High haemoglobin levels and mortality in males with intracerebral haemorrhage: a retrospective cohort study

Abstract

ObjectivesTo examine the association between high haemoglobin levels and outcomes in intracerebral haemorrhage (ICH) in a multicentre cohort study.DesignProspective multicentre cohort study.Settings21 tertiary hospitals across mainland China.ParticipantsA total of 5318 consecutive in-hospital spontaneous ICH patients were recruited between January 2012 and June 2016.Primary and secondary outcome measuresHaemoglobin levels were measured on admission. Binary or ordinary logistic regression was used to evaluate the independent relationship of haemoglobin level with clinical outcomes at 3 months, measured as death or disability. Restricted cubic spline regression was fitted to examine the potential non-linear shape of the dose–response curve between the whole haemoglobin levels and 3-month poor outcomes.ResultsA total of 5031 patients with ICH were analysed (64.3% male; mean age (SD), 57.8 (15.2) years). We found that the highest haemoglobin quintile was associated with poor outcomes 3 months in males (adjusted OR (aOR) 1.65, 95% CI 1.21 to 2.25) but not in females, which was also observed in the pooled analysis of three subcohorts in male patients (average aOR 1.70, 95% CI 1.23 to 2.33). The spline regression suggested a non-linear association between haemoglobin levels and outcomes and a linear relationship was observed between an elevated haemoglobin level and 3-month disability/death in males (haemoglobin level per 10 g/L: aOR 1.24, 95% CI 1.10 to 1.40, p<0.001), which was mediated by larger haematoma volume (effect size: 0.115, 95% CI 0.012 to 0.231).ConclusionsThis study found a sex-specific association between an elevated haemoglobin level and poor 3-month outcomes, which might be mediated by larger haematoma volume.

The relationship between hemoglobin and triglycerides in moyamoya disease: A cross-sectional study

“…A recent study ( 12 ) showed a U-shaped association between hemoglobin concentration and stroke sequelae and recurrence, with either too high or too low hemoglobin concentrations being associated with stroke disability, death and recurrence. Meanwhile, a multicentre study ( 14 ) noted that elevated hemoglobin concentrations within 3 months of onset were associated with poor prognosis in men but not significantly in women with cerebral hemorrhage. Several previous publications ( 15 – 17 ) suggest that dyslipidaemia is a known risk factor for cerebrovascular disease.…”

Iron, ferroptosis, and ischemic stroke

“…Elevated Tf level in response to iron deficiency may be the adoptive mechanism after anemic/hypoxic injury. Hemoglobin (Hb) is the iron‐containing oxygen‐transport metalloprotein in the red blood cells that is vital for oxygen supply in the brain (Zhang, Shu, Chen, et al, 2022), and higher Hb level was associated with increased mortality and disability in ischemic stroke patients (Zhang, Shu, Li, et al, 2022). However, in iron deficiency conditions, the suppression of Hb and red blood cell levels also leads to an anemic/hypoxic state, which induces hypoxia‐inducible factor‐1 (HIF‐1) expression (Rolfs et al, 1997).…”

Anemia and Optimal Transfusion Thresholds in Brain-Injured Patients: A Narrative Review of the Literature

“…96 Observational studies have mostly demonstrated an association between anemia and poor outcomes among ICH patients, though again not without inconsistency in the results (Table ). 66,[97][98][99][100][101][102][103][104] In a metaanalysis of 7 cohort studies from 2009 to 2016 that included 7328 ICH patients, anemia was associated with increased 30-day mortality (OR, 1.72; 95% CI, 1.37-2.15; P = .02; I 2 = 64%), and increased risk of poor functional outcome at 3 months (OR, 2.29; 95% CI, 1.16-4.51; I 2 = 91%; P < .0001). 105 This considerable heterogeneity should be noted when interpreting the data, as the definition of anemia and measurement of Hb varied significantly between studies.…”