gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Lower mean hemoglobin concentration is a predictor of unfavorable outcome, vasospasm and ischemic lesions after acute subarachnoid hemorrhage

Meeting Abstract

  • M. Stein - Klinik für Neurochirurgie, Universitätsklinikum Gießen and Marburg GmbH, Standort Gießen
  • L. Brokmeier - Klinik für Neurochirurgie, Universitätsklinikum Gießen and Marburg GmbH, Standort Gießen
  • J. Herrmann - AG Statistik, Justus-Liebig-Universität Gießen
  • W. Scharbrodt - Klinik für Neurochirurgie, Universitätsklinikum Gießen and Marburg GmbH, Standort Gießen
  • V. Schreiber - Klinik für Neurochirurgie, Universitätsklinikum Gießen and Marburg GmbH, Standort Gießen
  • M. Bender - Klinik für Neurochirurgie, Universitätsklinikum Gießen and Marburg GmbH, Standort Gießen
  • M.F. Oertel - Klinik für Neurochirurgie, Universitätsklinikum Gießen and Marburg GmbH, Standort Gießen

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocFR.08.01

DOI: 10.3205/12dgnc226, URN: urn:nbn:de:0183-12dgnc2266

Published: June 4, 2012

© 2012 Stein et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective: Currently no consensus about a critical mean hemoglobin (HGB) concentration after acute subarachnoid hemorrhage (SAH) exists. The aim of the present study was to identify a threshold for mean HGB concentration and to evaluate this threshold in the prediction of 30-day mortality, unfavorable outcome, vasospasm, and brain infarction after acute SAH.

Methods: The medical data of 702 patients with acute SAH were reviewed out of a prospective observational database. Patients with the diagnosis of spontaneous SAH were included in the analysis. Patients' age was not restricted. Patients with cerebral trauma, vascular malformation, tumor hemorrhage, or ischemic stroke were excluded. Mean HGB levels were calculated. Critical values for HGB were calculated with a logistic regression model. Predictors of outcome were proved by univariate analysis. Predictors with P < 0.1 were included in a binary logistic regression model.

Results: Matching the inclusion criteria, 522 patients were included in the present study. Average HGB concentration was 11.3 g/dl (± SD 1.6 g/dl). Nadir HGB concentration during the ICU stay was 9.4 g/dl (± SD 2 g/dl). In a binary logistic regression model mean HGB concentration ≤ 11.3 g/dl was identified as fourth strongest predictor of unfavorable outcome (OR: 3.2; 95% CI: 1.9–5.2; P < 0.001). Similar results were observed for the prediction of vasospasm (OR: 3.3; 95% CI: 2.1–5.2; P < 0.001) and new ischemic brain lesions (OR 2.6; 95% CI: 1.5–4.6; P = 0.001). No differences in mean HGB concentrations for 30-day mortality were observed (9.4 g/dl ± SD 2.2 g/dl vs.9.2 g/dl ± SD 1.7 g/dl, P = 0.217).Forty nine percent of the patients received red blood cell (RBC) transfusions. The infection rate was significant higher in the transfused group (44.6% compared to 7.5% in the group without RBC transfusion (P < 0.001)).

Conclusions: Regardless of the clinical presentation at admission, a threshold of a mean HGB concentration ≤ 11.3 g/dl was identified as a significant predictor of unfavorable outcome, vasospasm and new ischemic lesions after acute SAH. Our results need to be confirmed in a prospective randomized trial and new treatment models for anemia after acute SAH need to be evaluated.