Hemoglobin Decrements are Associated with Ischemic Brain Lesions and Poor Outcomes in Patients with Intracerebral Hemorrhage

被引：0

作者：

Poyraz, Fernanda Carvalho ^{[1
]}

Rossitto, Christina P. ^{[1
]}

Ridha, Mohamed ^{[2
]}

Simonetto, Marialaura ^{[2
]}

Kumar, Aditya ^{[2
]}

Hess, Evan ^{[2
]}

White, Emma ^{[1
]}

Mao, Eric ^{[2
]}

Sieh, Laura ^{[2
]}

Ghoshal, Shivani ^{[2
]}

Agarwal, Sachin ^{[2
]}

Park, Soojin ^{[2
]}

Claassen, Jan ^{[2
]}

Connolly, E. Sander ^{[2
]}

Mocco, J. ^{[1
]}

Kellner, Christopher P. ^{[1
]}

Roh, David J. ^{[2
]}

机构：

[1] Icahn Sch Med Mt Sinai, Dept Neurosurg, New York, NY USA

[2] Columbia Univ, Vagelos Coll Phys & Surg, Dept Neurol & Neurosurg, 177 Ft Washington Ave, New York, NY 10032 USA

来源：

NEUROCRITICAL CARE | 2025年

基金：

美国国家卫生研究院;

关键词：

Intracerebral hemorrhage; Hemoglobin; Magnetic resonance imaging; Ischemic brain lesions; Diffusion-weighted imaging; Outcome; HEALTH-CARE PROFESSIONALS; BLOOD-CELL TRANSFUSION; GUIDELINES; MANAGEMENT;

D O I：

10.1007/s12028-024-02206-9

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

BackgroundAcute ischemic lesions seen on brain magnetic resonance imaging (MRI) are associated with poor intracerebral hemorrhage (ICH) outcomes, but drivers for these lesions are unknown. Rapid hemoglobin decrements occur in the initial days after ICH and may impair brain oxygen delivery. We investigated whether acute hemoglobin decrements after ICH are associated with MRI ischemic lesions and poor long-term ICH outcomes.MethodsConsecutive patients with acute spontaneous ICH enrolled into a single-center prospective cohort study were assessed. Change in hemoglobin levels from admission to brain MRI was defined as the exposure variable. The presence of MRI ischemic lesions on diffusion-weighted imaging was the primary radiographic outcome. Poor 6-month modified Rankin Scale score (4-6) was assessed as our clinical outcome. Separate regression models assessed relationships between exposure and outcomes adjusting for relevant confounders. These relationships were also assessed in a separate prospective single-center cohort of patients with ICH receiving minimally invasive hematoma evacuation.ResultsOf 190 patients analyzed in our primary cohort, the mean age was 66.7 years, the baseline hemoglobin level was 13.4 g/dL, and 32% had MRI ischemic lesions. Greater hemoglobin decrements were associated with MRI ischemic lesions (adjusted odds ratio [OR] 0.77 for every 1 g/dL change, 95% confidence interval [CI] 0.60-0.99) and with poor 6-month outcomes (adjusted OR 0.73, 95% CI 0.55-0.98) after adjusting for demographics, ICH and medical disease severity, and antithrombotic use. In our separate cohort of 172 surgical patients with ICH, greater hemoglobin concentration decrements similarly associated with MRI ischemic lesions (adjusted OR 0.74, 95% CI 0.56-0.97) and poor 6-month outcomes (adjusted OR 0.69, 95% CI 0.48-0.98).ConclusionsGreater hemoglobin decrements after acute ICH are associated with ischemic lesions on brain MRI and poor long-term outcomes. Further work is required to clarify drivers for these relationships and whether anemia treatment and prevention can be used to improve ICH outcomes.

引用

页数：9

共 34 条

[1] Admission Hemoglobin Levels Are Associated With Functional Outcome in Spontaneous Intracerebral Hemorrhage [J].

Acosta, Julian N. ;

Leasure, Audrey C. ;

Kuohn, Lindsey R. ;

Both, Cameron P. ;

Petersen, Nils H. ;

Sansing, Lauren H. ;

Matouk, Charles C. ;

Testai, Fernando ;

Langefeld, Carl D. ;

Woo, Daniel ;

Kamel, Hooman ;

Murthy, Santosh B. ;

Qureshi, Adnan ;

Mayer, Stephan A. ;

Sheth, Kevin N. ;

Falcone, Guido J. .

CRITICAL CARE MEDICINE, 2021, 49 (05) :828-837

[2] Characterization of length of stay after minimally invasive endoscopic intracerebral hemorrhage evacuation [J].

