Preoperative anaemia and red blood cell transfusion in patients with aneurysmal subarachnoid and intracerebral haemorrhage — a multicentre subanalysis of the German PBM Network Registry

Abstract

Purpose Anaemia is common in patients presenting with aneurysmal subarachnoid (aSAH) and intracerebral haemorrhage (ICH). In surgical patients, anaemia was identified as an idenpendent risk factor for postoperative mortality, prolonged hospital length of stay (LOS) and increased risk of red blood cell (RBC) transfusion. This multicentre cohort observation study describes the incidence and effects of preoperative anaemia in this critical patient collective for a 10-year period. Methods This multicentre observational study included adult in-hospital surgical patients diagnosed with aSAH or ICH of 21 German hospitals (discharged from 1 January 2010 to 30 September 2020). Descriptive, univariate and multivariate analyses were performed to investigate the incidence and association of preoperative anaemia with RBC transfusion, in-hospital mortality and postoperative complications in patients with aSAH and ICH. Results A total of n = 9081 patients were analysed (aSAH n = 5008; ICH n = 4073). Preoperative anaemia was present at 28.3% in aSAH and 40.9% in ICH. RBC transfusion rates were 29.9% in aSAH and 29.3% in ICH. Multivariate analysis revealed that preoperative anaemia is associated with a higher risk for RBC transfusion (OR = 3.25 in aSAH, OR = 4.16 in ICH, p < 0.001), for in-hospital mortality (OR = 1.48 in aSAH, OR = 1.53 in ICH, p < 0.001) and for several postoperative complications. Conclusions Preoperative anaemia is associated with increased RBC transfusion rates, in-hospital mortality and postoperative complications in patients with aSAH and ICH. Trial registration ClinicalTrials.gov, NCT02147795, https://clinicaltrials.gov/ct2/show/NCT02147795

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

“…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). 9,10,33,57–75 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).…”

“…Observational studies have mostly demonstrated an association between anemia and poor outcomes among ICH patients, though again not without inconsistency in the results (Table). 66,97–104 In a meta-analysis of 7 cohort studies from 2009 to 2016 that included 7328 ICH patients, anemia was associated with increased 30-day mortality (OR, 1.72; 95% CI, 1.37–2.15; P = .02; I 2 = 64%), and increased risk of poor functional outcome at 3 months (OR, 2.29; 95% CI, 1.16–4.51; I 2 = 91%; P < .0001). 105 This considerable heterogeneity should be noted when interpreting the data, as the definition of anemia and measurement of Hb varied significantly between studies.…”

“…Observational cohorts to date have yielded conflicting results on the effects of RBC transfusion on outcomes in ICH patients. 33,66,112–114 A single-centered, retrospective observational study of 446 ICH patients identified RBC transfusion to be independently associated with decreased 30-day mortality (OR, 0.40; 95% CI, 0.19–0.60; P = .02). 113 Conversely, in a retrospective national cohort of 597,046 ICH patients where 22,904 of the subjects received one or more RBC transfusions during hospitalization, RBC transfusion was associated with increased in-hospital mortality (adjusted OR [aOR], 1.22; 95% CI, 1.10–1.35; P < .001) and lower odds of discharge with favorable functional outcomes (aOR, 0.56; 95% CI, 0.54–0.60; P < .001).…”

Red blood cell transfusion in neurocritical patients: a systematic review and meta-analysis

“…Therefore, brain hypoxia may also occur even in mild anemia [ 9 , 10 ]. Anemia is an independent risk factor for poor prognosis in neurocritical settings [ 11 ]. Previous studies have shown that in patients with TBI, SAH, and ICH, hemoglobin less than 9 g/dl is associated with tissue hypoxia and poor prognosis [ 11 ].…”

“…Anemia is an independent risk factor for poor prognosis in neurocritical settings [ 11 ]. Previous studies have shown that in patients with TBI, SAH, and ICH, hemoglobin less than 9 g/dl is associated with tissue hypoxia and poor prognosis [ 11 ]. However, RBC transfusion is associated with increased postoperative complications, poor neurological recovery, and mortality in critically ill neurologic patients [ 11 – 15 ].…”