Anemia prevalence and incidence and red blood cell transfusion practices in aneurysmal subarachnoid hemorrhage: results of a multicenter cohort study
Abstract Background Whether a restrictive strategy for red blood cell (RBC) transfusion is applied to patients with aneurysmal subarachnoid hemorrhage (aSAH) is unclear. To inform the design and conduct of a future clinical trial, we sought to describe transfusion practices, hemoglobin (Hb) triggers...
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| Language: | English |
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BMC
2018-07-01
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| Series: | Critical Care |
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| Online Access: | http://link.springer.com/article/10.1186/s13054-018-2089-7 |
| _version_ | 1828382497853931520 |
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| author | Shane W. English Michaël Chassé Alexis F. Turgeon François Lauzier Donald Griesdale Allan Garland Dean Fergusson Ryan Zarychanski Carl van Walraven Kaitlyn Montroy Jennifer Ziegler Raphael Dupont-Chouinard Raphaëlle Carignan Andy Dhaliwal Ranjeeta Mallick John Sinclair Amélie Boutin Giuseppe Pagliarello Alan Tinmouth Lauralyn McIntyre on behalf of the Canadian Critical Care Trials Group |
| author_facet | Shane W. English Michaël Chassé Alexis F. Turgeon François Lauzier Donald Griesdale Allan Garland Dean Fergusson Ryan Zarychanski Carl van Walraven Kaitlyn Montroy Jennifer Ziegler Raphael Dupont-Chouinard Raphaëlle Carignan Andy Dhaliwal Ranjeeta Mallick John Sinclair Amélie Boutin Giuseppe Pagliarello Alan Tinmouth Lauralyn McIntyre on behalf of the Canadian Critical Care Trials Group |
| author_sort | Shane W. English |
| collection | DOAJ |
| description | Abstract Background Whether a restrictive strategy for red blood cell (RBC) transfusion is applied to patients with aneurysmal subarachnoid hemorrhage (aSAH) is unclear. To inform the design and conduct of a future clinical trial, we sought to describe transfusion practices, hemoglobin (Hb) triggers, and predictors of RBC transfusion in patients with aSAH. Methods This is a retrospective cohort study of all consecutively admitted adult patients with aSAH at four tertiary care centers from January 1, 2012, to December 31, 2013. Patients were identified from hospital administrative discharge records and existing local aSAH databases. Data collection by trained abstractors included demographic data, aSAH characteristics, Hb and transfusion data, other major aSAH cointerventions, and outcomes using a pretested case report form with standardized procedures. Descriptive statistics were used to summarize data, and regression models were used to identify associations between anemia, transfusion, and other relevant predictors and outcome. Results A total of 527 patients met inclusion eligibility. Mean (±SD) age was 57 ± 13 years, and 357 patients (67.7%) were female. The median modified Fisher grade was 4 (IQR 3–4). Mean nadir Hb was 98 ± 20 g/L and occurred on median admission day 4 (IQR 2–11). RBC transfusion occurred in 100 patients (19.0%). Transfusion rates varied across centers (12.1–27.4%, p = 0.02). Patients received a median of 1 RBC unit (IQR 1–2) per transfusion episode and a median total of 2 units (IQR 1–4). Median pretransfusion Hb for first transfusion was 79 g/L (IQR 74–93) and did not vary substantially across centers (78–82 g/L, p = 0.37). Of patients with nadir Hb < 80 g/L, 66.3% received a transfusion compared with 2.0% with Hb nadir ≥ 100 g/L (p < 0.0001). Predictors of transfusion were history of oral anticoagulant use, anterior circulation aneurysm, neurosurgical clipping, and lower Hb. Controlling for numerous potential confounders, transfusion was not independently associated with poor outcome. Conclusions We observed that moderate anemia remains very common early in admission following SAH. Only one-fifth of patients with SAH received RBC transfusions, mostly in cases of significant anemia (Hb < 80 g/L), and this did not appear to be associated with outcome. |
| first_indexed | 2024-12-10T04:32:57Z |
| format | Article |
| id | doaj.art-30471a2d97424a278066692b3ca3cebc |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-10T04:32:57Z |
| publishDate | 2018-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-30471a2d97424a278066692b3ca3cebc2022-12-22T02:02:05ZengBMCCritical Care1364-85352018-07-012211910.1186/s13054-018-2089-7Anemia prevalence and incidence and red blood cell transfusion practices in aneurysmal subarachnoid hemorrhage: results of a multicenter cohort studyShane W. English0Michaël Chassé1Alexis F. Turgeon2François Lauzier3Donald Griesdale4Allan Garland5Dean Fergusson6Ryan Zarychanski7Carl van Walraven8Kaitlyn Montroy9Jennifer Ziegler10Raphael Dupont-Chouinard11Raphaëlle Carignan12Andy Dhaliwal13Ranjeeta Mallick14John Sinclair15Amélie Boutin16Giuseppe Pagliarello17Alan Tinmouth18Lauralyn McIntyre19on behalf of the Canadian Critical Care Trials GroupDepartment of Medicine (Critical Care), The Ottawa HospitalDepartment of Medicine, University of MontrealDepartment of Anesthesiology & Critical Care, Université LavalDepartment of Anesthesiology & Critical Care, Université LavalDeparment of Anesthesiology, Pharmacology & Therapeutics, University of British