• David J Roh, David J Albers, Jessica Magid-Bernstein, Kevin Doyle, Eldad Hod, Andrew Eisenberger, Santosh Murthy, Jens Witsch, Soojin Park, Sachin Agarwal, E Sander Connolly, Elkind Mitchell S V MSV From Vagelos College of Physicians and Surgeons (D.J.R., D.J.A., J.M.-B., K.D., E.H., A.E., S.P., S.A., E.S.C., M.S.V.E., J.C.), Columbia Universi, and Jan Claassen.
• From Vagelos College of Physicians and Surgeons (D.J.R., D.J.A., J.M.-B., K.D., E.H., A.E., S.P., S.A., E.S.C., M.S.V.E., J.C.), Columbia University; Weill Cornell Medical Center (S.M.), New York, NY; and Yale School of Medicine (J.W.), New Haven, CT. dr2753@cumc.columbia.edu.
• Neurology. 2019 Jul 23; 93 (4): e372-e380.

ObjectiveStudies have independently shown associations of lower hemoglobin levels with larger admission intracerebral hemorrhage (ICH) volumes and worse outcomes. We investigated whether lower admission hemoglobin levels are associated with more hematoma expansion (HE) after ICH and whether this mediates lower hemoglobin levels' association with worse outcomes.MethodsConsecutive patients enrolled between 2009 and 2016 to a single-center prospective ICH cohort study with admission hemoglobin and neuroimaging data to calculate HE (>33% or >6 mL) were evaluated. The association of admission hemoglobin levels with HE and poor clinical outcomes using modified Rankin Scale (mRS 4-6) were assessed using separate multivariable logistic regression models. Mediation analysis investigated causal associations among hemoglobin, HE, and outcome.ResultsOf 256 patients with ICH meeting inclusion criteria, 63 (25%) had HE. Lower hemoglobin levels were associated with increased odds of HE (odds ratio [OR] 0.80 per 1.0 g/dL change of hemoglobin; 95% confidence interval [CI] 0.67-0.97) after adjusting for previously identified covariates of HE (admission hematoma volume, antithrombotic medication use, symptom onset to admission CT time) and hemoglobin (age, sex). Lower hemoglobin was also associated with worse 3-month outcomes (OR 0.76 per 1.0 g/dL change of hemoglobin; 95% CI 0.62-0.94) after adjusting for ICH score. Mediation analysis revealed that associations of lower hemoglobin with poor outcomes were mediated by HE (p = 0.01).ConclusionsFurther work is required to replicate the associations of lower admission hemoglobin levels with increased odds of HE mediating worse outcomes after ICH. If confirmed, an investigation into whether hemoglobin levels can be a modifiable target of treatment to improve ICH outcomes may be warranted.© 2019 American Academy of Neurology.

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