Post Discharge Hemoglobin Level is Associated with Poor Neurological Outcomes in Patients with Acute Intracerebral Hemorrhage

Introduction: Hospitalization anemia is common in intracerebral hemorrhage (ICH) and associates with poor long-term outcomes. In other critical illnesses, hospitalization anemia is similarly common, yet can persist months after discharge and impacts clinical outcomes. In ICH, prevalence of post-hospitalization anemia is poorly characterized and its relationship with outcomes is unknown. We investigated relationships of 3-month post discharge hemoglobin levels with long-term ICH outcomes. Methods: Spontaneous ICH patients enrolled into a single-center, prospective observational study between 2009 and 2019 with available hospitalization and 3-month post-discharge complete blood count (CBC) assessments were assessed. Poor 6 and 12-month neurological outcomes (Modified Rankin Scale 4–6) were assessed. Multivariable logistic regression models assessed relationships between post discharge hemoglobin and poor neurological outcomes, adjusting for ICH severity and baseline demographics. Results: Of the initial cohort of 810 ICH patients, 67% of patients had anemia present on hospital discharge and 221 of these patients had follow-up CBC testing at 3-months post discharge. Amongst this analyzed cohort of 221 ICH patients with post discharge CBC testing, 13% met criteria for anemia. In our regression analyses, we identified that lower post discharge hemoglobin associated with increased odds of poor 6-month outcomes (adjusted OR 0.65, 95% CI: 0.50-0.84, p=0.001) and 12-month outcomes (adjusted OR 0.68, 95% CI: 0.52-0.88, p=0.004). Repeated measure analyses of serial hospitalization CBC and post discharge CBC data revealed significant differences in hemoglobin recoveries over time amongst patients with and without poor long-term outcomes. Conclusions: Post-discharge anemia remains prevalent after ICH and relates to poor long-term outcomes. Further work is needed to clarify the generalizability of these findings and to define factors contributing to anemia recovery after ICH and critical illness. This may elucidate hospitalization or post-discharge treatment targets and management strategies to improve ICH outcomes.