Blood Transfusion is an Important Predictor of Hospital Mortality Among Patients with Aneurysmal Subarachnoid Hemorrhage
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Red blood cell (RBC) transfusion after aneurysmal subarachnoid hemorrhage (aSAH) has been associated with increased mortality but prior studies have not adequately adjusted for transfusion-indication bias.
This is a retrospective study of consecutive aSAH patients admitted to the intensive care units of two academic medical centers over a 7-year period. Data collection included demographics, World Federation of Neurosurgical Surgeons score (WFNS), modified Fisher score (mFisher), admission and nadir hemoglobin (Hb) level, vasospasm, cerebral infarction, acute lung injury, and hospital mortality. The association between RBC transfusion and mortality was evaluated using a multivariate logistic regression analysis using the propensity for RBC transfusion as a covariate.
We identified 318 patients. The median age was 54 years (46, 65), and 204 (64 %) were females. Hospital mortality was 13 % (42/318). Seventy-two (23 %) patients were transfused. Predictors of transfusion were admit and nadir Hb levels (p < 0.001), age (p = 0.02), gender (0.008), WFNS score (p < 0.001), mFisher score (p = 0.009), surgical versus endovascular treatment (p < 0.001) and moderate to severe vasospasm (p = 0.025) were predictors of transfusion. After adjustment for probability of receiving RBC transfusion, APACHE IV and nadir Hb, transfusion remained independently associated with hospital mortality (OR 3.16, 95 % CI = 1.02–9.69, p = 0.047).
Among patients with aSAH, RBC transfusion was independently associated with an increased mortality after adjustment for the most common clinical indications for transfusion.
- Zacharia BE, Hickman ZL, Grobelny BT, et al. Epidemiology of aneurysmal subarachnoid hemorrhage. Neurosurg Clin N Am. 2010;21:221–33. CrossRef
- Berman MF, Solomon RA, Mayer SA, Johnston SC, Yung PP. Impact of hospital-related factors on outcome after treatment of cerebral aneurysms. Stroke. 2003;34:2200–7. CrossRef
- Cross DT 3rd, Tirschwell DL, Clark MA, et al. Mortality rates after subarachnoid hemorrhage: variations according to hospital case volume in 18 states. J Neurosurg. 2003;99:810–7. CrossRef
- Josephson SA, Douglas VC, Lawton MT, English JD, Smith WS, Ko NU. Improvement in intensive care unit outcomes in patients with subarachnoid hemorrhage after initiation of neurointensivist co-management. J Neurosurg. 2010;112:626–30. CrossRef
- Wartenberg KE, Mayer SA. Medical complications after subarachnoid hemorrhage: new strategies for prevention and management. Curr Opin Crit Care. 2006;12:78–84. CrossRef
- Wartenberg KE, Schmidt JM, Claassen J, et al. Impact of medical complications on outcome after subarachnoid hemorrhage. Critical Care Med. 2006;34:617–23. (quiz 24). CrossRef
- Corwin HL, Gettinger A, Pearl RG, et al. The CRIT study: anemia and blood transfusion in the critically ill—current clinical practice in the United States. Crit Care Med. 2004;32:39–52. CrossRef
- Hebert PC, Wells G, Blajchman MA, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. New England J Med. 1999;340:409–17. (erratum appears in N Engl J Med 1999; 340(13):1056). CrossRef
- Kramer AH, Gurka MJ, Nathan B, Dumont AS, Kassell NF, Bleck TP. Complications associated with anemia and blood transfusion in patients with aneurysmal subarachnoid hemorrhage. Crit Care Med. 2008;36:2070–5. CrossRef
- Kramer AH, Zygun DA. Anemia and red blood cell transfusion in neurocritical care. Crit Care. 2009;13:R89. CrossRef
- Kramer AH, Zygun DA, Bleck TP, Dumont AS, Kassell NF, Nathan B. Relationship between hemoglobin concentrations and outcomes across subgroups of patients with aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2009;10:157–65. CrossRef
- Naidech AM, Drescher J, Ault ML, Shaibani A, Batjer HH, Alberts MJ. Higher hemoglobin is associated with less cerebral infarction, poor outcome, and death after subarachnoid hemorrhage. Neurosurgery. 2006;59:775–9. (discussion 779–80). CrossRef
- Smith MJ, Le Roux PD, Elliott JP, Winn HR. Blood transfusion and increased risk for vasospasm and poor outcome after subarachnoid hemorrhage. J Neurosurg. 2004;101:1–7. CrossRef
- Tseng MY, Hutchinson PJ, Kirkpatrick PJ. Effects of fluid therapy following aneurysmal subarachnoid haemorrhage: a prospective clinical study. Br J Neurosurg. 2008;22:257–68. CrossRef
- Vincent JL, Baron J-F, Reinhart K, et al. Anemia and blood transfusion in critically ill patients. JAMA. 2002;288:1499–507. CrossRef
- Kramer AH, Diringer MN, Suarez JI, Naidech AM, Macdonald RL, Le Roux PD. Red blood cell transfusion in patients with subarachnoid hemorrhage: a multidisciplinary North American survey. Crit Care. 2011;15:R30. CrossRef
- Bernard GR, Artigas A, Brigham KL, et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994;149:818–24.
