Table 5 Clinical studies assessing the association between hemoglobin concentrations, anemia, or transfusion and subsequent outcomes among patients with aneurysmal subarachnoid hemorrhage
From: Anemia and red blood cell transfusion in neurocritical care
Study | Patients | Design and setting | Exposure | Mean pre-transfusion Hb/Hct | Analysis (variables) | Main result |
|---|---|---|---|---|---|---|
‡Kramer and colleagues [28] | 245 | Retrospective Single-center | - Anemia (nadir Hb <10 g/dl) - RBC transfusion (35%) | 9.5 g/dl No transfusion protocol | Logistic regression (WFNS score, age, vasospasm, modified Fisher score) | - Anemia and transfusion associated with poor 6 week outcome (association stronger for transfusion) - RBCs associated with nosocomial infection - Age of blood not associated with complications |
‡Kramer and colleagues [154] | 245 | Retrospective Single-center | Daily nadir Hb over 2 weeks | 9.5 g/dl No transfusion protocol | GEE to account for correlated data (WFNS score, age, vasospasm, modified Fisher score) | - Hb and decline in Hb over time predict poor outcome - Association between Hb and outcome stronger among high grade patients |
†Naidech and colleagues [155] | 611 | Retrospective (prospective database) Single-center | - Mean and nadir Hb over 2 weeks - 35% transfused | Not reported No transfusion protocol | Multinomial regression (Hunt-Hess, age, cerebral infarction) | Higher nadir (but not mean) Hb associated with better outcome after 3 months (OR = 0.83 per 10 g/dl increase; P = 0.04) |
Naidech and colleagues [156] | 103 | Retrospective (prospective database) Single-center | - Mean Hb over 2 weeks - 47% transfused | 9.2 g/dl No transfusion protocol | Logistic regression (Hunt-Hess, age, angiographic vasospasm) | Higher 2 week mean Hb associated with better outcome at discharge (OR = 0.57 per 10 g/dl increase; P = 0.04) |
Tseng and colleagues [157] | 160 | Post hoc analysis 2 RCTs) Single-center | RBC transfusion (19%) | Not reported | Logistic regression (age, WFNS, IVH, postoperative deficits, sepsis, DIDs) | - Transfusion associated with poor outcome at discharge (OR = 4.5, P = 0.04) but not 6 months - More colloid use predicted lower hct and need for transfusion |
†Wartenberg and colleagues [158] | 576 | Retrospective (prospective database) Single-center | Anemia (Hb <9 g/dl treated with transfusion; 36% of cohort) | Not reported No transfusion protocol | Logistic regression (Hunt-Hess, age, cerebral infarction, re-bleeding, aneurysm size >10 mm) | Anemia associated with worse 3 month outcome (OR = 1.8; P = 0.02) |
* DeGeorgia and colleagues [159] | 166 | Retrospective Single-center | RBC Transfusion (49%) | Not reported No transfusion protocol | Logistic regression (Hunt-Hess, APACHE II) | Transfusion associated with worse outcome at discharge among patients with vasospasm, not without (OR = 2.9, CI = 1.1 to 7.8) |
Smith and colleagues [160] | 441 | Retrospective (prospective database) Single-center | RBC transfusion (61%) | Intra-operative: 39.6% Post-operative: 32.0% No transfusion protocol | Logistic regression (Hunt-Hess, Fisher, smoking, intra-operative rupture, delay to surgery) | - Intraoperative transfusion associated with poor 6 month outcome (OR = 2.4, CI = 1.3 to 4.5) - Postoperative transfusion associated with angiographic vasospasm (OR = 1.7, CI = 1.0 to 2.8)) |