Higher hemoglobin is associated with less cerebral infarction, poor outcome, and death after subarachnoid hemorrhage

Andrew M. Naidech, Jessica Drescher, Michael L. Ault, Ali Shaibani, H. Hunt Batjer, Mark J. Alberts

Research output: Contribution to journalArticle

90 Citations (Scopus)

Abstract

OBJECTIVE: Higher-goal hemoglobin (hgb) and more packed red blood cell transfusions lead to worse outcomes in general critical care patients. There are few data on hgb, transfusion, and outcomes after aneurysmal subarachnoid hemorrhage (SAH). METHODS: We reviewed the daily hgb levels of 103 patients with aneurysmal SAH. Cerebral infarction was diagnosed by computed tomographic scan. We corrected for Hunt and Hess grade, age, and angiographic vasospasm in multivariate models. RESULTS: Of 103 patients, the mean age was 55.3 ± 14.5 years, 63% were women, and 29% were Hunt and Hess Grades 4 and 5; hgb values steadily declined from 12.6 ± 1.7 g/dl the day of SAH to 10.4 ± 1.2 g/dl by Day 14. Patients who died had lower hgb than survivors on Days 0, 1, 2, 4, 6, 10, 11, and 12 (P ≤ 0.05). Higher mean hgb was associated with reduced odds of poor outcome (odds ratio, 0.57 per g/dl; 95% confidence interval [CI], 0.38-0.87; P = 0.008) after correcting for Hunt and Hess grade, age, and vasospasm; results for hgb on Days 0 and 1 were similar. Higher Day 0 (odds ratio, 0.7 per g/dl; 95% CI, 0.5-0.99; P = 0.05) and mean hgb (odds ratio, 0.57 per g/dl; 95% CI, 0.38-0.87; P = 0.009) predicted a lower risk of cerebral infarction independent of vasospasm. There were no associations between hgb and other prognostic variables. CONCLUSION: We found that SAH patients with higher initial and mean hgb values had improved outcomes. Higher hgb in SAH patients may be beneficial. The efficacy and safety of blood transfusions to increase hgb in patients with SAH may warrant further study.

Original languageEnglish (US)
Pages (from-to)775-779
Number of pages5
JournalNeurosurgery
Volume59
Issue number4
DOIs
StatePublished - Oct 2006

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Cerebral Infarction
Subarachnoid Hemorrhage
Hemoglobins
Odds Ratio
Confidence Intervals
Erythrocyte Transfusion
Critical Care
Blood Transfusion
Survivors

Keywords

  • Anemia
  • Cerebral infarction
  • Subarachnoid hemorrhage
  • Transfusion

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Higher hemoglobin is associated with less cerebral infarction, poor outcome, and death after subarachnoid hemorrhage. / Naidech, Andrew M.; Drescher, Jessica; Ault, Michael L.; Shaibani, Ali; Batjer, H. Hunt; Alberts, Mark J.

In: Neurosurgery, Vol. 59, No. 4, 10.2006, p. 775-779.

Research output: Contribution to journalArticle

Naidech, Andrew M. ; Drescher, Jessica ; Ault, Michael L. ; Shaibani, Ali ; Batjer, H. Hunt ; Alberts, Mark J. / Higher hemoglobin is associated with less cerebral infarction, poor outcome, and death after subarachnoid hemorrhage. In: Neurosurgery. 2006 ; Vol. 59, No. 4. pp. 775-779.
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abstract = "OBJECTIVE: Higher-goal hemoglobin (hgb) and more packed red blood cell transfusions lead to worse outcomes in general critical care patients. There are few data on hgb, transfusion, and outcomes after aneurysmal subarachnoid hemorrhage (SAH). METHODS: We reviewed the daily hgb levels of 103 patients with aneurysmal SAH. Cerebral infarction was diagnosed by computed tomographic scan. We corrected for Hunt and Hess grade, age, and angiographic vasospasm in multivariate models. RESULTS: Of 103 patients, the mean age was 55.3 ± 14.5 years, 63{\%} were women, and 29{\%} were Hunt and Hess Grades 4 and 5; hgb values steadily declined from 12.6 ± 1.7 g/dl the day of SAH to 10.4 ± 1.2 g/dl by Day 14. Patients who died had lower hgb than survivors on Days 0, 1, 2, 4, 6, 10, 11, and 12 (P ≤ 0.05). Higher mean hgb was associated with reduced odds of poor outcome (odds ratio, 0.57 per g/dl; 95{\%} confidence interval [CI], 0.38-0.87; P = 0.008) after correcting for Hunt and Hess grade, age, and vasospasm; results for hgb on Days 0 and 1 were similar. Higher Day 0 (odds ratio, 0.7 per g/dl; 95{\%} CI, 0.5-0.99; P = 0.05) and mean hgb (odds ratio, 0.57 per g/dl; 95{\%} CI, 0.38-0.87; P = 0.009) predicted a lower risk of cerebral infarction independent of vasospasm. There were no associations between hgb and other prognostic variables. CONCLUSION: We found that SAH patients with higher initial and mean hgb values had improved outcomes. Higher hgb in SAH patients may be beneficial. The efficacy and safety of blood transfusions to increase hgb in patients with SAH may warrant further study.",
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T1 - Higher hemoglobin is associated with less cerebral infarction, poor outcome, and death after subarachnoid hemorrhage

