title: Mean hemoglobin concentration after acute subarachnoid hemorrhage and the relation to outcome, mortality, vasospasm, and brain infarction.
abstract: Lower mean hemoglobin (HGB) levels are associated with unfavorable outcome after spontaneous subarachnoid hemorrhage (SAH). Currently, there is no cutoff level for mean HGB levels associated with unfavorable outcome. This study was conducted to evaluate a threshold for mean HGB concentrations after SAH, and to observe the relation to outcome. The medical records of 702 patients with spontaneous SAH were reviewed. Predictors of outcome were proved by univariate analysis. Predictors with p<0.1 were included in a multivariate binary logistic regression model. Cutoff points for mean HGB levels were calculated by receiver operating characteristic curve analysis. Mean HGB was 11.9 g/dl (±standard deviation [SD] 1.7 g/dl) in patients with favorable outcome compared to 10.8 g/dl (±SD 1.1g/dl) in patients with unfavorable outcome (p<0.001). The highest Youden's index value was found for a HGB cutoff at 11.1 g/dl. In a binary logistic regression model, predictors of unfavorable outcome were identified as an initially high Hunt-Hess grade (odds ratio [OR]: 7.7; 95% confidence interval [CI]: 4.4-13.4; p<0.001), cerebral infarction on a CT scan during hospital stay (OR: 3.8; 95% CI: 2.0-7.3; p<0.001), rebleeding during the hospital stay (OR: 3.5; 95% CI: 1.6-8.0; p=0.002), mean HGB concentration <11.1g/dl (OR: 3.3; 95% CI: 2.0-5.3; p<0.001), and hydrocephalus (OR: 2.3; 95% CI: 1.4-3.7; p=0.001). In conclusion, a mean HGB concentration <11.1 g/dl during the hospital stay was associated with unfavorable outcome after acute SAH.
authors.affiliation: Department of Neurosurgery, University Hospital Giessen and Marburg GmbH, Campus Giessen, Klinikstrasse 33, 35392 Giessen, Germany. Electronic address: Marco.Stein@neuro.med.uni-giessen.de.
authors.forename: Marco
authors.initials: M
authors.lastname: Stein
authors.affiliation: Department of Neurosurgery, University Hospital Giessen and Marburg GmbH, Campus Giessen, Klinikstrasse 33, 35392 Giessen, Germany.
authors.forename: Lisa
authors.initials: L
authors.lastname: Brokmeier
authors.affiliation: Bureau of Statistics, Justus-Liebig-University Giessen, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Herrmann
authors.affiliation: Gemeinschaftskrankenhaus Herdecke, Germany.
authors.forename: Wolfram
authors.initials: W
authors.lastname: Scharbrodt
authors.affiliation: Department of Neurosurgery, HELIOS Vogtland Klinikum Plauen, Germany.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Schreiber
authors.affiliation: Department of Neurosurgery, University Hospital Giessen and Marburg GmbH, Campus Giessen, Klinikstrasse 33, 35392 Giessen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Bender
authors.affiliation: Department of Neurosurgery, HELIOS Vogtland Klinikum Plauen, Germany.
authors.forename: Matthias F
authors.initials: MF
authors.lastname: Oertel
mesh_terms: D000208:Acute Disease; D000368:Aged; D002544:Cerebral Infarction / Q000097:blood*; D005260:Female; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D006849:Hydrocephalus / Q000097:blood; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D013345:Subarachnoid Hemorrhage / Q000097:blood* / Q000401:mortality*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000097:blood*
chemical_list: D006454:Hemoglobins
keywords: Anemia; Hemoglobin; Outcome; Subarachnoid hemorrhage; Transfusion