title: Higher hemoglobin is associated with improved outcome after subarachnoid hemorrhage.
abstract: OBJECTIVE
  There are few data regarding anemia and transfusion after subarachnoid hemorrhage (SAH). We addressed the hypothesis that higher hemoglobin (HGB) levels are associated with less death and disability after SAH.
  
  
  METHODS
  Prospective registry with automated data retrieval.
  
  
  METHODS
  Six hundred eleven patients enrolled in the Columbia University SAH Outcomes Project between August 1996 and June 2002.
  
  
  METHODS
  Neurologic intensive care unit.
  
  
  METHODS
  Patients were treated according to standard management protocols.
  
  
  RESULTS
  We electronically retrieved all HGB readings during the acute hospital stay for 611 consecutively admitted SAH patients. Outcomes were measured with the modified Rankin Scale at 14 days or discharge, and at 3 months. Patients who were independent (modified Rankin Scale, 0-3) at discharge or 14 days had higher mean (11.7 +/- 1.5 vs. 10.9 +/- 1.2, p < .001) and nadir (9.9 +/- 2.1 vs. 8.6 +/- 1.8, p < .001) HGB, and had higher HGB values every day in the hospital. There were similar results when patients were stratified by mortality. Higher HGB was associated with reduced risk of poor outcome (modified Rankin Scale, 4-6) at 14 days/discharge and 3 months after correcting for Hunt and Hess grade, age, history of diabetes, and cerebral infarction. Length of stay and HGB interacted such that lower HGB has a more pronounced effect with length of stay > 14 days.
  
  
  CONCLUSIONS
  Higher HGB values are associated with improved outcomes after SAH at 14 days/discharge and 3 months. In contrast to general critical care patients, SAH patients may benefit from higher HGB. Determination of the optimal goal HGB after SAH will require separate prospective research.
authors: Neurological Institute, Columbia University, New York, NY, USA. a-naidech@northwestern.edu
authors: Andrew M
authors: AM
authors: Naidech
authors: Borko
authors: B
authors: Jovanovic
authors: Katja E
authors: KE
authors: Wartenberg
authors: Augusto
authors: A
authors: Parra
authors: Noeleen
authors: N
authors: Ostapkovich
authors: E Sander
authors: ES
authors: Connolly
authors: Stephan A
authors: SA
authors: Mayer
authors: Christopher
authors: C
authors: Commichau
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000097:blood* / Q000150:complications / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins