Admission anemia and 90-day outcomes after supratentorial intracerebral hemorrhage: a township-level cohort study.
Anemia is associated with worse stroke outcomes, but prior studies seldom focus on patients with spontaneous supratentorial intracerebral hemorrhage (ICH) treated in township-level primary hospitals.
We performed a single-center retrospective cohort study of consecutive adults with spontaneous supratentorial ICH and available 90-day outcomes. Anemia was defined by prespecified sex-specific hemoglobin thresholds at admission. The primary outcome was the 90-day modified Rankin Scale (mRS 0-6) analyzed with a partial proportional-odds model. Secondary outcomes were mRS 0-1, 0-2, 0-3, and 90-day all-cause mortality. Prespecified covariates were adjusted in all models. Exploratory mediation analyses assessed whether baseline hematoma volume mediated the association between anemia and 90-day functional outcomes.
Among 158 participants (median age, 66 years; 55 women), 32 had anemia. Anemia was associated with higher odds of greater disability at intermediate-to-high thresholds: mRS ≥ 3 (odds ratio [OR] 3.46; 95% CI 1.33-8.99; P = 0.01) and mRS ≥ 4 (OR 4.64; 95% CI 1.60-13.41; P < 0.01); estimates at other thresholds were directionally similar but not significant. In secondary analyses, anemia was associated with lower odds of achieving mRS 0-2 (OR 0.31; 95% CI 0.11-0.87; P = 0.03) and mRS 0-3 (OR 0.26; 95% CI 0.09-0.71; P = 0.01), with no association for mRS 0-1 (OR 0.59; 95% CI 0.15-2.03; P = 0.41) or 90-day mortality (OR 1.29; 95% CI 0.34-4.76; P = 0.70). Results were stable across sensitivity analyses (excluding the 5 largest and 5 smallest hematoma volumes, including participants lost to follow-up as worst and best cases). Mediation analyses suggested that larger baseline hematoma volume accounted for ~ 18% of the association between anemia and achieving mRS 0-3 (borderline for mRS 0-2).
In a township-level cohort with supratentorial ICH, admission anemia was associated with a shift toward greater 90-day disability. Exploratory mediation findings imply that larger baseline hematoma volume may partly underlie this association and warrant confirmation in prospective multicenter studies. The null results for mRS 0-1 and 90-day mortality should be interpreted cautiously given limited power.
We performed a single-center retrospective cohort study of consecutive adults with spontaneous supratentorial ICH and available 90-day outcomes. Anemia was defined by prespecified sex-specific hemoglobin thresholds at admission. The primary outcome was the 90-day modified Rankin Scale (mRS 0-6) analyzed with a partial proportional-odds model. Secondary outcomes were mRS 0-1, 0-2, 0-3, and 90-day all-cause mortality. Prespecified covariates were adjusted in all models. Exploratory mediation analyses assessed whether baseline hematoma volume mediated the association between anemia and 90-day functional outcomes.
Among 158 participants (median age, 66 years; 55 women), 32 had anemia. Anemia was associated with higher odds of greater disability at intermediate-to-high thresholds: mRS ≥ 3 (odds ratio [OR] 3.46; 95% CI 1.33-8.99; P = 0.01) and mRS ≥ 4 (OR 4.64; 95% CI 1.60-13.41; P < 0.01); estimates at other thresholds were directionally similar but not significant. In secondary analyses, anemia was associated with lower odds of achieving mRS 0-2 (OR 0.31; 95% CI 0.11-0.87; P = 0.03) and mRS 0-3 (OR 0.26; 95% CI 0.09-0.71; P = 0.01), with no association for mRS 0-1 (OR 0.59; 95% CI 0.15-2.03; P = 0.41) or 90-day mortality (OR 1.29; 95% CI 0.34-4.76; P = 0.70). Results were stable across sensitivity analyses (excluding the 5 largest and 5 smallest hematoma volumes, including participants lost to follow-up as worst and best cases). Mediation analyses suggested that larger baseline hematoma volume accounted for ~ 18% of the association between anemia and achieving mRS 0-3 (borderline for mRS 0-2).
In a township-level cohort with supratentorial ICH, admission anemia was associated with a shift toward greater 90-day disability. Exploratory mediation findings imply that larger baseline hematoma volume may partly underlie this association and warrant confirmation in prospective multicenter studies. The null results for mRS 0-1 and 90-day mortality should be interpreted cautiously given limited power.