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Background <p>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.</p> Methods <p>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.</p> Results <p>Among 158 participants (median age, 66&#xa0;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; <i>P</i> = 0.01) and mRS ≥ 4 (OR 4.64; 95% CI 1.60–13.41; <i>P</i> &lt; 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; <i>P</i> = 0.03) and mRS 0–3 (OR 0.26; 95% CI 0.09–0.71; <i>P </i>= 0.01), with no association for mRS 0–1 (OR 0.59; 95% CI 0.15–2.03; <i>P</i> = 0.41) or 90-day mortality (OR 1.29; 95% CI 0.34–4.76; <i>P</i> = 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).</p> Conclusions <p>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.</p>

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Admission anemia and 90-day outcomes after supratentorial intracerebral hemorrhage: a township-level cohort study

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  • 发表日期：

    2025年12月24日

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  • Yong He,
  • Benen Huang,
  • Jianhuang Chen,
  • Tieshi Zhu

摘要

Background

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.

Methods

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.

Results

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).

Conclusions

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.