title: Influence of red blood cell transfusion on mortality and long-term functional outcome in 292 patients with spontaneous subarachnoid hemorrhage.
abstract: OBJECTIVE
  To analyze the influence of red blood cell (RBC) transfusions on mortality and outcome of patients with spontaneous subarachnoid hemorrhage (SAH) and to determine predictors of unfavorable neurologic long-term outcome in this patient population.
  
  
  METHODS
  Cohort study with post-intensive care unit (ICU) prospective evaluation of functional long-term outcome.
  
  
  METHODS
  Ten-bed neuro-ICU in a tertiary care university hospital.
  
  
  METHODS
  A consecutive cohort of 292 patients with spontaneous SAH admitted to a neuro-ICU during a 70-month period.
  
  
  METHODS
  None.
  
  
  RESULTS
  A total of 292 consecutive patients with SAH were enrolled in the study. At admission, mean hemoglobin was 13.3 g/dL (+/-sd 1.8 g/dL), comparable in all Hunt and Hess groups (p = 0.61 by analysis of variance). Seventy-nine patients received at least one unit of RBC transfusion in the study period. In-ICU mortality was 20.5% (n = 60). Binary logistic regression analysis comparing survivors with nonsurvivors found only higher Hunt and Hess grades (i.e., Hunt and Hess 3-5) to be significantly (p < 0.01) associated with mortality in the neuro-ICU, whereas transfusion, sex, and even age had no significant influence. Functional long-term outcome was assessed after a mean of 3.3 years (sd +/-1.7 years) by evaluating modified Rankin Scale (mRS) and Glasgow Outcome Scale (GOS). More than 41% of all patients have almost fully recovered (i.e., mRS 0-1; GOS 4-5). Factors associated with unfavorable long-term outcome (i.e., GOS 1-3 and mRS 2-6) were age (odds ratio 1.06; 95% confidence interval 1.03-1.09; p < 0.01), Hunt and Hess Grade (odds ratio 11.43; 95% confidence interval 4.1-31.9; p < 0.01) but not transfusion (p = 0.46).
  
  
  CONCLUSIONS
  Transfusion of RBCs was not associated with in-neuro-ICU mortality or unfavorable long-term outcome. Of all patients with SAH, >41% have almost fully recovered with favorable neurologic long-term outcome.
authors.affiliation: Neurologic Intensive Care Unit, Innsbruck Medical University, Innsbruck, Austria. gregor.broessner@i-med.ac.at
authors.forename: Gregor
authors.initials: G
authors.lastname: Broessner
authors.forename: Peter
authors.initials: P
authors.lastname: Lackner
authors.forename: Clemens
authors.initials: C
authors.lastname: Hoefer
authors.forename: Ronny
authors.initials: R
authors.lastname: Beer
authors.forename: Raimund
authors.initials: R
authors.lastname: Helbok
authors.forename: Christoph
authors.initials: C
authors.lastname: Grabmer
authors.forename: Hanno
authors.initials: H
authors.lastname: Ulmer
authors.forename: Bettina
authors.initials: B
authors.lastname: Pfausler
authors.forename: Christian
authors.initials: C
authors.lastname: Brenneis
authors.forename: Erich
authors.initials: E
authors.lastname: Schmutzhard
mesh_terms: D015331:Cohort Studies; D017707:Erythrocyte Transfusion; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000401:mortality* / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome