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.
Crit Care Med. 2021 May 1;49(5):828-837. doi: 10.1097/CCM.0000000000004891.
To test the hypothesis that admission hemoglobin levels are associated with outcome in primary, nontraumatic intracerebral hemorrhage.
Individual patient data meta-analysis of three studies of intracerebral hemorrhage.
Two randomized clinical trials and one multiethnic observational study.
Patients with spontaneous, nontraumatic intracerebral hemorrhage.
None.
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.
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.
检验入院时血红蛋白水平与原发性非外伤性脑出血患者预后相关的假说。
对 3 项脑出血研究的个体患者数据进行汇总分析。
2 项随机临床试验和 1 项多民族观察性研究。
自发性、非外伤性脑出血患者。
无。
我们感兴趣的暴露因素是入院时的血红蛋白水平，主要结局是脑出血后 3 个月的改良 Rankin 量表（0-3 分与 4-6 分）。中间结局是入院时血肿量和血肿扩大，定义为 CT 复查时出血量增加 6 mL 或 33%。共有 4172 例脑出血患者纳入本研究（平均年龄 63 [标准差 14]；女性 1668 例[40%]）。入院时血红蛋白每增加 1 g/dL，不良预后的风险分别降低 14%（优势比，0.86；95%置信区间，0.82-0.91）和 7%（优势比，0.93；95%置信区间，0.88-0.98），在未校正和校正分析中均如此。剂量-反应分析表明，在整个评估范围内，入院时血红蛋白水平与不良预后之间存在线性关系（趋势检验 p < 0.001）。入院时血红蛋白水平与血肿体积或血肿扩大之间没有一致的相关性。
较高的血红蛋白水平与脑出血患者的良好预后相关。需要进一步研究以评估入院时血红蛋白水平作为治疗靶点和预后预测因素的作用。
