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Purpose Anaemia is common in patients presenting with aneurysmal subarachnoid (aSAH) and intracerebral haemorrhage (ICH). In surgical patients, anaemia was identified as an idenpendent risk factor for postoperative mortality, prolonged hospital length of stay (LOS) and increased risk of red blood cell (RBC) transfusion. This multicentre cohort observation study describes the incidence and effects of preoperative anaemia in this critical patient collective for a 10-year period. Methods This multicentre observational study included adult in-hospital surgical patients diagnosed with aSAH or ICH of 21 German hospitals (discharged from 1 January 2010 to 30 September 2020). Descriptive, univariate and multivariate analyses were performed to investigate the incidence and association of preoperative anaemia with RBC transfusion, in-hospital mortality and postoperative complications in patients with aSAH and ICH. Results A total of n = 9081 patients were analysed (aSAH n = 5008; ICH n = 4073). Preoperative anaemia was present at 28.3% in aSAH and 40.9% in ICH. RBC transfusion rates were 29.9% in aSAH and 29.3% in ICH. Multivariate analysis revealed that preoperative anaemia is associated with a higher risk for RBC transfusion (OR = 3.25 in aSAH, OR = 4.16 in ICH, p < 0.001), for in-hospital mortality (OR = 1.48 in aSAH, OR = 1.53 in ICH, p < 0.001) and for several postoperative complications. Conclusions Preoperative anaemia is associated with increased RBC transfusion rates, in-hospital mortality and postoperative complications in patients with aSAH and ICH. Trial registration ClinicalTrials.gov, NCT02147795, https://clinicaltrials.gov/ct2/show/NCT02147795

Background Blood transfusions are common medical procedures and every age group requires detailed insights and treatment bundles. The aim of this study was to examine the association of anaemia, co-morbidities, complications, in-hospital mortality, and transfusion according to age groups to identify patient groups who are particularly at risk when undergoing surgery. Methods Data from 21 Hospitals of the Patient Blood Management Network Registry were analysed. Patients were divided into age subgroups. The incidence of preoperative anaemia, co-morbidities, surgical disciplines, hospital length of stay, complications, in-hospital mortality rate, and transfusions were analysed by descriptive and multivariate regression analysis. Results A total of 1 117 919 patients aged 18–108 years were included. With increasing age, the number of co-morbidities and incidence of preoperative anaemia increased. Complications, hospital length of stay, and in-hospital mortality increased with age and were higher in patients with preoperative anaemia. The mean number of transfused red blood cells (RBCs) peaked, whereas the transfusion rate increased continuously. Multivariate regression analysis showed that increasing age, co-morbidities, and preoperative anaemia were independent risk factors for complications, longer hospital length of stay, in-hospital mortality, and the need for RBC transfusion. Conclusion Increasing age, co-morbidities, and preoperative anaemia are independent risk factors for complications, longer hospital length of stay, in-hospital mortality, and the need for RBC transfusion. Anaemia diagnosis and treatment should be established in all patients.