ColumbiaDepartment of Medicine, University of ManitobaClinical Epidemiology Program (Centre for Transfusion Research), Ottawa Hospital Research InstituteDepartment of Medicine, University of ManitobaDepartment of Medicine, University of OttawaClinical Epidemiology Program (Centre for Transfusion Research), Ottawa Hospital Research InstituteDepartment of Medicine, University of ManitobaDepartment of Anesthesiology & Critical Care, Université LavalDepartment of Anesthesiology & Critical Care, Université LavalDepartment of Medicine, University of SaskatchewanClinical Epidemiology Program (Centre for Transfusion Research), Ottawa Hospital Research InstituteDepartment of Surgery (Neurosurgery), University of OttawaDepartment of Social and Preventive Medicine, Université LavalDepartment of Surgery, University of OttawaClinical Epidemiology Program (Centre for Transfusion Research), Ottawa Hospital Research InstituteDepartment of Medicine (Critical Care), The Ottawa HospitalAbstract Background Whether a restrictive strategy for red blood cell (RBC) transfusion is applied to patients with aneurysmal subarachnoid hemorrhage (aSAH) is unclear. To inform the design and conduct of a future clinical trial, we sought to describe transfusion practices, hemoglobin (Hb) triggers, and predictors of RBC transfusion in patients with aSAH. Methods This is a retrospective cohort study of all consecutively admitted adult patients with aSAH at four tertiary care centers from January 1, 2012, to December 31, 2013. Patients were identified from hospital administrative discharge records and existing local aSAH databases. Data collection by trained abstractors included demographic data, aSAH characteristics, Hb and transfusion data, other major aSAH cointerventions, and outcomes using a pretested case report form with standardized procedures. Descriptive statistics were used to summarize data, and regression models were used to identify associations between anemia, transfusion, and other relevant predictors and outcome. Results A total of 527 patients met inclusion eligibility. Mean (±SD) age was 57 ± 13 years, and 357 patients (67.7%) were female. The median modified Fisher grade was 4 (IQR 3–4). Mean nadir Hb was 98 ± 20 g/L and occurred on median admission day 4 (IQR 2–11). RBC transfusion occurred in 100 patients (19.0%). Transfusion rates varied across centers (12.1–27.4%, p = 0.02). Patients received a median of 1 RBC unit (IQR 1–2) per transfusion episode and a median total of 2 units (IQR 1–4). Median pretransfusion Hb for first transfusion was 79 g/L (IQR 74–93) and did not vary substantially across centers (78–82 g/L, p = 0.37). Of patients with nadir Hb < 80 g/L, 66.3% received a transfusion compared with 2.0% with Hb nadir ≥ 100 g/L (p < 0.0001). Predictors of transfusion were history of oral anticoagulant use, anterior circulation aneurysm, neurosurgical clipping, and lower Hb. Controlling for numerous potential confounders, transfusion was not independently associated with poor outcome. Conclusions We observed that moderate anemia remains very common early in admission following SAH. Only one-fifth of patients with SAH received RBC transfusions, mostly in cases of significant anemia (Hb < 80 g/L), and this did not appear to be associated with outcome.http://link.springer.com/article/10.1186/s13054-018-2089-7Subarachnoid hemorrhageCerebral aneurysmAnemiaRed blood cell transfusionCohort study |
| spellingShingle | Shane W. English Michaël Chassé Alexis F. Turgeon François Lauzier Donald Griesdale Allan Garland Dean Fergusson Ryan Zarychanski Carl van Walraven Kaitlyn Montroy Jennifer Ziegler Raphael Dupont-Chouinard Raphaëlle Carignan Andy Dhaliwal Ranjeeta Mallick John Sinclair Amélie Boutin Giuseppe Pagliarello Alan Tinmouth Lauralyn McIntyre on behalf of the Canadian Critical Care Trials Group Anemia prevalence and incidence and red blood cell transfusion practices in aneurysmal subarachnoid hemorrhage: results of a multicenter cohort study Critical Care Subarachnoid hemorrhage Cerebral aneurysm Anemia Red blood cell transfusion Cohort study |
| title | Anemia prevalence and incidence and red blood cell transfusion practices in aneurysmal subarachnoid hemorrhage: results of a multicenter cohort study |
| title_full | Anemia prevalence and incidence and red blood cell transfusion practices in aneurysmal subarachnoid hemorrhage: results of a multicenter cohort study |
| title_fullStr | Anemia prevalence and incidence and red blood cell transfusion practices in aneurysmal subarachnoid hemorrhage: results of a multicenter cohort study |
| title_full_unstemmed | Anemia prevalence and incidence and red blood cell transfusion practices in aneurysmal subarachnoid hemorrhage: results of a multicenter cohort study |
| title_short | Anemia prevalence and incidence and red blood cell transfusion practices in aneurysmal subarachnoid hemorrhage: results of a multicenter cohort study |
| title_sort | anemia prevalence and incidence and red blood cell transfusion practices in aneurysmal subarachnoid hemorrhage results of a multicenter cohort study |
| topic | Subarachnoid hemorrhage Cerebral aneurysm Anemia Red blood cell transfusion Cohort study |
| url | http://link.springer.com/article/10.1186/s13054-018-2089-7 |
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