Anemia From Inflammation After Intracerebral Hemorrhage and Relationships With Outcome

Overview

Journal J Am Heart Assoc

Specialty Cardiology & Vascular Diseases

Date 2024 Jul 9

PMID 38979830

Authors

David J Roh

Fernanda Carvalho Poyraz

Eric Mao

Qi Shen

Vedant Kansara

Azzurra Cottarelli

Sandy Song

Travis Nemkov

Aditya Kumar

Krystalyn E Hudson

Shivani Ghoshal

Soojin Park

Sachin Agarwal

Edward Sander Connolly

Jan Claassen

Lisa Baumann Kreuziger

Eldad Hod

Sharon Yeatts

Lydia D Foster

Magdy Selim

Affiliations

Soon will be listed here.

Abstract

Background: Baseline anemia is associated with poor intracerebral hemorrhage (ICH) outcomes. However, underlying drivers for anemia and whether anemia development after ICH impacts clinical outcomes are unknown. We hypothesized that inflammation drives anemia development after ICH and assessed their relationship to outcomes.

Methods And Results: Patients with serial hemoglobin and iron biomarker concentrations from the HIDEF (High-Dose Deferoxamine in Intracerebral Hemorrhage) trial were analyzed. Adjusted linear mixed models assessed laboratory changes over time. Of 42 patients, significant decrements in hemoglobin occurred with anemia increasing from 19% to 45% by day 5. Anemia of inflammation iron biomarker criteria was met in 88%. A separate cohort of 521 patients with ICH with more granular serial hemoglobin and long-term neurological outcome data was also investigated. Separate regression models assessed whether (1) systemic inflammatory response syndrome (SIRS) scores related to hemoglobin changes over time and (2) hemoglobin changes related to poor 90-day outcome. In this cohort, anemia prevalence increased from 30% to 71% within 2 days of admission yet persisted beyond this time. Elevated systemic inflammatory response syndrome was associated with greater hemoglobin decrements over time (adjusted parameter estimate: -0.27 [95% CI, -0.37 to -0.17]) and greater hemoglobin decrements were associated with poor outcomes (adjusted odds ratio per 1 g/dL increase, 0.76 [95% CI, 0.62-0.93]) independent to inflammation and ICH severity.

Conclusions: We identified novel findings that acute anemia development after ICH is common, rapid, and related to inflammation. Because anemia development is associated with poor outcomes, further work is required to clarify if anemia, or its underlying drivers, are modifiable treatment targets that can improve ICH outcomes.

Registration: https://www.clinicaltrials.gov Unique identifier: NCT01662895.

Citing Articles

Hemoglobin Decrements are Associated with Ischemic Brain Lesions and Poor Outcomes in Patients with Intracerebral Hemorrhage.

Poyraz F, Rossitto C, Ridha M, Simonetto M, Kumar A, Hess E Neurocrit Care. 2025; .

PMID: 39843877 DOI: 10.1007/s12028-024-02206-9.

Low hemoglobin causes hematoma expansion and poor intracerebral hemorrhage outcomes.

Cottarelli A, Mamoon R, Ji R, Mao E, Boehme A, Kumar A bioRxiv. 2024; .

PMID: 39229082 PMC: 11370400. DOI: 10.1101/2024.08.15.608155.

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