A reassessment of hemoglobin and hematoma expansion in intracerebral hemorrhage

Christoph Stretz; Ali Mahta; Jens Witsch; Tina Burton; Shadi Yaghi; Karen L Furie; Michael E Reznik

doi:10.1016/j.jstrokecerebrovasdis.2023.107339

A reassessment of hemoglobin and hematoma expansion in intracerebral hemorrhage

J Stroke Cerebrovasc Dis. 2023 Nov;32(11):107339. doi: 10.1016/j.jstrokecerebrovasdis.2023.107339. Epub 2023 Sep 6.

Authors

Christoph Stretz¹, Ali Mahta², Jens Witsch³, Tina Burton⁴, Shadi Yaghi⁴, Karen L Furie⁴, Michael E Reznik²

Affiliations

¹ Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI. Electronic address: Christoph_stretz@brown.edu.
² Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI; Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, RI.
³ Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA.
⁴ Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI.

PMID: 37683527
DOI: 10.1016/j.jstrokecerebrovasdis.2023.107339

Abstract

Background: In patients with spontaneous intracerebral hemorrhage (ICH), prior studies identified an increased risk of hematoma expansion (HE) in those with lower admission hemoglobin (Hgb) levels. We aimed to reproduce these findings in an independent cohort.

Methods: We conducted a cohort study of patients admitted to a Comprehensive Stroke Center for acute ICH within 24 hours of onset. Admission laboratory and CT imaging data on ICH characteristics including HE (defined as >33% or >6 mL), and 3-month outcomes were collected. We compared laboratory data between patients with and without HE and used multivariable logistic regression to determine associations between Hgb, HE, and unfavorable 3-month outcomes (modified Rankin Scale 4-6) while adjusting for confounders including anticoagulant use, and laboratory markers of coagulopathy.

Results: Among 345 patients in our cohort (mean [SD] age 72.9 [13.7], 49% male), 71 (21%) had HE. Patients with HE had similar Hgb versus those without HE (mean [SD] 13.1 [1.8] g/dl vs. 13.1 [1.9] g/dl, p=0.92). In fully adjusted multivariable models, Hgb was not associated with HE (OR per 1g/dl 1.01, 95% CI 0.86 -1.17, p = 0.94), however higher admission Hgb levels were associated with lower odds of unfavorable 3-month outcome (OR 0.83 per 1 g/dl Hgb, 95% CI 0.72-0.96, p=0.01).

Conclusion: We did not confirm a previously reported association between admission Hgb and HE in patients with ICH, although Hgb and HE were both associated with poor outcome. These findings suggest that the association between Hgb and poor outcome is mediated by other factors.

Keywords: Hematoma expansion; Hemoglobin; Intracerebral hemorrhage; Outcome.