Anaemia on admission is associated with more severe intracerebral haemorrhage and worse outcomes

BackgroundLower 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. AimsWe evaluated whether anaemia on admission was associated with greater intracerebral haemorrhage severity and worse outcome. MethodsConsecutive 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. ResultsTwo thousand four hundred six patients with intracerebral haemorrhage were studied of whom 23% had anaemia (haemoglobin <120g/l) on admission, including 4% with haemoglobin <100g/l. Patients with anaemia were more likely to have severe neurological deficits at presentation [haemoglobin 100g/l, adjusted odds ratio 404 (95% confidence interval 239, 684); haemoglobin 101-120g/l, adjusted odds ratio 193 (95% confidence interval 143, 259), both P<00001]. In nonanticoagulated patients, severe anaemia was also associated with poor outcome (modified Rankin score 4-6) at discharge [haemoglobin 100g/l, adjusted odds ratio 242 (95% confidence interval 107-547), P=0034] and increased mortality at one-year [haemoglobin 100g/l, adjusted hazard ratio 173 (95% confidence interval 122-245), P=0002]. ConclusionsAnaemia on admission is associated with greater intracerebral haemorrhage severity and worse outcomes. The utility of transfusion remains unclear in this setting.