脑出血后的血红蛋白与血肿周围水肿：i-DEF试验的事后分析
Hemoglobin and Perihematomal Edema After Intracerebral Hemorrhage: A Post Hoc Analysis of the i-DEF Trial.
作者信息
Polymeris Alexandros A, Lioutas Vasileios-Arsenios, Marchina Sarah, Seiffge David J, Roh David J, Poyraz Fernanda Carvalho, Selim Magdy H
机构信息
Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.
出版信息
Neurocrit Care. 2025 May 21. doi: 10.1007/s12028-025-02284-3.
BACKGROUND
Anemia is common after intracerebral hemorrhage (ICH). It has been attributed to inflammation and is associated with poor outcomes. We investigated whether this could be related to the effects of hemoglobin (Hb) on perihematomal edema (PHE).
METHODS
We performed an exploratory post hoc analysis of the Intracerebral Hemorrhage Deferoxamine (i-DEF) randomized controlled trial. We included participants with primary supratentorial ICH, available baseline Hb levels, and computed tomography scans at baseline and follow-up after 72-96 h. We investigated the association of Hb and anemia (as continuous and dichotomous exposures, respectively) with edema extension distance (EED) as the main continuous outcome at baseline and follow-up and as its interscan change using Spearman correlation and unadjusted and adjusted linear models. We examined absolute and relative PHE in ancillary analyses.
RESULTS
We analyzed data from 276 of 293 (94%) i-DEF participants. The median age was 61 (interquartile range [IQR] 52-70) years, and 39% of participants were female. The median Hb level was 14.1 (IQR 13-15.2) g/dL, and 41 participants (15%) were anemic. The median EED was 4.4 (IQR 3.5-5.3) mm at baseline and 6.4 (IQR 5.3-7.3) mm at follow-up. Hb was weakly inversely correlated with baseline (ρ = - 0.12, p = 0.05) and follow-up EED (ρ = - 0.11, p = 0.07) but not with interscan EED change (ρ = - 0.01, p = 0.89). Linear models showed similar relationships of Hb with baseline and particularly follow-up EED but not with EED change. In ancillary analyses, absolute and relative PHE showed no clear correlation with Hb but maintained similar relationships with Hb in linear models as in the main analysis.
CONCLUSIONS
We identified signals for an association of baseline Hb with PHE after ICH. These findings may warrant further exploration in larger cohorts.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov identifier: NCT02175225.
背景
脑出血（ICH）后贫血很常见。这归因于炎症，且与不良预后相关。我们研究了这是否可能与血红蛋白（Hb）对血肿周围水肿（PHE）的影响有关。
方法
我们对脑出血去铁胺（i-DEF）随机对照试验进行了探索性事后分析。我们纳入了幕上原发性ICH患者、可用的基线Hb水平以及基线和72 - 96小时随访时的计算机断层扫描。我们分别将Hb和贫血（作为连续和二分暴露因素）与水肿扩展距离（EED）相关联，将EED作为基线和随访时的主要连续结局以及其扫描间变化，采用Spearman相关性分析以及未调整和调整的线性模型。我们在辅助分析中检查了绝对和相对PHE。
结果
我们分析了293名i-DEF参与者中276名（94%）的数据。中位年龄为61岁（四分位间距[IQR]52 - 70），39%的参与者为女性。中位Hb水平为14.1（IQR 13 - 15.2）g/dL，41名参与者（15%）贫血。基线时中位EED为4.4（IQR 3.5 - 5.3）mm，随访时为6.4（IQR 5.3 - 7.3）mm。Hb与基线（ρ = - 0.12，p = 0.05）和随访EED（ρ = - 0.11，p = 0.07）呈弱负相关，但与扫描间EED变化无关（ρ = - 0.01，p = 0.89）。线性模型显示Hb与基线尤其是随访EED有相似关系，但与EED变化无关。在辅助分析中，绝对和相对PHE与Hb无明显相关性，但在与主要分析相同的线性模型中与Hb保持相似关系。
结论
我们发现了基线Hb与ICH后PHE之间存在关联的信号。这些发现可能值得在更大的队列中进一步探索。
临床试验注册
ClinicalTrials.gov标识符：NCT02175225。
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