Abstract Details

Title Association Of Hemoglobin Over The First Week With Clinical Outcomes And Neuroimaging Characteristics In Patients With Spontaneous Intracerebral Hemorrhage

Topic Neurocritical Care

Presentation(s) S21 - Neurocritical Care (1:36 PM-1:48 PM)

Poster/Presentation
Number 004

Background Studies have shown associations of lower admission HB with larger ICH volumes and poor outcomes, possibly mediated by hematoma expansion (HE).

Objective To investigate the association of hemoglobin (HB) over the first week post spontaneous intracerebral hemorrhage (ICH) with functional outcomes (FO) and neuroimaging findings in patients with ICH>30mL.

Design/Methods We analyzed HB levels from subjects in the Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation phase 3 trial (MISTIE III). The exposure was admission HB and HB nadir in the first week. The primary outcome was good FO at 180 days, defined as modified Rankin Scale of 0-3. Secondary outcomes were good FO at 365 days, 30-day mortality, ICH volume, and HE(>6 mL). Appropriate regression models tested the association of HB with clinical and neuroimaging outcomes. Models were adjusted for age, sex, race, treatment (medical vs. MISTIE), Glasgow Coma Scale, ICH volume, presence of intraventricular hemorrhage, and ICH location (deep vs. lobar).

Results We included 493 of 499 enrolled patients (61% males, mean age 61(SD=12) years, median ICH volume 41.8mL (IQR=30.8-51.5). Patients with good FO at 180 days had higher admission HB (13.2 vs. 12.6 g/dl, p=0.001) and a higher nadir HB (11.7 vs. 10.9 g/dl, p<0.001). In adjusted analyses, each additional g/dl in nadir HB was associated with higher odds of good FO at 180 (OR 1.29, p=0.005) and 365 (OR1.18, p=0.048) days. Baseline (B= -1.16, p=0.02) and nadir HB (B= -1.71, p=0.001) were inversely associated with hematoma volumes. There was evidence of heterogeneity in the effects of diabetes on the association of nadir HB with day 180 FO (OR 0.67; p_interaction=0.045).

Conclusions

In patients with ICH, higher nadir HB in the first week was associated with better long-term FO and smaller ICH volumes. Early HB changes may serve as a prognostic biomarker and a potentially modifiable factor to improve FO.

Authors/Disclosures
Camilo Diaz-Cruz, MD (Einstein Medical Center) PRESENTER	Dr. Diaz-Cruz has nothing to disclose.
Kori A. Porosnicu Rodriguez, MD (Johns Hopkins University School of Medicine)	Miss Porosnicu Rodriguez has received personal compensation for serving as an employee of Johns Hopkins Centro SOL Policy Group. Miss Porosnicu Rodriguez has received personal compensation for serving as an employee of Johns Hopkins University Student Outreach Resource Center (SOURCE). Miss Porosnicu Rodriguez has received research support from National Center for Advancing Translational Sciences (NCATS), Grant: TL1 TR003100.
John R. Gatti	Mr. Gatti has nothing to disclose.
David Zhao	Mr. Zhao has nothing to disclose.
	No disclosure on file
Issam Awad, MD	No disclosure on file
Daniel F. Hanley, MD, FAAN (Johns Hopkins Medicine, Acute Care Neurology)	Dr. Hanley has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Neurotrope. Dr. Hanley has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for various law firms. The institution of Dr. Hanley has received research support from NIH/NCATS. The institution of Dr. Hanley has received research support from NIH/NINDS.
Wendy C. Ziai, MD (Johns Hopkins Univ, Neuro Critical Care)	Dr. Ziai has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Lumosa. Dr. Ziai has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bard. Dr. Ziai has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer. Dr. Ziai has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Phillips, Phillips & Smith-Delach, P.C.. Dr. Ziai has received research support from NIH. Dr. Ziai has received personal compensation in the range of $500-$4,999 for serving as a Consultant with DOJ.