Higher hemoglobin is associated with improved outcome after subarachnoid hemorrhage.
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.
Naidech
Andrew M
AM
Neurological Institute, Columbia University, New York, NY, USA. a-naidech@northwestern.edu
Jovanovic
Borko
B
Wartenberg
Katja E
KE
Parra
Augusto
A
Ostapkovich
Noeleen
N
Connolly
E Sander
ES
Mayer
Stephan A
SA
Commichau
Christopher
C
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
D006454:Hemoglobins