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Blood Transfusion is an Important Predictor of Hospital Mortality Among Patients with Aneurysmal Subarachnoid Hemorrhage

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Abstract

Background

Red blood cell (RBC) transfusion after aneurysmal subarachnoid hemorrhage (aSAH) has been associated with increased mortality but prior studies have not adequately adjusted for transfusion-indication bias.

Methods

This is a retrospective study of consecutive aSAH patients admitted to the intensive care units of two academic medical centers over a 7-year period. Data collection included demographics, World Federation of Neurosurgical Surgeons score (WFNS), modified Fisher score (mFisher), admission and nadir hemoglobin (Hb) level, vasospasm, cerebral infarction, acute lung injury, and hospital mortality. The association between RBC transfusion and mortality was evaluated using a multivariate logistic regression analysis using the propensity for RBC transfusion as a covariate.

Results

We identified 318 patients. The median age was 54 years (46, 65), and 204 (64 %) were females. Hospital mortality was 13 % (42/318). Seventy-two (23 %) patients were transfused. Predictors of transfusion were admit and nadir Hb levels (p < 0.001), age (p = 0.02), gender (0.008), WFNS score (p < 0.001), mFisher score (p = 0.009), surgical versus endovascular treatment (p < 0.001) and moderate to severe vasospasm (p = 0.025) were predictors of transfusion. After adjustment for probability of receiving RBC transfusion, APACHE IV and nadir Hb, transfusion remained independently associated with hospital mortality (OR 3.16, 95 % CI = 1.02–9.69, p = 0.047).

Conclusions

Among patients with aSAH, RBC transfusion was independently associated with an increased mortality after adjustment for the most common clinical indications for transfusion.

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Acknowledgments

This work was financially supported by the Mayo Clinic.

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Authors and Affiliations

  1. Department of Critical Care Medicine, Mayo Clinic, 4500, San Pablo Rd, Jacksonville, FL, 32224, USA

    Emir Festic, William D. Freeman & Augustine S. Lee

  2. Department of Neurology, Mayo Clinic, Rochester, MN, USA

    Alejandro A. Rabinstein, Elizabeth A. Mauricio & Maisha T. Robinson

  3. Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA

    Abba C. Zubair

  4. Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA

    Ognjen Gajic

  5. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA

    Jay Mandrekar

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  1. Emir Festic
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  2. Alejandro A. Rabinstein
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  3. William D. Freeman
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  4. Elizabeth A. Mauricio
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  7. Abba C. Zubair
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  8. Augustine S. Lee
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  9. Ognjen Gajic
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Correspondence to Emir Festic.

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Festic, E., Rabinstein, A.A., Freeman, W.D. et al. Blood Transfusion is an Important Predictor of Hospital Mortality Among Patients with Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care 18, 209–215 (2013). https://doi.org/10.1007/s12028-012-9777-y

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  • DOI: https://doi.org/10.1007/s12028-012-9777-y

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