Zhang Shuting, Shu Yang, Chen Yunlong, Liu Xiaoyang, Liu Yu, Cheng Yajun, Wu Bo, Lei Peng, Liu Ming
Department of Neurology, West China Hospital Sichuan University Chengdu P. R. China.
State Key Laboratory of Biotherapy, West China Hospital Sichuan University Chengdu P. R. China.
MedComm (2020). 2022 Feb 23;3(1):e96. doi: 10.1002/mco2.96. eCollection 2022 Mar.
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, = 0.004), and the hemoglobin levels were linearly associated with 3-month death (aOR 0.75, 95% CI 0.60-0.92; = 0.009), which was partially mediated by larger baseline hematoma volume (= 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.
血红蛋白是否与特定亚型的脑出血（ICH）预后相关尚不清楚。本分析纳入了来自多中心队列的4643例ICH患者（男性占64.0%；平均年龄[标准差]为58.3[15.2]岁），其中1319例（28.4%）入院时存在贫血。采用无监督一致性聚类方法将患者分为三个聚类。聚类3的患者贫血发生率高（85.3%），根据SMASH-U病因，主要由全身性疾病ICH亚型（SD-ICH；90.0%）的患者组成。在SD-ICH中，观察到贫血与3个月死亡率之间存在强烈的交互作用（调整优势比[aOR]为4.33，95%置信区间[CI]为1.60-11.9，P = 0.004），血红蛋白水平与3个月死亡率呈线性相关（aOR为0.75，95%CI为0.60-0.92；P = 0.009），这部分由更大的基线血肿体积介导（P = 0.008）。本研究表明，在SD-ICH中，低血红蛋白水平与较差的预后之间存在强烈的线性关联，提示在特定亚型的ICH中可能广泛需要提高血红蛋白的治疗。
