• Julián N Acosta, Audrey C Leasure, Lindsey R Kuohn, Cameron P Both, Nils H Petersen, Lauren H Sansing, Charles C Matouk, Fernando Testai, Carl D Langefeld, Daniel Woo, Hooman Kamel, Santosh B Murthy, Adnan Qureshi, Stephan A Mayer, Kevin N Sheth, and Guido J Falcone.
• Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT.
• Crit. Care Med. 2021 May 1; 49 (5): 828837828-837.

ObjectivesTo test the hypothesis that admission hemoglobin levels are associated with outcome in primary, nontraumatic intracerebral hemorrhage.DesignIndividual patient data meta-analysis of three studies of intracerebral hemorrhage.SettingTwo randomized clinical trials and one multiethnic observational study.PatientsPatients with spontaneous, nontraumatic intracerebral hemorrhage.InterventionsNone.Measurements And Main ResultsOur 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.ConclusionsHigher 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.Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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