Editors' note: Low hemoglobin and hematoma expansion after intracerebral hemorrhage

Abstract

To corroborate previous reports that lower hemoglobin levels may be associated with hematoma expansion (HE) and poor functional outcomes after intracerebral hemorrhage (ICH), Drs. Roh et al. queried their single-center prospective ICH registry of 256 patients. After adjustment for known predictors of HE, each 1 g/dL fall in hemoglobin levels was associated with a 20% higher odds of HE and 24% higher odds of severe disability (modified Rankin Scale score 4–6) at 3 months. Mediation analysis demonstrated that HE contributed to the poor long-term outcomes seen in patients with lower admission hemoglobin levels. Yu et al. address important unmeasured confounders—notably, coagulopathy—which could have also contributed to adverse radiographic and clinical outcomes. However, as Dr. Roh responds, patients in this study were excluded if there was evidence of coagulopathy secondary to systemic disease. Furthermore, the investigators adjusted for the use of therapeutic anticoagulation, irrespective of coagulation studies. Ultimately, both groups agree that these results warrant replication in further studies. To corroborate previous reports that lower hemoglobin levels may be associated with hematoma expansion (HE) and poor functional outcomes after intracerebral hemorrhage (ICH), Drs. Roh et al. queried their single-center prospective ICH registry of 256 patients. After adjustment for known predictors of HE, each 1 g/dL fall in hemoglobin levels was associated with a 20% higher odds of HE and 24% higher odds of severe disability (modified Rankin Scale score 4–6) at 3 months. Mediation analysis demonstrated that HE contributed to the poor long-term outcomes seen in patients with lower admission hemoglobin levels. Yu et al. address important unmeasured confounders—notably, coagulopathy—which could have also contributed to adverse radiographic and clinical outcomes. However, as Dr. Roh responds, patients in this study were excluded if there was evidence of coagulopathy secondary to systemic disease. Furthermore, the investigators adjusted for the use of therapeutic anticoagulation, irrespective of coagulation studies. Ultimately, both groups agree that these results warrant replication in further studies.