Sex-specific hemoglobin thresholds and longitudinal trajectories in intracerebral hemorrhage outcomes: a multicenter cohort study
Abstract Background We aim to investigate the association between admission hemoglobin and outcomes after primary intracerebral hemorrhage (ICH), including 3-month outcome and long-term survival and recurrence. Methods Utilizing a multicenter stroke registry database, we retrospectively analyzed pat...
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2025-07-01
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| Online Access: | https://doi.org/10.1186/s12883-025-04254-w |
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| author | Yu-jia Jin Guo-shen Yu Li-li Tang Jia-wen Li Qing Lin Jian Wu Zai-jun Song Hong-na An Xiang-hua Ye Cheng-jia Liu Feng Gao Lu-sha Tong |
| author_facet | Yu-jia Jin Guo-shen Yu Li-li Tang Jia-wen Li Qing Lin Jian Wu Zai-jun Song Hong-na An Xiang-hua Ye Cheng-jia Liu Feng Gao Lu-sha Tong |
| author_sort | Yu-jia Jin |
| collection | DOAJ |
| description | Abstract Background We aim to investigate the association between admission hemoglobin and outcomes after primary intracerebral hemorrhage (ICH), including 3-month outcome and long-term survival and recurrence. Methods Utilizing a multicenter stroke registry database, we retrospectively analyzed patients with spontaneous ICH confirmed within 48 h of symptom onset who had admission hemoglobin measurements and baseline neuroimaging. Cox proportional hazards regression models were employed to evaluate associations between admission hemoglobin levels and risks of all-cause mortality and ICH recurrence during follow-up. Nonlinear relationships were assessed using threshold effect models with inflection point determination. Sensitivity analyses were restricted to patients who underwent repeated routine blood testing during hospitalization to examine whether increased hemoglobin levels during hospitalization correlated with improved clinical outcomes. Results The cohort comprised 2,407 patients (mean age 64 ± 14 years; 65.1% male) with spontaneous ICH, followed for a median duration of 2.0 years (IQR 0.8–3.2). Threshold analysis revealed a nonlinear L-shaped association between admission hemoglobin and mortality. Below 14.3 g/dL, hemoglobin elevation correlated with reduced mortality risk (adjusted HR 0.88 per 1-g/dL increase, 95% CI 0.81–0.95). Above this threshold, no significant association was observed (HR 1.13, 95% CI 0.98–1.31). Lower admission hemoglobin was independently associated with higher ICH recurrence risk (HR 0.88 per 1-g/dL decrease, 95% CI 0.775–0.998). In sensitivity analyses of 954 patients with serial hemoglobin measurements, improved 3-month functional outcomes and reduced long-term mortality were observed in patients with longitudinal elevation during hospitalization. Conclusions Admission hemoglobin demonstrates a L-shaped association with post-ICH mortality, with inflection point observed near 14.3 g/dL. Lower hemoglobin independently predicts higher hemorrhage recurrence risk. Longitudinal hemoglobin elevation during hospitalization correlates with improved functional outcomes and survival. Trial registration Clinical trials NCT06548737 (retrospectively registered) |
| format | Article |
| id | doaj-art-5eacb2e8bbe6443a818d2a81970e3b4b |
| institution | Kabale University |
| issn | 1471-2377 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Neurology |
| spelling | doaj-art-5eacb2e8bbe6443a818d2a81970e3b4b2025-08-20T03:45:49ZengBMCBMC Neurology1471-23772025-07-0125111010.1186/s12883-025-04254-wSex-specific hemoglobin thresholds and longitudinal trajectories in intracerebral hemorrhage outcomes: a multicenter cohort studyYu-jia Jin0Guo-shen Yu1Li-li Tang2Jia-wen Li3Qing Lin4Jian Wu5Zai-jun Song6Hong-na An7Xiang-hua Ye8Cheng-jia Liu9Feng Gao10Lu-sha Tong11Department of Neurology, School of Medicine, The Second Affiliated Hospital of Zhejiang UniversityDepartment of Neurology, The People’s Hospital of HaiyanDepartment of Neurology, School of Medicine, The Second Affiliated Hospital of Zhejiang UniversityDepartment of Neurology, School of Medicine, The Second Affiliated Hospital of Zhejiang UniversityDepartment of Neurology, The First People’s Hospital of TaizhouDepartment of Neurology, Tiantai People’s Hospital of Zhejiang