title: Higher hemoglobin is associated with less cerebral infarction, poor outcome, and death after subarachnoid hemorrhage.
abstract: OBJECTIVE
  Higher-goal hemoglobin (hgb) and more packed red blood cell transfusions lead to worse outcomes in general critical care patients. There are few data on hgb, transfusion, and outcomes after aneurysmal subarachnoid hemorrhage (SAH).
  
  
  METHODS
  We reviewed the daily hgb levels of 103 patients with aneurysmal SAH. Cerebral infarction was diagnosed by computed tomographic scan. We corrected for Hunt and Hess grade, age, and angiographic vasospasm in multivariate models.
  
  
  RESULTS
  Of 103 patients, the mean age was 55.3 +/- 14.5 years, 63% were women, and 29% were Hunt and Hess Grades 4 and 5; hgb values steadily declined from 12.6 +/- 1.7 g/dl the day of SAH to 10.4 +/- 1.2 g/dl by Day 14. Patients who died had lower hgb than survivors on Days 0, 1, 2, 4, 6, 10, 11, and 12 (P < or = 0.05). Higher mean hgb was associated with reduced odds of poor outcome (odds ratio, 0.57 per g/dl; 95% confidence interval [CI], 0.38-0.87; P = 0.008) after correcting for Hunt and Hess grade, age, and vasospasm; results for hgb on Days 0 and 1 were similar. Higher Day 0 (odds ratio, 0.7 per g/dl; 95% CI, 0.5-0.99; P = 0.05) and mean hgb (odds ratio, 0.57 per g/dl; 95% CI, 0.38-0.87; P = 0.009) predicted a lower risk of cerebral infarction independent of vasospasm. There were no associations between hgb and other prognostic variables.
  
  
  CONCLUSIONS
  We found that SAH patients with higher initial and mean hgb values had improved outcomes. Higher hgb in SAH patients may be beneficial. The efficacy and safety of blood transfusions to increase hgb in patients with SAH may warrant further study.
authors.affiliation: Departments of Neurology and Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA. a-naidech@northwestern.edu
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Naidech
authors.forename: Jessica
authors.initials: J
authors.lastname: Drescher
authors.forename: Michael L
authors.initials: ML
authors.lastname: Ault
authors.forename: Ali
authors.initials: A
authors.lastname: Shaibani
authors.forename: H Hunt
authors.initials: HH
authors.lastname: Batjer
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Alberts
mesh_terms: D000328:Adult; D000368:Aged; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D017707:Erythrocyte Transfusion; D005260:Female; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D015994:Incidence; D002532:Intracranial Aneurysm / Q000150:complications* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019635:Neurosurgical Procedures; D016017:Odds Ratio; D011379:Prognosis; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000097:blood* / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging / Q000209:etiology
chemical_list: D006454:Hemoglobins