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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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Anemia in patients with subarachnoid haemorrhage – a systematic review and meta-analysis

Anämie bei Patienten mit Subarachnoidalblutung: Ein systematischer Review und Meta-Analyse

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  • presenting/speaker Maryam Said - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Meltem Gümüs - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Mehdi Chihi - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Thiemo F. Dinger - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Marvin Darkwah Oppong - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Philipp Dammann - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Karsten H. Wrede - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Ulrich Sure - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Ramazan Jabbarli - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocP107

doi: 10.3205/22dgnc417, urn:nbn:de:0183-22dgnc4175

Published: May 25, 2022

© 2022 Said et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Anemia is common in patients with aneurysmal subarachnoid hemorrhage (SAH) and has been reported to be associated with poor outcome. As there are still no guidelines for anemia management after SAH, we intended to analyze the evidence in the literature on the risk factors for occurrence and clinical impact of post-SAH anemia.

Methods: We systematically searched PubMed, Embase, Scopus, Web of Science, and Cochrane Library for publications before Dec 1st, 2021, reporting on anemia in SAH patients. The presence and severity of anemia were assessed according to the reported hemoglobin values and/or institutional thresholds for red blood cells transfusion (RBCT).

Results: Of 1755 original records, 34 full-text articles with 8387 patients treated between 1996 and 2020 were included in the final analysis (mean: 287.2 patients/study). Almost half of the patients (mean: 49.1%, range: 32%-82.6%) developed anemia during SAH. RBCT was performed in 33.6% of the cases, with institution-dependent transfusion thresholds ranging between 7.0 and 10.0 g/dL (mean: 8.4 g/dL). Independent associations with the risk of cerebral infarcts, in-hospital mortality and poor outcome were repetitively reported for the nadir hemoglobin values ≤10.0 g/dL. Moreover, patients with anemia and/or RBCT were at higher risk for cerebral vasospasm, hydrocephalus, epileptic seizures, infectious complications, and longer hospital stay. Female sex, higher initial clinical and radiographic severity of SAH and aneurysm clipping were the most consistently reported risk factors for post-SAH anemia.

Conclusion: Due to predominantly restrictive RBCT practices in most neurovascular centers, every second SAH patient develops anemia. The decrease in Hb becomes relevant starting from a hemoglobin level of 10.0 g/dL. Our findings underline the need for a prospective randomized controlled trial comparing the risks and benefits of restrictive and generous RBCT policies in SAH patients.