Admission Hemoglobin Levels Are Associated With Functional Outcome in Spontaneous Intracerebral Hemorrhage

Crit Care Med. 2021 May 1;49(5):828-837. doi: 10.1097/CCM.0000000000004891.


Objectives: To test the hypothesis that admission hemoglobin levels are associated with outcome in primary, nontraumatic intracerebral hemorrhage.

Design: Individual patient data meta-analysis of three studies of intracerebral hemorrhage.

Setting: Two randomized clinical trials and one multiethnic observational study.

Patients: Patients with spontaneous, nontraumatic intracerebral hemorrhage.

Interventions: None.

Measurements and main results: Our exposure of interest was admission hemoglobin levels and the primary outcome was 3-month postintracerebral hemorrhage-dichotomized modified Rankin Scale (0-3 vs 4-6). Intermediate outcomes were admission hematoma volume and hematoma expansion defined as 6 mL or 33% increase in hemorrhage size on repeat CT. A total of 4,172 intracerebral hemorrhage patients were included in the study (mean age 63 [sd = 14]; female sex 1,668 [40%]). Each additional g/dL of admission hemoglobin was associated with 14% (odds ratio, 0.86; 95% CI, 0.82-0.91) and 7% (odds ratio, 0.93; 95% CI, 0.88-0.98) reductions in the risk of poor outcome in unadjusted and adjusted analyses, respectively. Dose-response analyses indicated a linear relationship between admission hemoglobin levels and poor outcome across the entire evaluated range (test-for-trend p < 0.001). No consistent associations were found between the admission hemoglobin levels and hematoma volume or hematoma expansion.

Conclusions: Higher hemoglobin levels are associated with better outcome in intracerebral hemorrhage. Further research is needed to evaluate admission hemoglobin levels as both a therapeutic target and predictor of outcome.

Publication types

  • Meta-Analysis
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cerebral Hemorrhage / diagnostic imaging
  • Cerebral Hemorrhage / metabolism*
  • Cerebral Hemorrhage / physiopathology*
  • Female
  • Heart Conduction System / physiopathology
  • Hemoglobins / metabolism*
  • Humans
  • Male
  • Middle Aged
  • Observational Studies as Topic
  • Randomized Controlled Trials as Topic
  • Time Factors


  • Hemoglobins