Anemia After Aneurysmal Subarachnoid Hemorrhage Is Associated With Poor Outcome and Death

被引:52
作者
Ayling, Oliver G. S. [1 ]
Ibrahim, George M. [2 ]
Alotaibi, Naif M. [3 ,4 ,5 ]
Gooderham, Peter A. [1 ]
Macdonald, R. Loch [3 ,5 ]
机构
[1] Univ British Columbia, Dept Surg, Div Neurosurg, Vancouver, BC, Canada
[2] Univ Toronto, Hosp Sick Children, Div Neurosurg, Toronto, ON, Canada
[3] Univ Toronto, Li Ka Shing Knowledge Inst, Dept Surg, Toronto, ON, Canada
[4] Univ Toronto, Inst Med Sci, Toronto, ON, Canada
[5] St Michaels Hosp, Keenan Res Ctr Biomed Res, Labatt Family Ctr Excellence Brain Injury & Traum, Div Neurosurg, 30 Bond St, Toronto, ON M5B 1W8, Canada
关键词
anemia; brain ischemia; critical care; humans; subarachnoid hemorrhage; aneurysm; BLOOD-CELL TRANSFUSION; HIGHER HEMOGLOBIN; INTRAVENTRICULAR HEMORRHAGE; CEREBRAL OXYGENATION; RANDOMIZED-TRIAL; CRITICAL-CARE; INFARCTION; MORTALITY; COMPLICATIONS; REQUIREMENTS;
D O I
10.1161/STROKEAHA.117.020260
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Purpose Anemia after aneurysmal subarachnoid hemorrhage is common and potentially modifiable. Here, we first evaluate the effect of anemia on neurological outcome and death and second, study the effects of packed red blood cell transfusion on outcome. Methods A secondary analysis on 413 subjects in the CONSCIOUS-1 study (Clazosentan to Overcome Neurological Ischemia and Infarction Occurring After Subarachnoid Hemorrhage). Multivariable logistic regression identified independent risk factors for anemia and determined the effect of anemia on neurological outcome and death, while adjusting for selected covariates. Optimal predictive thresholds for hemoglobin levels were determined using receiver operating characteristic curve analysis. Finally, patients were pseudorandomized to transfusion using propensity score matching to study the effect of transfusions on outcome. Results Anemia, defined as hemoglobin <10 g/dL, was present in 5% of patients at presentation, in 29% of patients after aneurysm securing (days 1-3), and in 32% of patients during the peak delayed cerebral ischemia risk period (days 5-9). Anemia after aneurysm securing (odds ratio, 1.96; 95% confidence interval, 1.07-3.59; P=0.03) and during the delayed cerebral ischemia window (odds ratio, 2.63; 95% confidence interval, 1.46-4.76; P=0.0014) was independently associated with poor neurological outcome. Anemia postaneurysm securing (odds ratio, 3.50; 95% confidence interval, 1.15-10.62; P=0.027) but not during the delayed cerebral ischemia window was associated with death. Using propensity score-matched cohorts, we found that transfusion of anemic patients did not improve long-term outcome (P=0.8) or mortality rates (P=0.9). Transfusion of patients with a hemoglobin concentration >10 g/dL was associated with improved neurological outcomes (odds ratio, 0.09; 95% confidence interval, 0.002-0.72; P=0.015), with no differences in mortality. Conclusions Anemia after aneurysmal subarachnoid hemorrhage is associated with poor long-term neurological outcome and death. Transfusion of packed red blood cells is beneficial for patients who are not considerably anemic beforehand, suggesting further work needs to define the threshold but also the time period of anemia that is sufficient and necessary to contribute to poor outcomes. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT00111085.
引用
收藏
页码:1859 / 1865
页数:7
相关论文
共 36 条
[1]   Dissociation of Early and Delayed Cerebral Infarction After Aneurysmal Subarachnoid Hemorrhage [J].
Ayling, Oliver G. S. ;
Ibrahim, George M. ;
Alotaibi, Naif M. ;
Gooderham, Peter A. ;
Macdonald, R. Loch .
STROKE, 2016, 47 (12) :2945-2951
[2]   Operative complications and differences in outcome after clipping and coiling of ruptured intracranial aneurysms [J].
