title: Packed red blood cell transfusion and decreased mortality in intracerebral hemorrhage.
abstract: BACKGROUND
  Accumulating data suggest that anemia worsens outcomes in critically ill patients, including those with subarachnoid and intracerebral hemorrhage (ICH). Although packed red blood cell (PRBC) transfusion appears to increase brain tissue oxygen, it is unknown whether such transfusions, which are commonly administered in patients with intracranial hemorrhage, alter outcome.
  
  
  OBJECTIVE
  Following up on our observation that anemia is associated with poor outcome in patients with ICH, we investigated whether PRBC transfusion was associated with any benefit.
  
  
  METHODS
  Five hundred forty-six consecutive subjects were identified from an ongoing single-center, prospective cohort study of nontraumatic ICH over a 6-year period. Clinical and radiographic characteristics, laboratory values including admission and daily mean hemoglobin values, and all instances of PRBC transfusion were recorded. Aggressiveness of care was assessed by whether the patient had a "do not resuscitate" order activated during hospitalization. The primary endpoint was 30-day survival.
  
  
  RESULTS
  Anemia was present in 144 of 546 patients (26%) on admission and developed subsequently in an additional 250, leaving just 152 of 546 patients (28%) who never developed anemia. PRBC transfusion was administered to 100 patients (18%) during their hospital stay, 98% of whom were anemic. In multivariable analysis, PRBC transfusion was associated with improved survival at 30 days (odds ratio: 2.76; 95% confidence interval: 1.45-5.26; P = .002).
  
  
  CONCLUSIONS
  Anemia develops in the majority of patients with ICH at some point during their hospitalization. PRBC transfusion was associated with improved outcome in these patients.
authors.affiliation: Department of Neurology, Division of Stroke and Neurocritical Care, University of Maryland Medical Center, Baltimore, Maryland 21201, USA. ksheth@som.umaryland.edu
authors.forename: Kevin N
authors.initials: KN
authors.lastname: Sheth
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Gilson
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.forename: Mona A
authors.initials: MA
authors.lastname: Kumar
authors.forename: Rosanna M
authors.initials: RM
authors.lastname: Rahman
authors.forename: Natalia S
authors.initials: NS
authors.lastname: Rost
authors.forename: Kristin
authors.initials: K
authors.lastname: Schwab
authors.forename: Lynelle
authors.initials: L
authors.lastname: Cortellini
authors.forename: Joshua N
authors.initials: JN
authors.lastname: Goldstein
authors.forename: Eric E
authors.initials: EE
authors.lastname: Smith
authors.forename: Steven M
authors.initials: SM
authors.lastname: Greenberg
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rosand
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000401:mortality / Q000628:therapy; D002543:Cerebral Hemorrhage / Q000401:mortality* / Q000628:therapy*; D015331:Cohort Studies; D017707:Erythrocyte Transfusion / Q000379:methods*; D005260:Female; D006400:Hematocrit / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies