Evidence map›Paper›PMID 40110594›Full record

Observational studyStroke2025

Low Hemoglobin Causes Hematoma Expansion and Poor Intracerebral Hemorrhage Outcomes.

Azzurra Cottarelli, Rayan Mamoon, Robin Ji, Eric Mao, Amelia Boehme, Aditya Kumar, Sandy Song, Valentina Allegra, Sabrina V Sharma, Elisa Konofagou and 6 more

Abstract readObservational StudyMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Stroke, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
  2. Article
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  5. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

16 authors.

Azzurra CottarelliDepartment of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons (A.C.), Columbia University, New York, NY.ORCID 0000-0003-4525-2028
Rayan MamoonDepartment of Neurology, Vagelos College of Physicians and Surgeons (R.M., E.M., A.B., A.K., S.S., V.A., S.V.S., D.J.R.), Columbia University, New York, NY.ORCID 0000-0003-0630-8041
Robin JiDepartment of Biomedical Engineering (R.J., E.K.), Columbia University, New York, NY.ORCID 0000-0003-1361-141X
Eric MaoDepartment of Neurology, Vagelos College of Physicians and Surgeons (R.M., E.M., A.B., A.K., S.S., V.A., S.V.S., D.J.R.), Columbia University, New York, NY.ORCID 0000-0001-9967-4790
Amelia BoehmeDepartment of Neurology, Vagelos College of Physicians and Surgeons (R.M., E.M., A.B., A.K., S.S., V.A., S.V.S., D.J.R.), Columbia University, New York, NY.ORCID 0000-0001-7408-1075
Aditya KumarDepartment of Neurology, Vagelos College of Physicians and Surgeons (R.M., E.M., A.B., A.K., S.S., V.A., S.V.S., D.J.R.), Columbia University, New York, NY.ORCID 0009-0003-1544-8844
Sandy SongDepartment of Neurology, Vagelos College of Physicians and Surgeons (R.M., E.M., A.B., A.K., S.S., V.A., S.V.S., D.J.R.), Columbia University, New York, NY.ORCID 0009-0008-6962-9305
Valentina AllegraDepartment of Neurology, Vagelos College of Physicians and Surgeons (R.M., E.M., A.B., A.K., S.S., V.A., S.V.S., D.J.R.), Columbia University, New York, NY.ORCID 0009-0000-6612-2893
Sabrina V SharmaDepartment of Neurology, Vagelos College of Physicians and Surgeons (R.M., E.M., A.B., A.K., S.S., V.A., S.V.S., D.J.R.), Columbia University, New York, NY.
Elisa KonofagouDepartment of Biomedical Engineering (R.J., E.K.), Columbia University, New York, NY.ORCID 0000-0002-9636-7936
Vadim SpektorDepartment of Radiology, Vagelos College of Physicians and Surgeons (V.S.), Columbia University, New York, NY.ORCID 0000-0002-0967-1287
Jia GuoDepartment of Psychiatry (J.G.), Columbia University, New York, NY.ORCID 0000-0003-4803-0279
E Sander ConnollyDepartment of Neurological Surgery, Vagelos College of Physicians and Surgeons (E.S.C.), Columbia University, New York, NY.
Padmini SekarDepartment of Neurology, University of Cincinnati Academic Health Center, OH (P.S., D.W.).ORCID 0000-0002-3734-5075
Daniel WooDepartment of Neurology, University of Cincinnati Academic Health Center, OH (P.S., D.W.).ORCID 0000-0002-2466-7155
David J RohDepartment of Neurology, Vagelos College of Physicians and Surgeons (R.M., E.M., A.B., A.K., S.S., V.A., S.V.S., D.J.R.), Columbia University, New York, NY.ORCID 0000-0003-1927-7686

Funding

Ethnic/Racial Variation in Intracerebral Hemorrhage (ERICH)U01NS069763 · NINDS · UNIVERSITY OF CINCINNATI · PI ANDERSON, CHRISTOPHER DAVID, DEMEL, STACIE · 2010 to 2024
$34.2M
The Impact of Oxidative Stress on Erythocyte BiologyR01HL148151 · NHLBI · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI D'ALESSANDRO, ANGELO, KARAFIN, MATTHEW S · 2019 to 2022
$8.9M
Erythrocyte contribution to coagulopathy and cerebral oxygenation after intracerebral hemorrhageK23HL151901 · NHLBI · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI ROH, DAVID · 2021 to 2025
$950k
NHLBI NIH HHS K23 HL151901NHLBI NIH HHS R01 HL148151NINDS NIH HHS U01 NS069763
6 · The paper itself

Abstract

backgroundAlthough lower hemoglobin levels associate with worse intracerebral hemorrhage (ICH) outcomes, causal drivers for this relationship remain unclear. We investigated the hypothesis that lower hemoglobin relates to increased hematoma expansion risk and poor outcomes using human observational data and assessed causal relationships using a translational murine model of anemia and ICH.

methodsA multicenter, prospective observational cohort study of 2997 patients with ICH enrolled between 2010 and 2016 was assessed. Patients with baseline hemoglobin measurements and serial computed tomography neuroimaging were included for analyses. Patients with systemic evidence of coagulopathy were excluded. Separate regression models assessed relationships of baseline hemoglobin with hematoma expansion (≥33% and/or ≥6 mL growth) and poor long-term neurological outcomes (modified Rankin Scale score of 4-6) after adjusting for relevant covariates. Using a murine collagenase ICH model with serial neuroimaging in anemic versus nonanemic C57/BL6 mice, intergroup differences in ICH lesion volume, lesion volume changes, and early mortality were assessed.

resultsAmong 1190 ICH patients analyzed, the mean age was 61 years old, and 62% of the cohort were males. Lower baseline hemoglobin levels are associated with increased odds of hematoma expansion (adjusted odds ratio per -1 g/dL hemoglobin decrement, 1.10 [95% CI, 1.02-1.19]) and poor 3-month clinical outcomes (adjusted odds ratio per -1 g/dL hemoglobin decrement, 1.11 [95% CI, 1.03-1.21]). Similar relationships were seen with poor 6- and 12-month outcomes. In our animal model, anemic mice had significantly greater ICH lesion expansion, 24-hour lesion volumes, and greater mortality, as compared with nonanemic mice.

conclusionsThese results, in a human cohort and a mouse model, provide novel evidence suggesting that anemia has causal roles in hematoma expansion and poor ICH outcomes. Additional studies are required to clarify whether correcting anemia can improve these outcomes.

Indexed as

AnemiaCerebral HemorrhageHematomaHemoglobinsAgedAnimalsCohort StudiesDisease Models, AnimalFemaleHumansMaleMiceMice, Inbred C57BLMiddle AgedProspective StudiesHemoglobinsanemiacerebral hemorrhagehematologic diseaseshemoglobinsneuroimaging

Identifiers

PMID40110594
PMCPMC12037308

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.