Abstract 3266: Nadir Hemoglobin Predicts Poor Functional Outcome and Death in ICH Patients

Abstract

Background: Anemia has been associated with increased mortality in ICU patients and with poor outcomes in patients with intracerebral hemorrhage (ICH). This study investigates the relationship between hemoglobin (Hb) values and outcomes in ICH patients. Methods: Consecutive patients with spontaneous ICH admitted to the Tulane Stroke Center between July 2008 and December 2010 were evaluated. Records were reviewed for demographic and clinical information. Patients were divided into two groups based on admission Hb (low vs. normal based on laboratory reference range for gender). Baseline characteristics were compared between groups using chi-square, t-tests and Wilcoxon Rank Sum tests. Outcomes included length of stay, discharge NIHSS, discharge modified Rankin Scale (mRS) (mRS 0-3 vs. 4-6), and in-hospital mortality. Cumulative logit models were used to assess the relationship between baseline and nadir hemoglobin with outcomes adjusting for age, baseline NIHSS score, transfusion status, INR and length of stay. Results: Of the 109 patients, 28% (n=30) were anemic on admission. Baseline characteristics and outcomes are shown in Table 1. Patients with baseline anemia had significantly longer stays in the hospital (13.5 vs. 7 days, p=0.037). There was no significant association between admission Hb and discharge NIHSS, mRS, or mortality. Nadir Hb was associated with poor functional outcome (OR=1.58, 95%CI 1.31-1.90, p<0.0001) and remained significant after adjusting for age, baseline NIHSS, transfusion, and length of stay (OR=1.43, 95%CI 1.06-1.94, p=0.02). Conclusion: Low admission Hb values are associated with longer lengths of stay in the hospital. This study suggests that nadir Hb, not admission Hb, can be used to predict poor functional outcome and death. Nadir Hb is lowest in patients with baseline anemia may serve as a surrogate marker for medically complex patients and/or complications.