Approximately one in three patients has untreated preoperative anaemia, which in turn is associated with an increased need for transfusion of allogenic red blood cell concentrates (RBC) and complications in the context of a surgical intervention. Here, the prevalence of preoperative and postoperative anaemia as well as their effects on transfusion rate, hospital length of stay and hospital mortality in primary hip and knee arthroplasty has been analysed.From January 2012 to September 2018, 378,069 adult inpatients from 13 German hospitals were analysed on the basis of an anonymized registry. Of these, n = 10,017 patients had a hip and knee joint primary arthroplasty. The primary endpoint was the incidence of preoperative anaemia, which was analysed by the first available preoperative haemoglobin value according to the WHO definition. Secondary endpoints included in-hospital length of stay, number of patients with red blood cell concentrate transfusion, incidence of hospital-acquired anaemia, number of deceased patients, and postoperative complications.The preoperative anaemia rate was 14.8% for elective knee joint arthroplasty, 22.9% for elective hip joint arthroplasty and 45.0% for duo-prosthesis implantation. Preoperative anaemia led to a significantly higher transfusion rate (knee: 8.3 vs. 1.8%; hip: 34.5 vs. 8.1%; duo-prosthesis: 42.3 vs. 17.4%), an increased red blood cell concentrate consumption (knee: 256 ± 107 vs. 29 ± 5 RBC/1000 patients; hip: 929 ± 60 vs. 190 ± 16 RBC/1000 patients; duo-prosthesis: 1411 ± 98 vs. 453 ± 42 RBC/1000 patients). Pre-operative anaemia was associated with prolonged hospital stay (12.0 [10.0; 17.0] d vs. 11.0 [9.0; 13.0] d; p 0.001) and increased mortality (5.5% [4.6 - 6.5%] vs. 0.9% [0.7 - 1.2%]; Fisher p 0.001) compared to non-anaemic patients. In patients aged 80 years and older, the incidence of preoperative anaemia and thus the transfusion rate was almost twice as high as in patients under 80 years of age.Preoperative anaemia is common in knee and hip primary arthroplasty and was associated with a relevant increase in red blood cell concentrate consumption. In the context of patient blood management, a relevant potential arises, especially in elective orthopaedic surgery, to better prepare elective patients, to avoid unnecessary transfusions and thus to conserve the valuable resource blood.Präoperativ liegt bei etwa jedem 3. Patienten eine nicht therapierte Anämie vor, die wiederum im Kontext eines chirurgischen Eingriffs mit einem erhöhten Transfusionsbedarf von allogenen Erythrozytenkonzentraten (EK) sowie Komplikationen einhergeht. In der vorliegenden Arbeit soll die Prävalenz einer prä- und postoperativen Anämie und deren Einfluss auf den Transfusionsbedarf von EK, Krankenhausverweildauer sowie Krankenhaussterblichkeit in der primären Hüft- und Kniegelenkendoprothetik analysiert werden.Basierend auf einem anonymisierten Register wurden von Januar 2012 bis September 2018 378 069 erwachsene stationäre Patienten aus 13 deutschen Krankenhäusern analysiert, von denen n = 10 017 Patienten eine Hüft- und Kniegelenkprimärimplantation hatten. Der primäre Endpunkt war die Inzidenz einer präoperativen Anämie, die über den 1. präoperativ verfügbaren Hämoglobinwert entsprechend der WHO-Definition analysiert wurde. Zu den sekundären Endpunkten zählte die Krankenhausverweildauer, Anzahl Patienten mit EK-Transfusion, Inzidenz einer postoperativen krankenhauserworbenen Anämie, Anzahl verstorbener Patienten sowie verschiedene postoperative Komplikationen.Die präoperative Anämierate betrug bei elektiver Kniegelenkendoprothetik 14,8%, bei elektiver Hüftgelenkendoprothetik 22,9% und bei Duokopfprothesenimplantation sogar 45,0%. Eine präoperative Anämie führte zu einer signifikant höheren EK-Transfusionsrate (Kniegelenkprothese: 8,3 vs. 1,8%; Hüftgelenksprothese: 34,5 vs. 8,1%; Duokopfprothese: 42,3 vs. 17,4%) sowie einem erhöhten EK-Verbrauch (Kniegelenk: 256 ± 107 vs. 29 ± 5 EK/1000 Patienten; Hüftgelenk: 929 ± 60 vs. 190 ± 16 EK/1000 Patienten; Duokopfprothese: 1411 ± 98 vs. 453 ± 42). Im Gesamtkollektiv war eine präoperative Anämie gegenüber nicht anämischen Patienten mit einer verlängerten Krankenhausverweildauer (12,0 [10,0; 17,0] d vs. 11,0 [9,0; 13,0] d; p 0,001) sowie einer erhöhten Sterblichkeit assoziiert (5,5% [4,6 – 6,5%] vs. 0,9% [0,7% – 1,2%]; Fisher p 0,001). Bei Patienten mit einem Alter von 80 Jahren und höher war die Inzidenz einer präoperativen Anämie und damit die Transfusionsrate nahezu doppelt so hoch wie bei den unter 80-Jährigen.Eine präoperative Anämie kommt bei Knie- und Hüftgelenkprimärimplantation häufig vor und ist mit einem relevant erhöhten EK-Verbrauch assoziiert. Vor diesem Hintergrund könnte sich in der Zukunft vor allem in der elektiven orthopädischen Chirurgie ein relevantes Potenzial ergeben, im Sinne von Patient Blood Management die elektiven Patienten besser vorzubereiten, um unnötige Transfusionen zu vermeiden und so die wertvolle Ressource Blut zu schonen.

Neuronal growth factors regulate the survival of neurons by their survival and death-promoting activity on distinct populations of neurons. The neurotrophins nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), and neurotrophin-3 (NT-3) promote neuronal survival via tyrosine kinase (Trk) receptors, whereas NGF and BDNF can also induce apoptosis in developing neurons through p75NTRreceptors in the absence of their respective Trk receptors. Using mutant mice and inactivation of neurotrophins and their receptors with antibodies in rats, we show that endogenous NT-3 induces death of adult BDNF-dependent, axotomized corticospinal neurons (CSNs). When NT-3 is neutralized, the neurons survive even without BDNF, suggesting complete antagonism. Whereas virtually all unlesioned and axotomized CSNs express both trkB and trkC mRNA, p75 is barely detectable in unlesioned CSNs but strongly upregulated in axotomized CSNs by day 3 after lesion, the time point when cell death occurs. Blocking either cortical TrkC or p75NTRreceptors alone prevents death, indicating that the opposing actions of NT-3 and BDNF require their respective Trk receptors, but induction of death depends on p75NTRcosignaling. The results show that neuronal survival can be regulated antagonistically by neurotrophins and that neurotrophins can induce neuronal death in the adult mammalian CNS. We further present evidence that signaling of tyrosine kinase receptors of thetrkfamily can be crucially involved in the promotion of neuronal deathin vivo.