Admission Hemoglobin Levels Are Associated With Functional Outcome in Spontaneous Intracerebral Hemorrhage.

Autor:	Acosta JN; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT., Leasure AC; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT., Kuohn LR; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT., Both CP; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT., Petersen NH; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT.; Division of Vascular Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT., Sansing LH; Division of Vascular Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT., Matouk CC; Neurovascular Surgery, Department of Neurosurgery, Yale School of Medicine, New Haven, CT., Testai F; Vascular Neurology, Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL., Langefeld CD; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT.; Division of Vascular Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT.; Neurovascular Surgery, Department of Neurosurgery, Yale School of Medicine, New Haven, CT.; Vascular Neurology, Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL.; Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC.; Department of Neurology, University of Cincinnati, Cincinnati, OH.; Division of Neurocritical Care, Department of Neurology, Weill Cornell Medicine, New York, NY.; Department of Neurology, University of Missouri, Columbia, MO.; Zeenat Qureshi Stroke Institute, St. Cloud, MO.; Department of Neurology, Henry Ford Hospital, Detroit, MI., Woo D; Department of Neurology, University of Missouri, Columbia, MO., Kamel H; Division of Neurocritical Care, Department of Neurology, Weill Cornell Medicine, New York, NY., Murthy SB; Division of Neurocritical Care, Department of Neurology, Weill Cornell Medicine, New York, NY., Qureshi A; Department of Neurology, University of Missouri, Columbia, MO.; Zeenat Qureshi Stroke Institute, St. Cloud, MO., Mayer SA; Department of Neurology, Henry Ford Hospital, Detroit, MI., Sheth KN; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT., Falcone GJ; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT.
Jazyk:	angličtina
Zdroj:	Critical care medicine [Crit Care Med] 2021 May 01; Vol. 49 (5), pp. 828-837.
DOI:	10.1097/CCM.0000000000004891
Abstrakt:	Objectives: To test the hypothesis that admission hemoglobin levels are associated with outcome in primary, nontraumatic intracerebral hemorrhage. Design: Individual patient data meta-analysis of three studies of intracerebral hemorrhage. Setting: Two randomized clinical trials and one multiethnic observational study. Patients: Patients with spontaneous, nontraumatic intracerebral hemorrhage. Interventions: None. Measurements and Main Results: Our exposure of interest was admission hemoglobin levels and the primary outcome was 3-month postintracerebral hemorrhage-dichotomized modified Rankin Scale (0-3 vs 4-6). Intermediate outcomes were admission hematoma volume and hematoma expansion defined as 6 mL or 33% increase in hemorrhage size on repeat CT. A total of 4,172 intracerebral hemorrhage patients were included in the study (mean age 63 [sd = 14]; female sex 1,668 [40%]). Each additional g/dL of admission hemoglobin was associated with 14% (odds ratio, 0.86; 95% CI, 0.82-0.91) and 7% (odds ratio, 0.93; 95% CI, 0.88-0.98) reductions in the risk of poor outcome in unadjusted and adjusted analyses, respectively. Dose-response analyses indicated a linear relationship between admission hemoglobin levels and poor outcome across the entire evaluated range (test-for-trend p < 0.001). No consistent associations were found between the admission hemoglobin levels and hematoma volume or hematoma expansion. Conclusions: Higher hemoglobin levels are associated with better outcome in intracerebral hemorrhage. Further research is needed to evaluate admission hemoglobin levels as both a therapeutic target and predictor of outcome. Competing Interests: Ms. Leasure is supported by the National Institutes of Health (NIH) (R03NS112859). Dr. Sansing is supported by the NIH (R01NS095993, R01NS097728, U01NS113445). Dr. Kamel is supported by the NIH (R01NS097443, U01NS095869, R01HL144541, U01NS106513). Dr. Murthy is supported by the NIH (K23NS105948) and the Leon Levy Foundation. Dr. Sheth is supported by the NIH (U24NS107136, U24NS107215, R01NR018335, U01NS106513, R03NS112859) and the American Heart Association (18TPA34170180,17CSA33550004). Dr. Falcone is supported by the National Institute on Aging (K76AG59992), the National Institute of Neurological Disorders and Stroke (R03NS112859), the American Heart Association (18IDDG34280056), a Yale Pepper Scholar Award (P30AG021342), and the Neurocritical Care Society Research Fellowship. Drs. Acosta, Sansing, Langefeld, Woo, Sheth, and Falcone received support for article research from the NIH. Drs. Langefeld’s and Woo’s institutions received funding from the NIH. Dr. Kamel serves as a principal investigator for the NIH-funded AtRial Cardiopathy and Antithrombotic Drugs In Prevention After Cryptogenic Stroke (ARCADIA) trial (National Institute of Nuerological Disoders and Stroke U01NS095869), which receives in-kind study drug from the Bristol-Myers-Squibb-Pfizer Alliance for Eliquis and ancillary study support from Roche Diagnostics, serves as Deputy Editor for JAMA Neurology, serves as a steering committee member of Medtronic’s Stroke atrial fibrillation trial (uncompensated), serves on an end point adjudication committee for a trial of empagliflozin for Boehringer-Ingelheim, and has served on an advisory board for Roivant Sciences related to Factor XI inhibition. Dr. Mayer recieved funding from Idorsia, MaxQ AI, Bayer, Brain Cool, Biogen, and Nestle. Dr. Sheth’s institution received funding from Biogen, Novartis, and Bard, and he recieved funding from Hyperfine and Zoll. The remaining authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)
Databáze:	MEDLINE
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