Ali, Muhammad ;

Smith, Colton ;

Vasan, Vikram ;

Downes, Margaret ;

Schuldt, Braxton R. ;

Odland, Ian ;

Murtaza-Ali, Muhammad ;

Dullea, Jonathan ;

Rossitto, Christina P. ;

Schupper, Alexander J. ;

Hardigan, Trevor ;

Asghar, Nek ;

Liang, John ;

Mocco, J. ;

Kellner, Christopher P. .

JOURNAL OF NEUROINTERVENTIONAL SURGERY, 2024, 16 (01) :15-23

[3] RBC Transfusion Improves Cerebral Oxygen Delivery in Subarachnoid Hemorrhage [J].

Dhar, Rajat ;

Zazulia, Allyson R. ;

Derdeyn, Colin P. ;

Diringer, Michael N. .

CRITICAL CARE MEDICINE, 2017, 45 (04) :653-659

[4] Low hemoglobin is associated with poor functional outcome after non-traumatic, supratentorial intracerebral hemorrhage [J].

Diedler, Jennifer ;

Sykora, Marek ;

Hahn, Philipp ;

Heerlein, Kristin ;

Schoelzke, Marion N. ;

Kellert, Lars ;

Boesel, Julian ;

Poli, Sven ;

Steiner, Thorsten .

CRITICAL CARE, 2010, 14 (02)

[5] Aneurysmal SubArachnoid Hemorrhage - Red Blood Cell Transfusion And Outcome (SAHaRA): a pilot randomised controlled trial protocol [J].

English, Shane W. ;

Fergusson, D. ;

Chasse, M. ;

Turgeon, A. F. ;

Lauzier, F. ;

Griesdale, D. ;

Algird, A. ;

Kramer, A. ;

Tinmouth, A. ;

Lum, C. ;

Sinclair, J. ;

Marshall, S. ;

Dowlatshahi, D. ;

Boutin, A. ;

Pagliarello, G. ;

McIntyre, L. A. .

BMJ OPEN, 2016, 6 (12)

[6] Intracerebral Hemorrhage Incidence, Mortality, and Association With Oral Anticoagulation Use A Population Study [J].

Fernando, Shannon M. ;

Qureshi, Danial ;

Talarico, Robert ;

Tanuseputro, Peter ;

Dowlatshahi, Dar ;

Sood, Manish M. ;

Smith, Eric E. ;

Hill, Michael D. ;

McCredie, Victoria A. ;

Scales, Damon C. ;

English, Shane W. ;

Rochwerg, Bram ;

Kyeremanteng, Kwadwo .

STROKE, 2021, 52 (05) :1673-1681

[7] Association of Perioperative Red Blood Cell Transfusions With Venous Thromboembolism in a North American Registry [J].

Goel, Ruchika ;

Patel, Eshan U. ;

Cushing, Melissa M. ;

Frank, Steven M. ;

Ness, Paul M. ;

Takemoto, Clifford M. ;

Vasovic, Ljiljana V. ;

Sheth, Sujit ;

Nellis, Marianne E. ;

Shaz, Beth ;

Tobian, Aaron A. R. .

JAMA SURGERY, 2018, 153 (09) :826-833

[8] 2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association [J].

Greenberg, Steven M. ;

Ziai, Wendy C. ;

Cordonnier, Charlotte ;

Dowlatshahi, Dar ;

Francis, Brandon ;

Goldstein, Joshua N. ;

Hemphill, J. Claude, III ;

Johnson, Ronda ;

Keigher, Kiffon M. ;

Mack, William J. ;

Mocco, J. ;

Newton, Eileena J. ;

Ruff, Ilana M. ;

Sansing, Lauren H. ;

Schulman, Sam ;

Selim, Magdy H. ;

Sheth, Kevin N. ;

Sprigg, Nikola ;

Sunnerhagen, Katharina S. .

STROKE, 2022, 53 (07) :E282-E361

[9] Acute ischaemic brain lesions in intracerebral haemorrhage: multicentre cross-sectional magnetic resonance imaging study [J].

Gregoire, Simone M. ;

Charidimou, Andreas ;

Gadapa, Naveen ;

Dolan, Eamon ;

Antoun, Nagui ;

Peeters, Andre ;

Vandermeeren, Yves ;

Laloux, Patrice ;

Baron, Jean-Claude ;

Jaeger, Hans R. ;

Werring, David J. .

BRAIN, 2011, 134 :2376-2386

[10] Guidelines for the Management of Spontaneous Intracerebral Hemorrhage A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association [J].

Hemphill, J. Claude, III ;

Greenberg, Steven M. ;

Anderson, Craig S. ;

Becker, Kyra ;

Bendok, Bernard R. ;

Cushman, Mary ;

Fung, Gordon L. ;

Goldstein, Joshua N. ;

Macdonald, R. Loch ;

Mitchell, Pamela H. ;

Scott, Phillip A. ;

Selim, Magdy H. ;

Woo, Daniel .

STROKE, 2015, 46 (07) :2032-2060

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