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The Effects of Red Blood Cell Transfusion on Functional Outcome after Aneurysmal Subarachnoid Hemorrhage
- Source :
- World neurosurgery. 108
- Publication Year :
- 2016
-
Abstract
- Background The optimal red blood cell transfusion (RBCT) trigger for patients with aneurysmal subarachnoid hemorrhage (SAH) is unknown. In patients with cerebral vasospasm, anemia may increase susceptibility to ischemic injury; conversely, RBCT may worsen outcome given known deleterious effects. Objective To examine the association between RBCT, delayed cerebral ischemia (DCI), vasospasm, and outcome after SAH. Methods A total of 421 consecutive patients with SAH, admitted to a neurocritical care unit at a university-affiliated hospital and who underwent surgical occlusion of their ruptured aneurysm were retrospectively identified from a prospective observational database. Propensity score methods were used to reduce the bias associated with treatment selection. Results Two hundred and sixty-one patients (62.0%) received an RBCT. Angiographic vasospasm (odds ratio [OR] 1.6; 95% confidence interval [CI], 1.1–2.3; P = 0.025) but not severe angiographic spasm, DCI, or delayed infarction was associated with RBCT. A total of 283 patients (67.2%) experienced a favorable outcome, defined as good or moderately disabled on the Glasgow Outcome Scale; 47 (11.2%) were severely disabled or vegetative and 91 patients (21.6%) were dead at 6-month follow-up. Among patients who survived ≥2 days, RBCT was associated with unfavorable outcome (OR, 2.6; 95% CI, 1.6–4.1). Transfusion of ≥3 units of blood was associated with an increased incidence of unfavorable outcome. Propensity analysis to control for the probability of exposure to RBCT conditional on observed covariates measured before RBCT indicates that RBCT is associated with unfavorable outcome in the absence of DCI (OR, 2.17; 95% CI, 1.56–3.01; P P = 0.65). Conclusions Blood transfusions are associated with unfavorable outcome after SAH particularly when DCI is absent. Propensity analysis suggests that RBCT may be associated with poor outcome rather than being a marker of disease severity. However, when DCI is present, RBCT may help improve outcome.
- Subjects :
- Adult
Male
Subarachnoid hemorrhage
Databases, Factual
Anemia
Infarction
Glasgow Outcome Scale
Aneurysm, Ruptured
Neurosurgical Procedures
Brain Ischemia
03 medical and health sciences
0302 clinical medicine
Cerebral vasospasm
medicine
Odds Ratio
Humans
Vasospasm, Intracranial
cardiovascular diseases
Aged
Retrospective Studies
business.industry
Incidence
Neurointensive care
030208 emergency & critical care medicine
Vasospasm
Intracranial Aneurysm
Odds ratio
Cerebral Infarction
Middle Aged
Subarachnoid Hemorrhage
medicine.disease
Cerebral Angiography
Treatment Outcome
Anesthesia
Surgery
Female
Neurology (clinical)
business
Erythrocyte Transfusion
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 18788769
- Volume :
- 108
- Database :
- OpenAIRE
- Journal :
- World neurosurgery
- Accession number :
- edsair.doi.dedup.....95eca5f52357b265c0e9a9c337179983