Anemia and hematoma volume in acute intracerebral hemorrhage

Kumar, Monisha A.; Rost, Natalia S.; Snider, Ryan W.; Chanderraj, Rishi; Greenberg, Steven M.; Smith, Eric E.; Rosand, Jonathan

doi:10.1097/ccm.0b013e31819ced3a

Cited by 69 publications

(97 citation statements)

References 31 publications

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“…After detailed screening, 20 studies were included in our systematic review; the flow chart of study selection is shown in Figure 4, and Tables 5 and 6 show the key features of the selected studies. Overall, 10 studies assessed the impact of anemia on stroke1, 2, 10, 16, 17, 18, 19, 20, 21, 22 and 10 evaluated the association between stroke and hemoglobin levels 6, 7, 8, 9, 23, 24, 25, 26, 27, 28. In terms of study design, 3 were retrospective cohort studies,1, 16, 20 13 were prospective cohort studies,2, 6, 7, 8, 9, 10, 17, 18, 19, 22, 23, 24, 25 and 2 were secondary analyses of randomized control trials 27, 28.…”

Section: Resultsmentioning

confidence: 99%

“…There were also 2 studies that did not state the design 21, 26. There was a high degree of diversity in geographic location, with cohorts from Germany,8, 19, 25 Switzerland,16, 20 the United States,18, 24 the People's Republic of China,2, 22 Canada,23, 28 India,6 Israel,10 the Republic of Korea,9 Denmark,21 Taiwan,17 the United Kingdom,26 and Poland 7. In addition, 2 studies were conducted across multiple countries 1, 27.…”

Section: Resultsmentioning

confidence: 99%

“…In addition, 2 studies were conducted across multiple countries 1, 27. Regarding stroke type, 9 studies assessed patients with ischemic stroke,1, 2, 8, 9, 17, 20, 21, 27, 28 6 assessed patients with hemorrhagic stroke,9, 18, 22, 23, 24, 25 and 5 evaluated both types of stroke 6, 7, 10, 16, 26. The number of participants in the studies ranged from 106 to 3020.…”

Section: Resultsmentioning

confidence: 99%

“…Imaging (computed tomography, magnetic resonance imaging, or both) was used in 17 studies,1, 2, 6, 7, 8, 10, 17, 18, 19, 20, 21, 22, 23, 24, 25, 27, 28 1 study relied on clinical evaluation alone,26 and 2 did not state the method used 9, 16. The methods used to ascertain mortality also varied.…”

Section: Resultsmentioning

confidence: 99%

“…Attending doctors confirmed in‐hospital mortality in 2 studies,24, 25 whereas death registry data were used in 4 studies 10, 20, 21, 23. Telephone interviews were used by 7 studies, typically in conjunction with other methods such as outpatient visit, home visit, mailed questionnaire, analysis of death registries, or review of medical records 6, 8, 9, 16, 18, 19, 22. One study used outpatient visits only,17 and the method used to establish mortality status was unclear in 6 studies 1, 2, 7, 26, 27, 28.…”

Section: Resultsmentioning

confidence: 99%

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Impact of Hemoglobin Levels and Anemia on Mortality in Acute Stroke: Analysis of UK Regional Registry Data, Systematic Review, and Meta‐Analysis

Barlas¹,

Honney

Loke

et al. 2016

JAHA

131

136

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BackgroundThe impact of hemoglobin levels and anemia on stroke mortality remains controversial. We aimed to systematically assess this association and quantify the evidence.Methods and ResultsWe analyzed data from a cohort of 8013 stroke patients (mean±SD, 77.81±11.83 years) consecutively admitted over 11 years (January 2003 to May 2015) using a UK Regional Stroke Register. The impact of hemoglobin levels and anemia on mortality was assessed by sex‐specific values at different time points (7 and 14 days; 1, 3, and 6 months; 1 year) using multiple regression models controlling for confounders. Anemia was present in 24.5% of the cohort on admission and was associated with increased odds of mortality at most of the time points examined up to 1 year following stroke. The association was less consistent for men with hemorrhagic stroke. Elevated hemoglobin was also associated with increased mortality, mainly within the first month. We then conducted a systematic review using the Embase and Medline databases. Twenty studies met the inclusion criteria. When combined with the cohort from the current study, the pooled population had 29 943 patients with stroke. The evidence base was quantified in a meta‐analysis. Anemia on admission was found to be associated with an increased risk of mortality in both ischemic stroke (8 studies; odds ratio 1.97 [95% CI 1.57–2.47]) and hemorrhagic stroke (4 studies; odds ratio 1.46 [95% CI 1.23–1.74]).ConclusionsStrong evidence suggests that patients with anemia have increased mortality with stroke. Targeted interventions in this patient population may improve outcomes and require further evaluation.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Impact of Hemoglobin Levels and Anemia on Mortality in Acute Stroke: Analysis of UK Regional Registry Data, Systematic Review, and Meta‐Analysis

