Influence of red blood cell transfusion on mortality and long-term functional outcome in 292 patients with spontaneous subarachnoid hemorrhage.
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.
Broessner
Gregor
G
Neurologic Intensive Care Unit, Innsbruck Medical University, Innsbruck, Austria. gregor.broessner@i-med.ac.at
Lackner
Peter
P
Hoefer
Clemens
C
Beer
Ronny
R
Helbok
Raimund
R
Grabmer
Christoph
C
Ulmer
Hanno
H
Pfausler
Bettina
B
Brenneis
Christian
C
Schmutzhard
Erich
E
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