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Elevated blood hemoglobin on admission as an independent predictor of unfavorable outcomes in patients with aneurysmal subarachnoid hemorrhage

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Abstract

Hemoglobin (HGB), a potent spasmogen, may cause irreversible damage to the brain after aneurysm rupture. However, there is no clinical evidence to reveal the relationship between blood HGB concentrations on admission and the prognosis of patients with aneurysmal subarachnoid hemorrhage (aSAH). We retrospectively reviewed all aSAH patients admitted to our institution between January 2015 and December 2020. Functional outcome was assessed at 90 days after discharge using the modified Rankin scale (mRS). Independent risk factors associated with 90-day unfavorable outcomes were derived from a forward stepwise multivariate analysis. Receiver operating characteristic curve analysis was conducted to identify the best cutoff value of HGB to discriminate 90-day unfavorable outcomes. Then, patients were divided into two groups according to the cutoff value of HGB, and to account for imbalances in baseline characteristics, propensity score matching (PSM) was carried out to assess the impact of HGB on in-hospital complications. A total of 800 aSAH patients without anemia on admission were retrospectively enrolled in this study. Elevated blood HGB (OR = 1.02, 95% CI = 1.00–1.03, p = 0.018) on admission was identified as an independent risk factor associated with 90-day unfavorable outcomes, and the cutoff value was 149.5 g/L. After PSM, patients with an HGB > 149.5 g/L had a higher incidence of in-hospital delayed cerebral ischemia (DCI) (33.9% vs. 22.0%, p = 0.013) and deep vein thrombosis (DVT) (11.9% vs. 4.0%, p = 0.006). Patients with a blood HGB > 149.5 g/L on admission might develop more DCI and DVT during hospitalization, leading to 90-day unfavorable outcomes in aSAH patients. ClinicalTrials.gov Identifier: NCT04785976. 2021/03/05, retrospectively registered.

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The data supporting the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

We thank all the staff and participants for their contribution to this study.

Funding

This study was supported by the National Key Research and Development Program of China (Grant Nos. 2021YFC2501101 and 2020YFC2004701) and the National Natural Science Foundation of China (Grant Nos. 82071296, 81671129, and 81471210).

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Authors and Affiliations

  1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China

    Runting Li, Fa Lin, Yu Chen, Junlin Lu, Heze Han, Li Ma, Yahui Zhao, Debin Yan, Ruinan Li, Jun Yang, Shihao He, Zhipeng Li, Haibin Zhang, Kexin Yuan, Ke Wang, Qiang Hao, Xun Ye, Hao Wang, Shuo Wang, Xiaolin Chen & Yuanli Zhao

  2. Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Hongliang Li, Linlin Zhang, Guangzhi Shi & Jianxin Zhou

  3. Department of Neurosurgery, Peking University International Hospital, Beijing, China

    Yang Zhao, Yukun Zhang & Yuanli Zhao

  4. Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Youxiang Li

  5. China National Clinical Research Center for Neurological Diseases, Beijing, China

    Shuo Wang & Yuanli Zhao

  6. Stroke Center, Beijing Institute for Brain Disorders, Beijing, China

    Shuo Wang, Xiaolin Chen & Yuanli Zhao

  7. Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China

    Shuo Wang, Xiaolin Chen & Yuanli Zhao

Authors
  1. Runting Li
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  2. Fa Lin
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  3. Yu Chen
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  4. Junlin Lu
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  6. Li Ma
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  7. Yahui Zhao
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  8. Debin Yan
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  10. Jun Yang
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  11. Shihao He
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  12. Zhipeng Li
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  15. Ke Wang
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  16. Qiang Hao
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  18. Hao Wang
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  19. Hongliang Li
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  20. Linlin Zhang
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  21. Guangzhi Shi
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  23. Yang Zhao
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  27. Xiaolin Chen
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  28. Yuanli Zhao
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Contributions

Conception and design: Xiaolin Chen, Yuanli Zhao. Acquisition of data: Runting Li, Fa Lin, Yu Chen, Junlin Lu, Heze Han, Li Ma, Yahui Zhao, Debin Yan, Ruinan Li, Jun Yang, Shihao He, Zhipeng Li, Haibin Zhang, Kexin Yuan, Ke Wang, Hongliang Li, Linlin Zhang, Yang Zhao, Yukun Zhang. Analysis and interpretation of data: all authors. Drafting the article: Runting Li. Reviewed the submitted version of manuscript: Xiaolin Chen, Yuanli Zhao. Statistical analysis: Runting Li, Fa Lin, Yu Chen, Junlin Lu, Qiang Hao. Administrative/technical/material support: Youxiang Li, Shuo Wang, Guangzhi Shi, Jianxin Zhou. Study supervision: Xiaolin Chen, Yuanli Zhao.

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Correspondence to Xiaolin Chen or Yuanli Zhao.

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This study was approved by the Institutional Review Board of Beijing Tiantan Hospital (KY 2021–008-01). All the analyses were performed according to the Declaration of Helsinki and the local ethics policies.

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Li, R., Lin, F., Chen, Y. et al. Elevated blood hemoglobin on admission as an independent predictor of unfavorable outcomes in patients with aneurysmal subarachnoid hemorrhage. Neurosurg Rev 45, 2689–2699 (2022). https://doi.org/10.1007/s10143-022-01780-w

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