Low neurologic intensive care unit hemoglobin as a predictor for intra-arterial vasospasm therapy and poor discharge modified Rankin Scale in aneurysmal subarachnoid haemorrhage-induced cerebral vasospasm

Bell, Donnie; Kimberly, W. Taylor; Yoo, Albert J.; Leslie‐Mazwi, Thabele M; Rabinov, James D.; Bell, Jania E; Hirsch, Joshua A

doi:10.1136/neurintsurg-2014-011164

Cited by 9 publications

(5 citation statements)

References 30 publications

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“…Microdialysis studies and cohort studies have largely supported, with only few exceptions, the notion that anemia in aSAH patients is associated with brain tissue hypoxia, DCI, and poor clinical outcome (Table ). 9,10,33,[57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75] This critical Hb level appeared to be between 9 and 11 g/dL. In a recent post hoc analysis of 413 aSAH patients in the Clazosentan to Overcome Neurological Ischemia and Infarction Occurring After Subarachnoid Hemorrhage (CONSCIOUS-1) study, a multivariate regression analysis identified anemia postaneurysm securement to be associated with poor neurological outcome (OR, 1.96; 95% CI, 1.07-3.59; P = .03) and death (OR, 3.50; 95% CI, 1.15-10.62; P = .027).…”

Section: Aneurysmal Subarachnoid Hemorrhagementioning

confidence: 99%

Anemia and Optimal Transfusion Thresholds in Brain-Injured Patients: A Narrative Review of the Literature

Ma,

Bebawy

2023

Anesthesia &Amp; Analgesia

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Anemia is a highly prevalent condition that may compromise oxygen delivery to vital organs, especially among the critically ill. Although current evidence supports the adoption of a restrictive transfusion strategy and threshold among the nonbleeding critically ill patient, it remains unclear whether this practice should apply to the brain-injured patient, given the predisposition to cerebral ischemia in this patient population, in which even nonprofound anemia may exert a detrimental effect on clinical outcomes. The purpose of this review is to provide an overview of the pathophysiological changes related to impaired cerebral oxygenation in the brain-injured patient and to present the available evidence on the effect of anemia and varying transfusion thresholds on the clinical outcomes of patients with acute brain injury.

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Section: Aneurysmal Subarachnoid Hemorrhagementioning

confidence: 99%

Anemia and Optimal Transfusion Thresholds in Brain-Injured Patients: A Narrative Review of the Literature

Ma,

Bebawy

2023

Anesthesia &Amp; Analgesia

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“…com/ health/ hct-hgb). To estimate Hb values from the studies analyzing the impact of RBCT on the primary review endpoints, the corresponding institutional cutoffs for RBCT or, if reported, the mean/nadir Hb values in the RBCT/non-RBCT subgroups were applied 9,12,14,[21][22][23][24][25][26][27][28][29][30][31][32][33][34] . In the remaining studies, the severity of anemia could be assessed upon the reported absolute, nadir and mean/median Hb values.…”

Section: Study Endpoints and Data Synthesismentioning

confidence: 99%

Systematic review and meta-analysis of outcome-relevant anemia in patients with subarachnoid hemorrhage