Ayling, Oliver G. S. ;
Ibrahim, George M. ;
Drake, Brian ;
Torner, James C. ;
Macdonald, R. Loch .
JOURNAL OF NEUROSURGERY, 2015, 123 (03) :621-628
[3]   Influence of red blood cell transfusion on mortality and long-term functional outcome in 292 patients with spontaneous subarachnoid hemorrhage [J].
Broessner, Gregor ;
Lackner, Peter ;
Hoefer, Clemens ;
Beer, Ronny ;
Helbok, Raimund ;
Grabmer, Christoph ;
Ulmer, Hanno ;
Pfausler, Bettina ;
Brenneis, Christian ;
Schmutzhard, Erich .
CRITICAL CARE MEDICINE, 2009, 37 (06) :1886-1892
[4]   Aneurysmal SubArachnoid Hemorrhage - Red Blood Cell Transfusion And Outcome (SAHaRA): a pilot randomised controlled trial protocol [J].
English, Shane W. ;
Fergusson, D. ;
Chasse, M. ;
Turgeon, A. F. ;
Lauzier, F. ;
Griesdale, D. ;
Algird, A. ;
Kramer, A. ;
Tinmouth, A. ;
Lum, C. ;
Sinclair, J. ;
Marshall, S. ;
Dowlatshahi, D. ;
Boutin, A. ;
Pagliarello, G. ;
McIntyre, L. A. .
BMJ OPEN, 2016, 6 (12)
[5]   Blood Transfusion is an Important Predictor of Hospital Mortality Among Patients with Aneurysmal Subarachnoid Hemorrhage [J].
Festic, Emir ;
Rabinstein, Alejandro A. ;
Freeman, William D. ;
Mauricio, Elizabeth A. ;
Robinson, Maisha T. ;
Mandrekar, Jay ;
Zubair, Abba C. ;
Lee, Augustine S. ;
Gajic, Ognjen .
NEUROCRITICAL CARE, 2013, 18 (02) :209-215
[6]   COMPUTED TOMOGRAPHIC DIAGNOSIS OF INTRAVENTRICULAR HEMORRHAGE - ETIOLOGY AND PROGNOSIS [J].
GRAEB, DA ;
ROBERTSON, WD ;
LAPOINTE, JS ;
NUGENT, RA ;
HARRISON, PB .
RADIOLOGY, 1982, 143 (01) :91-96
[7]   Transfusion Requirements After Cardiac Surgery The TRACS Randomized Controlled Trial [J].
Hajjar, Ludhmila A. ;
Vincent, Jean-Louis ;
Galas, Filomena R. B. G. ;
Nakamura, Rosana E. ;
Silva, Carolina M. P. ;
Santos, Marilia H. ;
Fukushima, Julia ;
Kalil Filho, Roberto ;
Sierra, Denise B. ;
Lopes, Neuza H. ;
Mauad, Thais ;
Roquim, Aretusa C. ;
Sundin, Marcia R. ;
Leao, Wanderson C. ;
Almeida, Juliano P. ;
Pomerantzeff, Pablo M. ;
Dallan, Luis O. ;
Jatene, Fabio B. ;
Stolf, Noedir A. G. ;
Auler, Jose O. C., Jr. .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2010, 304 (14) :1559-1567
[8]   A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care [J].
Hébert, PC ;
Wells, G ;
Blajchman, MA ;
Marshall, J ;
Martin, C ;
Pagliarello, G ;
Tweeddale, M ;
Schweitzer, I ;
Yetisir, E .
NEW ENGLAND JOURNAL OF MEDICINE, 1999, 340 (06) :409-417
[9]   GRADING THE AMOUNT OF BLOOD ON COMPUTED TOMOGRAMS AFTER SUBARACHNOID HEMORRHAGE [J].
HIJDRA, A ;
BROUWERS, PJAM ;
VERMEULEN, M ;
VANGIJN, J .
STROKE, 1990, 21 (08) :1156-1161
[10]   Restrictive versus liberal transfusion strategy for red blood cell transfusion: systematic review of randomised trials with meta-analysis and trial sequential analysis [J].
Holst, Lars B. ;
Petersen, Marie W. ;
Haase, Nicolai ;
Perner, Anders ;
Wetterslev, Jorn .
BMJ-BRITISH MEDICAL JOURNAL, 2015, 350