Abstract Details

Title Admission Hemoglobin Level is Associated with Hematoma Expansion and Poor Outcome after Intracerebral Hemorrhage

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) S2 - Neurocritical Care (1:00 PM-1:11 PM)

Poster/Presentation
Number 001

Background Increasing evidence has shown the importance of erythrocytes in hemostasis, with lower hemoglobin levels associated with coagulopathy and bleeding. The role of lower hemoglobin levels in HE after ICH is unknown.

Objective We sought to investigate whether lower hemoglobin concentrations are associated with hematoma expansion (HE) after primary intracerebral hemorrhage (ICH), and its effect on outcome.

Design/Methods Consecutive ICH patients admitted to a tertiary referral academic center between 2009 and 2016 with admission hemoglobin levels and available neuroimaging to calculate HE were enrolled in an ICH cohort study. Secondary ICH, non-medication related coagulopathy, and patients presenting 24 hours after symptom onset were excluded. HE was defined as >33% or >6mL growth on follow-up CT scan. The association of admission hemoglobin with HE and poor 3-month outcomes (modified Rankin Scale 4-6) were assessed using multivariable logistic regression models. Mediation analysis investigated causal relationships between hemoglobin, HE, and outcome.

Results Of 256 ICH patients, 63 (25%) had HE. Patients with HE had significantly more antiplatelet and anticoagulant medication use and faster symptom onset to admission CT times (median: 3.5 vs. 6.9 hours) compared to those without. There was a significant association of lower hemoglobin and increased odds of HE (OR 0.80 per 1g/dL hemoglobin change; 95%CI: 0.67-0.97) adjusting for age, sex, race, and covariates of HE. Lower hemoglobin was also associated with poor 3-month outcomes (OR 0.76; 95%CI: 0.62-0.94) adjusting for ICH score. Mediation analysis revealed that associations of low hemoglobin levels with poor outcomes were mediated by HE (p=0.01).

Conclusions

We identified independent associations of lower admission hemoglobin levels with HE and poor outcomes following ICH with HE mediating these worse outcomes.

Authors/Disclosures
Jessica Magid-Bernstein, MD, PhD (Yale School of Medicine) PRESENTER	Dr. Magid-Bernstein has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Santosh B. Murthy, MD (Weill Cornell Medicine)	Dr. Murthy has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Stroke and Neurological disorders. The institution of Dr. Murthy has received research support from National Institutes of Health/NINDS.
Soojin Park, MD	Dr. Park has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurocritical Care. The institution of Dr. Park has received research support from National Institutes of Health.
Sachin Agarwal, MD, MPH (Columbia University Med Center)	Dr. Agarwal has nothing to disclose.
	No disclosure on file
Mitchell S. Elkind, MD, MS, FAAN	Dr. Elkind has received personal compensation for serving as an employee of American Heart Association. Dr. Elkind has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Atria Academy.
Jan Claassen, MD, PhD (Columbia University College of Physicians & Surgeons)	Dr. Claassen has stock in iCE Neurosystems. The institution of Dr. Claassen has received research support from NINDS. The institution of Dr. Claassen has received research support from McDonnel Foundation. Dr. Claassen has received publishing royalties from a publication relating to health care. Dr. Claassen has received publishing royalties from a publication relating to health care.
David J. Roh, MD (Columbia University Medical Center)	Dr. Roh has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Portola Pharmaceuticals.

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