AU - Naidech, Andrew M.

AU - Drescher, Jessica

AU - Ault, Michael L.

AU - Shaibani, Ali

AU - Batjer, H. Hunt

AU - Alberts, Mark J.

PY - 2006/10

Y1 - 2006/10

N2 - OBJECTIVE: Higher-goal hemoglobin (hgb) and more packed red blood cell transfusions lead to worse outcomes in general critical care patients. There are few data on hgb, transfusion, and outcomes after aneurysmal subarachnoid hemorrhage (SAH). METHODS: We reviewed the daily hgb levels of 103 patients with aneurysmal SAH. Cerebral infarction was diagnosed by computed tomographic scan. We corrected for Hunt and Hess grade, age, and angiographic vasospasm in multivariate models. RESULTS: Of 103 patients, the mean age was 55.3 ± 14.5 years, 63% were women, and 29% were Hunt and Hess Grades 4 and 5; hgb values steadily declined from 12.6 ± 1.7 g/dl the day of SAH to 10.4 ± 1.2 g/dl by Day 14. Patients who died had lower hgb than survivors on Days 0, 1, 2, 4, 6, 10, 11, and 12 (P ≤ 0.05). Higher mean hgb was associated with reduced odds of poor outcome (odds ratio, 0.57 per g/dl; 95% confidence interval [CI], 0.38-0.87; P = 0.008) after correcting for Hunt and Hess grade, age, and vasospasm; results for hgb on Days 0 and 1 were similar. Higher Day 0 (odds ratio, 0.7 per g/dl; 95% CI, 0.5-0.99; P = 0.05) and mean hgb (odds ratio, 0.57 per g/dl; 95% CI, 0.38-0.87; P = 0.009) predicted a lower risk of cerebral infarction independent of vasospasm. There were no associations between hgb and other prognostic variables. CONCLUSION: We found that SAH patients with higher initial and mean hgb values had improved outcomes. Higher hgb in SAH patients may be beneficial. The efficacy and safety of blood transfusions to increase hgb in patients with SAH may warrant further study.

AB - OBJECTIVE: Higher-goal hemoglobin (hgb) and more packed red blood cell transfusions lead to worse outcomes in general critical care patients. There are few data on hgb, transfusion, and outcomes after aneurysmal subarachnoid hemorrhage (SAH). METHODS: We reviewed the daily hgb levels of 103 patients with aneurysmal SAH. Cerebral infarction was diagnosed by computed tomographic scan. We corrected for Hunt and Hess grade, age, and angiographic vasospasm in multivariate models. RESULTS: Of 103 patients, the mean age was 55.3 ± 14.5 years, 63% were women, and 29% were Hunt and Hess Grades 4 and 5; hgb values steadily declined from 12.6 ± 1.7 g/dl the day of SAH to 10.4 ± 1.2 g/dl by Day 14. Patients who died had lower hgb than survivors on Days 0, 1, 2, 4, 6, 10, 11, and 12 (P ≤ 0.05). Higher mean hgb was associated with reduced odds of poor outcome (odds ratio, 0.57 per g/dl; 95% confidence interval [CI], 0.38-0.87; P = 0.008) after correcting for Hunt and Hess grade, age, and vasospasm; results for hgb on Days 0 and 1 were similar. Higher Day 0 (odds ratio, 0.7 per g/dl; 95% CI, 0.5-0.99; P = 0.05) and mean hgb (odds ratio, 0.57 per g/dl; 95% CI, 0.38-0.87; P = 0.009) predicted a lower risk of cerebral infarction independent of vasospasm. There were no associations between hgb and other prognostic variables. CONCLUSION: We found that SAH patients with higher initial and mean hgb values had improved outcomes. Higher hgb in SAH patients may be beneficial. The efficacy and safety of blood transfusions to increase hgb in patients with SAH may warrant further study.

KW - Anemia

KW - Cerebral infarction

KW - Subarachnoid hemorrhage

KW - Transfusion

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