(P-PB-5) Anemia development during intracerebral hemorrhage hospitalization is associated with poor long-term outcomes

Background/Case Studies: Baseline anemia is associated with poor outcomes in patients with intracerebral hemorrhage (ICH). Temporal changes of hemoglobin and anemia development over an ICH hospitalization is unclear. Though liberal red blood cell (RBC) transfusion studies are currently underway in other acute brain injury processes, it is unknown whether similar efforts are warranted in ICH. We sought to evaluate hemoglobin changes acutely after ICH and assess how these changes relate to neurological outcomes.

Study

Design/Methods: Consecutive spontaneous ICH patients enrolled into a single-center, prospective cohort study between 2009 and 2018 were assessed. Change in hemoglobin from admission to day 4 was assessed using paired samples t test. We also assessed relationships of hemoglobin change (baseline to day 4) and anemia on day 4 with discharge and 3-month neurological outcomes (modified Rankin Scale [mRS] 4-6) using logistic regression models adjusted for age, sex, race, and ICH severity.

Results/Findings: Amongst 588 ICH patients analyzed, mean age was 65.5, 43.5% were female, and baseline anemia was present in 31%. We identified significant decrements of hemoglobin over time (mean difference 2.09 g/dL; 95%CI 1.83-2.35; p< 0.01) from baseline to follow-up at 4 days. Anemia was notable in 41.7% of patients at day 4. In our adjusted regression models, greater decrements of hemoglobin were associated with poor neurological outcomes at discharge (OR 1.39, 95%CI 1.16-1.65, p< 0.01) and 3-months (OR 1.19, 95%CI 1.02-1.38, p=0.02). Anemia on day 4 was also associated with poor neurological outcomes (discharge: OR 2.51, 95%CI 1.38-4.60, p< 0.01; 3-months: OR 2.34, 95%CI 1.19-4.61, p=0.014).

Conclusions: In our ICH cohort, anemia development over time was frequent and associated with poor ICH outcomes. Further work is required to assess whether RBC transfusions should be used as a therapeutic strategy during an ICH hospitalization to improve long term outcomes.

Importance of research: Liberal RBC transfusion approaches are being studied for patients with acute brain injury, but it is unknown whether similar efforts are warranted in ICH patients. Observational studies suggest that baseline anemia is associated with poor ICH outcomes. Our findings indicate that the development of anemia over time is frequent, with these changes similarly impacting long-term outcomes. Further efforts are needed to assess the therapeutic role of RBC transfusions across an ICH hospitalization.