Impact of Increased Hemoglobin on Spontaneous Intracerebral Hemorrhage

Abstract

Background Studies of the impact of increased hemoglobin on spontaneous intracerebral hemorrhage (ICH) are limited. The present study aimed to explore the effect of increased hemoglobin on ICH. Methods A retrospective single-center study using medical records from a database processed by univariate and multivariate analyses was performed in the People’s Hospital of Tibet Autonomous Region in Lhasa, Tibet, China. Results The mean hemoglobin level in 211 patients with ICH was 165.03 ± 34.12 g/l, and a median hematoma volume was 18.5 ml. Eighty-eight (41.7%) patients had large hematomas (supratentorial hematoma ≥ 30 ml; infratentorial hematoma ≥ 10 ml). No differences in ICH risk factors between the groups with different hemoglobin levels were detected. Increased hemoglobin was independently associated with large hematomas [odds ratio (OR) 1.013, P = 0.023]. Increased hemoglobin was independently associated with ICH with subarachnoid hemorrhage (OR 1.014, P = 0.016), which was more pronounced in men (OR 1.027, P = 0.002). Increased hemoglobin was independently associated with basal ganglia hemorrhage and lobar hemorrhage in men (OR 0.986, P = 0.022; OR 1.013, P = 0.044, respectively) but not in women (P > 0.1). Conclusions Increased hemoglobin was independently associated with large hemorrhage volume. Increased hemoglobin was independently associated with lobar hemorrhage in men and ICH with subarachnoid hemorrhage, which was more pronounced in men. Additional studies are needed to confirm our findings and explore potential mechanisms.

Relationships of Hemoglobin Concentration, Ischemic Lesions, and Clinical Outcomes in Patients With Intracerebral Hemorrhage

“…Previous studies have identified that hemoglobin at both extremes (ie, low and high hemoglobin) has been linked to poor cardiovascular and cerebrovascular (including ICH) outcomes. 9,10,12–16,28–30 In this regard, even our own data may similarly suggest a U-shaped relationship of hemoglobin with clinical ICH outcomes. If our hemoglobin-DWI lesion associations are truly related to high hemoglobin concentrations, it could be posited from this and other work that hemoglobin has separate, multimodal pathophysiologic impacts on clinical outcomes at both extremes after ICH, 13,14,16,29 as has been reported in other disease processes.…”

“…9,10,12–16,28–30 In this regard, even our own data may similarly suggest a U-shaped relationship of hemoglobin with clinical ICH outcomes. If our hemoglobin-DWI lesion associations are truly related to high hemoglobin concentrations, it could be posited from this and other work that hemoglobin has separate, multimodal pathophysiologic impacts on clinical outcomes at both extremes after ICH, 13,14,16,29 as has been reported in other disease processes. 9,11,12,28,30 Specifically, it could be speculated at lower baseline hemoglobin concentrations, patients with ICH are at risk for acute hematoma expansion and larger ICH volumes.…”