Anemia From Inflammation After Intracerebral Hemorrhage and Relationships With Outcome.

Autor: Roh DJ; Department of Neurology Vagelos College of Physicians and Surgeons Columbia University New York City NY USA., Poyraz FC; Department of Neurology Vagelos College of Physicians and Surgeons Columbia University New York City NY USA., Mao E; Department of Neurology Vagelos College of Physicians and Surgeons Columbia University New York City NY USA., Shen Q; Department of Neurology Vagelos College of Physicians and Surgeons Columbia University New York City NY USA., Kansara V; Department of Neurology Vagelos College of Physicians and Surgeons Columbia University New York City NY USA., Cottarelli A; Department of Pathology and Cell Biology Vagelos College of Physicians and Surgeons Columbia University New York City NY USA., Song S; Department of Neurology Vagelos College of Physicians and Surgeons Columbia University New York City NY USA., Nemkov T; Department of Biochemistry and Molecular Genetics University of Colorado Denver Anschutz Medical Campus Aurora CO USA., Kumar A; Department of Neurology Vagelos College of Physicians and Surgeons Columbia University New York City NY USA., Hudson KE; Department of Pathology and Cell Biology Vagelos College of Physicians and Surgeons Columbia University New York City NY USA., Ghoshal S; Department of Neurology Vagelos College of Physicians and Surgeons Columbia University New York City NY USA., Park S; Department of Neurology Vagelos College of Physicians and Surgeons Columbia University New York City NY USA., Agarwal S; Department of Neurology Vagelos College of Physicians and Surgeons Columbia University New York City NY USA., Connolly ES; Department of Neurological Surgery Vagelos College of Physicians and Surgeons Columbia University New York City NY USA., Claassen J; Department of Neurology Vagelos College of Physicians and Surgeons Columbia University New York City NY USA., Kreuziger LB; Versiti Blood Research Institute Versiti; Department of Medicine Division of Hematology and Oncology Medical College of Wisconsin Milwaukee WI USA., Hod E; Department of Pathology and Cell Biology Vagelos College of Physicians and Surgeons Columbia University New York City NY USA., Yeatts S; Department of Public Health Sciences Medical University of South Carolina Charleston SC USA., Foster LD; Department of Public Health Sciences Medical University of South Carolina Charleston SC USA., Selim M; Department of Neurology Beth Israel Deaconness Boston MA USA.
Jazyk: angličtina
Zdroj: Journal of the American Heart Association [J Am Heart Assoc] 2024 Jul 16; Vol. 13 (14), pp. e035524. Date of Electronic Publication: 2024 Jul 09.
DOI: 10.1161/JAHA.124.035524
Abstrakt: Background: Baseline anemia is associated with poor intracerebral hemorrhage (ICH) outcomes. However, underlying drivers for anemia and whether anemia development after ICH impacts clinical outcomes are unknown. We hypothesized that inflammation drives anemia development after ICH and assessed their relationship to outcomes.
Methods and Results: Patients with serial hemoglobin and iron biomarker concentrations from the HIDEF (High-Dose Deferoxamine in Intracerebral Hemorrhage) trial were analyzed. Adjusted linear mixed models assessed laboratory changes over time. Of 42 patients, significant decrements in hemoglobin occurred with anemia increasing from 19% to 45% by day 5. Anemia of inflammation iron biomarker criteria was met in 88%. A separate cohort of 521 patients with ICH with more granular serial hemoglobin and long-term neurological outcome data was also investigated. Separate regression models assessed whether (1) systemic inflammatory response syndrome (SIRS) scores related to hemoglobin changes over time and (2) hemoglobin changes related to poor 90-day outcome. In this cohort, anemia prevalence increased from 30% to 71% within 2 days of admission yet persisted beyond this time. Elevated systemic inflammatory response syndrome was associated with greater hemoglobin decrements over time (adjusted parameter estimate: -0.27 [95% CI, -0.37 to -0.17]) and greater hemoglobin decrements were associated with poor outcomes (adjusted odds ratio per 1 g/dL increase, 0.76 [95% CI, 0.62-0.93]) independent to inflammation and ICH severity.
Conclusions: We identified novel findings that acute anemia development after ICH is common, rapid, and related to inflammation. Because anemia development is associated with poor outcomes, further work is required to clarify if anemia, or its underlying drivers, are modifiable treatment targets that can improve ICH outcomes.
Registration: https://www.clinicaltrials.gov Unique identifier: NCT01662895.
Databáze: MEDLINE
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