Skip to main content

Advertisement

Log in

Blood Transfusion is an Important Predictor of Hospital Mortality Among Patients with Aneurysmal Subarachnoid Hemorrhage

  • Published:
Neurocritical Care Aims and scope Submit manuscript

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

Among patients with aSAH, RBC transfusion was independently associated with an increased mortality after adjustment for the most common clinical indications for transfusion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Zacharia BE, Hickman ZL, Grobelny BT, et al. Epidemiology of aneurysmal subarachnoid hemorrhage. Neurosurg Clin N Am. 2010;21:221–33.

    Article  PubMed  Google Scholar 

  2. 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.

    Article  PubMed  Google Scholar 

  3. 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.

    Article  PubMed  Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. Wartenberg KE, Mayer SA. Medical complications after subarachnoid hemorrhage: new strategies for prevention and management. Curr Opin Crit Care. 2006;12:78–84.

    Article  PubMed  Google Scholar 

  6. 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).

    Article  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. 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).

    Article  CAS  Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  10. Kramer AH, Zygun DA. Anemia and red blood cell transfusion in neurocritical care. Crit Care. 2009;13:R89.

    Article  PubMed  Google Scholar 

  11. 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.

    Article  PubMed  CAS  Google Scholar 

  12. 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).

    Article  PubMed  Google Scholar 

  13. 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.

    Article  PubMed  Google Scholar 

  14. 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.

    Article  PubMed  Google Scholar 

  15. Vincent JL, Baron J-F, Reinhart K, et al. Anemia and blood transfusion in critically ill patients. JAMA. 2002;288:1499–507.

    Article  PubMed  Google Scholar 

  16. 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.

    Article  PubMed  Google Scholar 

  17. 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.

    PubMed  CAS  Google Scholar 

  18. 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.

    Article  PubMed  Google Scholar 

  19. 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.

    PubMed  CAS  Google Scholar 

  20. 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.

    CAS  Google Scholar 

  21. 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.

    PubMed  CAS  Google Scholar 

  22. 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.

    Article  PubMed  CAS  Google Scholar 

  23. Smith MJ, Stiefel MF, Magge S, et al. Packed red blood cell transfusion increases local cerebral oxygenation. Crit Care Med. 2005;33:1104–8.

    Article  PubMed  Google Scholar 

  24. 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.

    Article  PubMed  CAS  Google Scholar 

  25. 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.

    Article  PubMed  CAS  Google Scholar 

  26. 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.

    Article  PubMed  Google Scholar 

  27. 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.

    Article  PubMed  CAS  Google Scholar 

  28. 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.

    Google Scholar 

  29. 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.

    Article  PubMed  Google Scholar 

  30. 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.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was financially supported by the Mayo Clinic.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Emir Festic.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Festic, E., Rabinstein, A.A., Freeman, W.D. et al. Blood Transfusion is an Important Predictor of Hospital Mortality Among Patients with Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care 18, 209–215 (2013). https://doi.org/10.1007/s12028-012-9777-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12028-012-9777-y

Keywords

Navigation