authors.initials: KC
authors.lastname: Albright
authors.forename: Christopher
authors.initials: C
authors.lastname: Burns
authors.forename: T Mark
authors.initials: TM
authors.lastname: Beasley
authors.forename: Sheryl
authors.initials: S
authors.lastname: Martin-Schild
keywords: Anemia; Hemoglobin; Intracerebral hemorrhage; Outcome; Transfusion