- D’agostino RB. Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med. 1998;17:2265–81. CrossRef
- Bruder N, Cohen B, Pellissier D, Francois G. The effect of hemodilution on cerebral blood flow velocity in anesthetized patients. Anesth Analg. 1998;86:320–4.
- Rebel A, Ulatowski JA, Kwansa H, Bucci E, Koehler RC. Cerebrovascular response to decreased hematocrit: effect of cell-free hemoglobin, plasma viscosity, and CO2. Am J Physiol. 2003;285:H1600–8.
- Hare GMT, Mazer CD, Mak W, et al. Hemodilutional anemia is associated with increased cerebral neuronal nitric oxide synthase gene expression. J Appl Physiol. 2003;94:2058–67.
- Kurtz P, Schmidt JM, Claassen J, et al. Anemia is associated with metabolic distress and brain tissue hypoxia after subarachnoid hemorrhage. Neurocrit Care. 2010;13:10–6. CrossRef
- Smith MJ, Stiefel MF, Magge S, et al. Packed red blood cell transfusion increases local cerebral oxygenation. Crit Care Med. 2005;33:1104–8. CrossRef
- Dellinger RP, Zimmerman JL, Taylor RW, et al. Effects of inhaled nitric oxide in patients with acute respiratory distress syndrome: results of a randomized phase II trial. Inhaled nitric oxide in ARDS Study Group. Crit Care Med. 1998;26:15–23. CrossRef
- Mercat A, Richard J-CM, Vielle B, et al. Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA. 2008;299:646–55. CrossRef
- Tinmouth A, Fergusson D, Yee IC, Hebert PC, ABLE Investigators, Canadian Critical Care Trials G. Clinical consequences of red cell storage in the critically ill. Transfusion. 2006;46:2014–27. CrossRef
- Bennett-Guerrero E, Veldman TH, Doctor A, et al. Evolution of adverse changes in stored RBCs. Proc Nat Acad Sci USA. 2007;104:17063–8. CrossRef
- Festic E, Freeman WD, Trapani RD, Ng HK, Zubair A, Gajic O. Transfusion, red cell storage age and adverse outcomes in critically ill patients with subarachnoid hemorrhage. Am J Respir Crit Care Med. 2009;179:A3118.
- Hebert PC, Fergusson D, Blajchman MA, et al. Clinical outcomes following institution of the Canadian universal leukoreduction program for red blood cell transfusions. JAMA. 2003;289:1941–9. CrossRef
- Gong MN, Thompson BT, Williams P, Pothier L, Boyce PD, Christiani DC. Clinical predictors of and mortality in acute respiratory distress syndrome: potential role of red cell transfusion. Crit Care Med. 2005;33:1191–8. CrossRef
- Blood Transfusion is an Important Predictor of Hospital Mortality Among Patients with Aneurysmal Subarachnoid Hemorrhage
Volume 18, Issue 2 , pp 209-215
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- 1. Department of Critical Care Medicine, Mayo Clinic, 4500, San Pablo Rd, Jacksonville, FL, 32224, USA
- 2. Department of Neurology, Mayo Clinic, Rochester, MN, USA
- 5. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
- 3. Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA
- 4. Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA