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Impact of Anemia Severity on the Outcome of an Aneurysmal Subarachnoid Hemorrhage

Objective: Previous reports indicate a negative impact of anemia on the outcome of an aneurysmal subarachnoid hemorrhage (SAH). We aimed to identify the outcome-relevant severity of post-SAH anemia. Methods: SAH cases treated at our institution between 01/2005 and 06/2016 were included (n = 640). Th...

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Autores principales: Said, Maryam, Dinger, Thiemo Florin, Gümüs, Meltem, Rauschenbach, Laurèl, Chihi, Mehdi, Rodemerk, Jan, Lenz, Veronika, Oppong, Marvin Darkwah, Uerschels, Anne-Kathrin, Dammann, Philipp, Wrede, Karsten Henning, Sure, Ulrich, Jabbarli, Ramazan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9657573/
https://www.ncbi.nlm.nih.gov/pubmed/36362486
http://dx.doi.org/10.3390/jcm11216258
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author Said, Maryam
Dinger, Thiemo Florin
Gümüs, Meltem
Rauschenbach, Laurèl
Chihi, Mehdi
Rodemerk, Jan
Lenz, Veronika
Oppong, Marvin Darkwah
Uerschels, Anne-Kathrin
Dammann, Philipp
Wrede, Karsten Henning
Sure, Ulrich
Jabbarli, Ramazan
author_facet Said, Maryam
Dinger, Thiemo Florin
Gümüs, Meltem
Rauschenbach, Laurèl
Chihi, Mehdi
Rodemerk, Jan
Lenz, Veronika
Oppong, Marvin Darkwah
Uerschels, Anne-Kathrin
Dammann, Philipp
Wrede, Karsten Henning
Sure, Ulrich
Jabbarli, Ramazan
author_sort Said, Maryam
collection PubMed
description Objective: Previous reports indicate a negative impact of anemia on the outcome of an aneurysmal subarachnoid hemorrhage (SAH). We aimed to identify the outcome-relevant severity of post-SAH anemia. Methods: SAH cases treated at our institution between 01/2005 and 06/2016 were included (n = 640). The onset, duration, and severity (nadir hemoglobin (nHB) level) of anemia during the initial hospital stay were recorded. Study endpoints were new cerebral infarctions, a poor outcome six months post-SAH (modified Rankin scale > 3), and in-hospital mortality. To assess independent associations with the study endpoints, different multivariable regression models were performed, adjusted for relevant patient and baseline SAH characteristics as well as anemia-associated clinical events during the SAH. Results: The rates of anemia were 83.3%, 67.7%, 40.0%, 15.9%, and 4.5% for an nHB < 11 g/dL, < 10 g/dL, < 9 g/dL, < 8 g/dL, and < 7 g/dL, respectively. The higher the anemia severity, the later was the onset (post-SAH days 2, 4, 5.4, 7.6 and 8, p < 0.0001) and the shorter the duration (8 days, 6 days, 4 days, 3 days, and 2 days, p < 0.0001) of anemia. In the final multivariable analysis, only an nHB < 9 g/dL was independently associated with all study endpoints: adjusted odds ratio 1.7/3.22/2.44 for cerebral infarctions/in-hospital mortality/poor outcome. The timing (post-SAH day 3.9 vs. 6, p = 0.001) and duration (3 vs. 5 days, p = 0.041) of anemia with an nHB < 9 g/dL showed inverse associations with the risk of in-hospital mortality, but not with other study endpoints. Conclusions: Anemia is very common in SAH patients affecting four of five individuals during their hospital stay. An nHB decline to < 9 g/dL was strongly associated with all study endpoints, independent of baseline characteristics and SAH-related clinical events. Our data encourage further prospective evaluations of the value of different transfusion strategies in the functional outcomes of SAH patients.
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spelling pubmed-96575732022-11-15 Impact of Anemia Severity on the Outcome of an Aneurysmal Subarachnoid Hemorrhage Said, Maryam Dinger, Thiemo Florin Gümüs, Meltem Rauschenbach, Laurèl Chihi, Mehdi Rodemerk, Jan Lenz, Veronika Oppong, Marvin Darkwah Uerschels, Anne-Kathrin Dammann, Philipp Wrede, Karsten Henning Sure, Ulrich Jabbarli, Ramazan J Clin Med Article Objective: Previous reports indicate a negative impact of anemia on the outcome of an aneurysmal subarachnoid hemorrhage (SAH). We aimed to identify the outcome-relevant severity of post-SAH anemia. Methods: SAH cases treated at our institution between 01/2005 and 06/2016 were included (n = 640). The onset, duration, and severity (nadir hemoglobin (nHB) level) of anemia during the initial hospital stay were recorded. Study endpoints were new cerebral infarctions, a poor outcome six months post-SAH (modified Rankin scale > 3), and in-hospital mortality. To assess independent associations with the study endpoints, different multivariable regression models were performed, adjusted for relevant patient and baseline SAH characteristics as well as anemia-associated clinical events during the SAH. Results: The rates of anemia were 83.3%, 67.7%, 40.0%, 15.9%, and 4.5% for an nHB < 11 g/dL, < 10 g/dL, < 9 g/dL, < 8 g/dL, and < 7 g/dL, respectively. The higher the anemia severity, the later was the onset (post-SAH days 2, 4, 5.4, 7.6 and 8, p < 0.0001) and the shorter the duration (8 days, 6 days, 4 days, 3 days, and 2 days, p < 0.0001) of anemia. In the final multivariable analysis, only an nHB < 9 g/dL was independently associated with all study endpoints: adjusted odds ratio 1.7/3.22/2.44 for cerebral infarctions/in-hospital mortality/poor outcome. The timing (post-SAH day 3.9 vs. 6, p = 0.001) and duration (3 vs. 5 days, p = 0.041) of anemia with an nHB < 9 g/dL showed inverse associations with the risk of in-hospital mortality, but not with other study endpoints. Conclusions: Anemia is very common in SAH patients affecting four of five individuals during their hospital stay. An nHB decline to < 9 g/dL was strongly associated with all study endpoints, independent of baseline characteristics and SAH-related clinical events. Our data encourage further prospective evaluations of the value of different transfusion strategies in the functional outcomes of SAH patients. MDPI 2022-10-24 /pmc/articles/PMC9657573/ /pubmed/36362486 http://dx.doi.org/10.3390/jcm11216258 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Said, Maryam
Dinger, Thiemo Florin
Gümüs, Meltem
Rauschenbach, Laurèl
Chihi, Mehdi
Rodemerk, Jan
Lenz, Veronika
Oppong, Marvin Darkwah
Uerschels, Anne-Kathrin
Dammann, Philipp
Wrede, Karsten Henning
Sure, Ulrich
Jabbarli, Ramazan
Impact of Anemia Severity on the Outcome of an Aneurysmal Subarachnoid Hemorrhage
title Impact of Anemia Severity on the Outcome of an Aneurysmal Subarachnoid Hemorrhage
title_full Impact of Anemia Severity on the Outcome of an Aneurysmal Subarachnoid Hemorrhage
title_fullStr Impact of Anemia Severity on the Outcome of an Aneurysmal Subarachnoid Hemorrhage
title_full_unstemmed Impact of Anemia Severity on the Outcome of an Aneurysmal Subarachnoid Hemorrhage
title_short Impact of Anemia Severity on the Outcome of an Aneurysmal Subarachnoid Hemorrhage
title_sort impact of anemia severity on the outcome of an aneurysmal subarachnoid hemorrhage
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9657573/
https://www.ncbi.nlm.nih.gov/pubmed/36362486
http://dx.doi.org/10.3390/jcm11216258
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