Barlas¹,

Honney

Loke

et al. 2016

JAHA

131

136

View full text Add to dashboard Cite

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Low hemoglobin is associated with worse outcomes via larger hematoma volume in intracerebral hemorrhage due to systemic disease

Zhang

Shu

Chen

et al. 2022

MedComm

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Whether hemoglobin is associated with outcomes of a specific subtype of intracerebral hemorrhage (ICH) is unknown. A total of 4643 patients with ICH from a multicenter cohort were included in the analysis (64.0% male; mean age [SD], 58.3 [15.2] year), of whom 1319 (28.4%) had anemia on admission. The unsupervised consensus cluster method was employed to classify the patients into three clusters. The patients of cluster 3 were characterized by a high frequency of anemia (85.3%) and mainly composed of patients of systemic disease ICH subtype (SD‐ICH; 90.0%) according to the SMASH‐U etiologies. In SD‐ICH, a strong interaction effect was observed between anemia and 3‐month death (adjusted odds ratio [aOR] 4.33, 95% confidence interval [CI] 1.60–11.9, p = 0.004), and the hemoglobin levels were linearly associated with 3‐month death (aOR 0.75, 95% CI 0.60–0.92; p = 0.009), which was partially mediated by larger baseline hematoma volume ( p = 0.008). This study demonstrated a strong linear association between low hemoglobin levels and worse outcomes in SD‐ICH, suggesting that hemoglobin‐elevating therapy might be extensively needed in a specific subtype of ICH.

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Intracranial Hemorrhage

Diffusion-Weighted MR Imaging of the Brain

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Intracranial hemorrhage is a life-threatening condition, the outcome of which can be improved by intensive care. Intracranial hemorrhage may be spontaneous, precipitated by an underlying vascular malformation, induced by trauma, or related to therapeutic anticoagulation. The goals of critical care are to assess the proximate cause, minimize the risks of hemorrhage expansion through blood pressure control and correction of coagulopathy, and obliterate vascular lesions with a high risk of acute rebleeding. Simple bedside scales and interpretation of computed tomography scans assess the severity of neurological injury. Myocardial stunning and pulmonary edema related to neurological injury should be anticipated, and can usually be managed. Fever (often not from infection) is common and can be effectively treated, although therapeutic cooling has not been shown to improve outcomes after intracranial hemorrhage. Most functional and cognitive recovery takes place weeks to months after discharge; expected levels of functional independence (no disability, disability but independence with a device, dependence) may guide conversations with patient representatives. Goals of care impact mortality, with do-not-resuscitate status increasing the predicted mortality for any level of severity of intraparenchymal hemorrhage. Future directions include refining the use of bedside neuromonitoring (electroencephalogram, invasive monitors), novel approaches to reduce intracranial hemorrhage expansion, minimizing vasospasm, and refining the assessment of quality of life to guide rehabilitation and therapy.

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Anemia and hematoma volume in acute intracerebral hemorrhage

Cited by 69 publications

References 31 publications

Impact of Hemoglobin Levels and Anemia on Mortality in Acute Stroke: Analysis of UK Regional Registry Data, Systematic Review, and Meta‐Analysis

Impact of Hemoglobin Levels and Anemia on Mortality in Acute Stroke: Analysis of UK Regional Registry Data, Systematic Review, and Meta‐Analysis

Low hemoglobin is associated with worse outcomes via larger hematoma volume in intracerebral hemorrhage due to systemic disease

Intracranial Hemorrhage

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