ProvinceDepartment of Neurology, The First People’s Hospital of PinghuDepartment of Neurology, The 2nd People’s Hospital of QuzhouDepartment of Neurology, School of Medicine, The Second Affiliated Hospital of Zhejiang UniversityDepartment of Radiology, School of Medicine, The Second Affiliated Hospital of Zhejiang UniversityDepartment of Neurology, School of Medicine, The Second Affiliated Hospital of Zhejiang UniversityDepartment of Neurology, School of Medicine, The Second Affiliated Hospital of Zhejiang UniversityAbstract Background We aim to investigate the association between admission hemoglobin and outcomes after primary intracerebral hemorrhage (ICH), including 3-month outcome and long-term survival and recurrence. Methods Utilizing a multicenter stroke registry database, we retrospectively analyzed patients with spontaneous ICH confirmed within 48 h of symptom onset who had admission hemoglobin measurements and baseline neuroimaging. Cox proportional hazards regression models were employed to evaluate associations between admission hemoglobin levels and risks of all-cause mortality and ICH recurrence during follow-up. Nonlinear relationships were assessed using threshold effect models with inflection point determination. Sensitivity analyses were restricted to patients who underwent repeated routine blood testing during hospitalization to examine whether increased hemoglobin levels during hospitalization correlated with improved clinical outcomes. Results The cohort comprised 2,407 patients (mean age 64 ± 14 years; 65.1% male) with spontaneous ICH, followed for a median duration of 2.0 years (IQR 0.8–3.2). Threshold analysis revealed a nonlinear L-shaped association between admission hemoglobin and mortality. Below 14.3 g/dL, hemoglobin elevation correlated with reduced mortality risk (adjusted HR 0.88 per 1-g/dL increase, 95% CI 0.81–0.95). Above this threshold, no significant association was observed (HR 1.13, 95% CI 0.98–1.31). Lower admission hemoglobin was independently associated with higher ICH recurrence risk (HR 0.88 per 1-g/dL decrease, 95% CI 0.775–0.998). In sensitivity analyses of 954 patients with serial hemoglobin measurements, improved 3-month functional outcomes and reduced long-term mortality were observed in patients with longitudinal elevation during hospitalization. Conclusions Admission hemoglobin demonstrates a L-shaped association with post-ICH mortality, with inflection point observed near 14.3 g/dL. Lower hemoglobin independently predicts higher hemorrhage recurrence risk. Longitudinal hemoglobin elevation during hospitalization correlates with improved functional outcomes and survival. Trial registration Clinical trials NCT06548737 (retrospectively registered)https://doi.org/10.1186/s12883-025-04254-wStrokeIntracerebral hemorrhageCerebrovascular diseaseHemoglobinDeathOutcome |
| spellingShingle | Yu-jia Jin Guo-shen Yu Li-li Tang Jia-wen Li Qing Lin Jian Wu Zai-jun Song Hong-na An Xiang-hua Ye Cheng-jia Liu Feng Gao Lu-sha Tong Sex-specific hemoglobin thresholds and longitudinal trajectories in intracerebral hemorrhage outcomes: a multicenter cohort study BMC Neurology Stroke Intracerebral hemorrhage Cerebrovascular disease Hemoglobin Death Outcome |
| title | Sex-specific hemoglobin thresholds and longitudinal trajectories in intracerebral hemorrhage outcomes: a multicenter cohort study |
| title_full | Sex-specific hemoglobin thresholds and longitudinal trajectories in intracerebral hemorrhage outcomes: a multicenter cohort study |
| title_fullStr | Sex-specific hemoglobin thresholds and longitudinal trajectories in intracerebral hemorrhage outcomes: a multicenter cohort study |
| title_full_unstemmed | Sex-specific hemoglobin thresholds and longitudinal trajectories in intracerebral hemorrhage outcomes: a multicenter cohort study |
| title_short | Sex-specific hemoglobin thresholds and longitudinal trajectories in intracerebral hemorrhage outcomes: a multicenter cohort study |
| title_sort | sex specific hemoglobin thresholds and longitudinal trajectories in intracerebral hemorrhage outcomes a multicenter cohort study |
| topic | Stroke Intracerebral hemorrhage Cerebrovascular disease Hemoglobin Death Outcome |
| url | https://doi.org/10.1186/s12883-025-04254-w |
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