Anemia is an independent prognostic factor in intracerebral hemorrhage: an observational cohort study.
Anemia is an independent prognostic factor in intracerebral hemorrhage: an observational cohort study.
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DOI：
10.1186/cc12827
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发表时间：
2013-07-23
期刊：
影响因子：
--
通讯作者：
Huttner HB
中科院分区：
文献类型：
--
作者：
Kuramatsu JB;Gerner ST;Lücking H;Kloska SP;Schellinger PD;Köhrmann M;Huttner HB
迄今为止，只有两项研究评估了急性脑出血（ICH）患者的贫血状态，报道入院时贫血（OAA）与住院期间血肿量较大和血红蛋白水平较低相关，这与较差的预后有关。问题仍然是贫血是通过相关的容量效应影响结果，还是它本身具有独立的影响？这项单中心研究纳入了435例连续5年以上在神经内科住院的自发性脑出血患者。分析贫血状态的功能性短期和长期结果（3个月和1年）。计算了贫血相关性的多变量逻辑分析和图形回归分析，以确定对功能结局的独立影响。决定对脑出血容量<30cm3的患者（小容量脑出血）进行单独分析。总体而言，贫血患者的短期预后较差（mRS[4-6] OAA = 93.3% vs.非OAA = 61.2%, P < 0.01），且长期死亡率进一步升高（P = 0.02）。OAA患者出现不良长期预后的概率（mRS[4-6]）提高了7倍（OR:7.5; P < 0.01）。受试者工作特征曲线（ROC）分析显示ICH-volume与贫血呈正相关，但相关性较差（AUC = 0.67），提示贫血的预后效应与容量无关（AUC = 0.75）。多因素回归分析显示，除了既定参数外，贫血与不良结局的关系最为密切（OR:3.0; P < 0.01）。这在小容量ich中更为明显（OR:5.6; P < 0.01）。贫血似乎是一个以前未被认识到的不良功能结局的重要预测因子，其独立影响超出了与大出血的关联。认识到贫血及其治疗可能会影响脑出血后的预后，因此前瞻性干预研究是必要的。
To date only two studies have evaluated anemia status in acute intracerebral hemorrhage (ICH) reporting that on admission anemia (OAA) was associated with larger hematoma volume, and lower hemoglobin levels during hospital stay, which related to poorer outcome. The question remains whether anemia influences outcome through related volume-effects or itself has an independent impact? This single-center investigation included 435 consecutive patients with spontaneous ICH admitted to the Department of Neurology over five years. Functional short- and long-term outcome (3 months and 1 year) were analyzed for anemia status. Multivariate logistic and graphical regression analyses were calculated for associations of anemia and to determine independent effects on functional outcome. It was decided to perform a separate analysis for patients with ICH-volume <30cm3 (minor-volume-ICH). Overall short-term-outcome was worse in anemic patients (mRS[4-6] OAA = 93.3% vs. non-OAA = 61.2%, P < 0.01), and there was a further shift towards an increased long-term mortality (P = 0.02). The probability of unfavorable long-term-outcome (mRS[4-6]) in OAA was elevated 7-fold (OR:7.5; P < 0.01). Receiver operating characteristics curve (ROC) analysis revealed a positive but poor association of ICH-volume and anemia (AUC = 0.67) suggesting volume-undriven outcome-effects of anemia (AUC = 0.75). Multivariate regression analyses revealed that anemia, besides established parameters, has the strongest relation to unfavorable outcome (OR:3.0; P < 0.01). This is even more pronounced in minor-volume-ICH (OR:5.6; P < 0.01). Anemia seems to be a previously unrecognized significant predictor of unfavorable functional outcome with independent effects beyond its association with larger hemorrhage volumes. The recognition of anemia and its treatment may possibly influence outcome after ICH and as such prospective interventional studies are warranted.
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