Said

Gümüş

Rodemerk

et al. 2022

Sci Rep

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Anemia is a common, treatable condition in patients with aneurysmal subarachnoid hemorrhage (SAH) and has been associated with poor outcome. As there are still no guidelines for anemia management after aneurysm rupture, we aimed to identify outcome-relevant severity of anemia in SAH. We systematically searched PubMed, Embase, Scopus, Web of Science, and Cochrane Library for publications before Oct 23rd, 2022, reporting on anemia in SAH patients. The presence and severity of anemia were assessed according to the reported hemoglobin values and/or institutional thresholds for red blood cells transfusion (RBCT). Out of 1863 original records, 40 full-text articles with a total of 14,701 patients treated between 1996 and 2020 were included in the final analysis (mean 445.48 patients per study). A substantial portion of patients developed anemia during SAH (mean pooled prevalence 40.76%, range 28.3–82.6%). RBCT was administered in a third of the cases (mean 32.07%, range 7.8–88.6%), with institutional threshold varying from 7.00 to 10.00 g/dL (mean 8.5 g/dL). Anemia at the onset of SAH showed no impact on SAH outcome. In contrast, even slight anemia (nadir hemoglobin < 11.0–11.5 g/dL) occurring during SAH was associated with the risk of cerebral infarction and poor outcome at discharge and follow-up. The strongest association with SAH outcome was observed for nadir hemoglobin values ranging between 9.0 and 10.0 g/dL. The effect of anemia on SAH mortality was marginal. The development of anemia during SAH is associated with the risk of cerebral infarction and poor outcome at discharge and follow-up. Outcome-relevant severity of post-SAH anemia begins at hemoglobin levels clearly above the thresholds commonly set for RBCT. Our findings underline the need for further studies to define the optimal management of anemia in SAH patients.

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“…Clinical studies have also shown an increased incidence of DCI, cerebral infarction, and poor outcome in anemic SAH pat ients. 8,12,[54][55][56] However, in a multicenter cohort study on SAH patients, RBCs were transfused only when the Hb fell below 8 g/dL (66.3% of cohorts), and this practice was not associated with poor outcome. 13 In fact, researchers have shown that administering blood despite Hb > 10 g/dL has led to improved outcomes.…”

Section: Aneurysmal Subarachnoid Hemorrhagementioning

confidence: 99%

Red Blood Cell Transfusion Practices in the Neurointensive Care Unit: A Narrative Review

Surve

Bansal

Radhakrishnan

2019

Journal of Neuroanaesthesiology and Critical Care

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Anemia is common in neurointensive care unit (NICU) patients and is one of the common causes of systemic insults to the brain. Though the recent literature favors restrictive blood transfusion practices over liberal transfusion to correct anemia in the general ICU, whether a similar practice can be adopted in NICU patients is doubtful due to lack of strong evidence. Impairment of cerebral autoregulation and cardiac function following acute brain injury affects the body's compensatory mechanism to anemia and renders the brain susceptible to anemic hypoxia at different hemoglobin (Hb) thresholds. Hence, red blood cell transfusion (RBCT) practice based on a single Hb threshold value might be inappropriate. On the other hand, allogenic RBCT has its own risks, both in short and in long run, leading to adverse outcomes. Thus, instead of relying only on arbitrary Hb values, a better way to decide the need for RBCT in NICU patients is to target parameters based on systemic and regional cerebral oxygenation. This approach will help us to individualize RBCT practices. In this narrative review, based on the available literature, authors have discussed the impact of anemia and blood transfusion on the immediate and late neurological outcomes and the current role of regional brain monitoring in guiding blood transfusion practices. In the end, authors have tried to update on the current RBCT practices in neurosurgical and neuromedical patients admitted to the NICU.

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Low neurologic intensive care unit hemoglobin as a predictor for intra-arterial vasospasm therapy and poor discharge modified Rankin Scale in aneurysmal subarachnoid haemorrhage-induced cerebral vasospasm

Abstract: Lower mean hemoglobin during the acute phase of aneurysmal subarachnoid hemorrhage-induced cerebral vasospasm is an independent predictor of IAVT and poor discharge mRS. This relationship warrants further evaluation.

Cited by 9 publications

References 30 publications

Anemia and Optimal Transfusion Thresholds in Brain-Injured Patients: A Narrative Review of the Literature

Anemia and Optimal Transfusion Thresholds in Brain-Injured Patients: A Narrative Review of the Literature

Systematic review and meta-analysis of outcome-relevant anemia in patients with subarachnoid hemorrhage

Red Blood Cell Transfusion Practices in the Neurointensive Care Unit: A Narrative Review

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