title: The association between anemia and neurological outcome in hypoxic ischemic brain injury after cardiac arrest.
abstract: To examine the relationship between daily mean hemoglobin concentration and neurological outcome in hypoxic ischemic brain injury (HIBI) following cardiac arrest.
  
  
  
  We conducted a single center retrospective observational study using a database of HIBI patients between March 2009 and December 2014. We included all adults admitted to the intensive care unit following an in-hospital or out-of-hospital cardiac arrest. The primary outcome was neurological outcome measured by the Cerebral Performance Category (CPC) at hospital discharge. Multivariable logistic regression was used to analyze the association of mean hemoglobin concentration over 48h and 7 days after the onset of HIBI and discharge CPC. Favorable and unfavorable neurological outcome was dichotomized for a discharge CPC 1-2 vs 3-5, respectively.
  
  
  
  118 patients were included in the analysis. Patients with a favorable neurological outcome had higher mean 7-day hemoglobin (115g/L vs 107g/L; p=0.05) compared to those with unfavorable outcome. Multivariate logistic regression controlling for age, time to return of spontaneous circulation and blood transfusion demonstrated that lower mean 48-h hemoglobin concentration was associated with unfavorable outcome (OR 0.69 per 10 unit change in Hgb, 95% CI 0.54-0.88, p<0.01). A repeated analysis using mean Hgb for the first 7 days yielded similar results for unfavorable outcome (OR 0.75 per 10 unit change in Hgb, 95% CI 0.57-0.97, p=0.03).
  
  
  
  Lower mean hemoglobin concentration in the first 48h and 7 days following HIBI is associated with a higher odds of unfavorable outcome at hospital discharge. Further study to examine this association is warranted.
authors.affiliation: Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, 899 West 12th Avenue, University of British Columbia, Vancouver, BC, Canada V5Z 1M9. Electronic address: awormsbecker@gmail.com.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wormsbecker
authors.affiliation: Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, 899 West 12th Avenue, University of British Columbia, Vancouver, BC, Canada V5Z 1M9. Electronic address: mypindersekhon@gmail.com.
authors.forename: Mypinder S
authors.initials: MS
authors.lastname: Sekhon
authors.affiliation: Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, 899 West 12th Avenue, University of British Columbia, Vancouver, BC, Canada V5Z 1M9; Division of Critical Care Medicine, Department of Anaesthesiology, Pharmacology and Therapeutics, Vancouver General Hospital, West 12th Avenue, University of British Columbia, Vancouver, BC, Canada V5Z 1M9; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, 899 West 12th Avenue, University of British Columbia, Vancouver, BC, Canada V5Z 1M9. Electronic address: donald.griesdale@vch.ca.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Griesdale
authors.affiliation: Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, 899 West 12th Avenue, University of British Columbia, Vancouver, BC, Canada V5Z 1M9. Electronic address: katiewiskar@gmail.com.
authors.forename: Katie
authors.initials: K
authors.lastname: Wiskar
authors.affiliation: Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, 899 West 12th Avenue, University of British Columbia, Vancouver, BC, Canada V5Z 1M9; Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Ave, Boston, MA 02115, USA. Electronic address: bar890@mail.harvard.edu.
authors.forename: Barret
authors.initials: B
authors.lastname: Rush
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood / Q000150:complications*; D016887:Cardiopulmonary Resuscitation; D004909:Erythrocyte Indices; D017707:Erythrocyte Transfusion; D005260:Female; D006323:Heart Arrest / Q000097:blood / Q000150:complications* / Q000628:therapy; D006441:Hemoglobin A / Q000032:analysis*; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000097:blood / Q000150:complications*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009424:Nervous System Physiological Phenomena; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D006441:Hemoglobin A
keywords: Anemia; Cardiac arrest; Hemoglobin; Hypoxic ischemic brain injury