Impact of Anemia Severity on the Outcome of an Aneurysmal Subarachnoid Hemorrhage
Objective: Previous reports indicate a negative impact of anemia on the outcome of an aneurysmal subarachnoid hemorrhage (SAH). We aimed to identify the outcome-relevant severity of post-SAH anemia. Methods: SAH cases treated at our institution between 01/2005 and 06/2016 were included (<i>n&l...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
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MDPI AG
2022-10-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/21/6258 |
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| author | Maryam Said Thiemo Florin Dinger Meltem Gümüs Laurèl Rauschenbach Mehdi Chihi Jan Rodemerk Veronika Lenz Marvin Darkwah Oppong Anne-Kathrin Uerschels Philipp Dammann Karsten Henning Wrede Ulrich Sure Ramazan Jabbarli |
| author_facet | Maryam Said Thiemo Florin Dinger Meltem Gümüs Laurèl Rauschenbach Mehdi Chihi Jan Rodemerk Veronika Lenz Marvin Darkwah Oppong Anne-Kathrin Uerschels Philipp Dammann Karsten Henning Wrede Ulrich Sure Ramazan Jabbarli |
| author_sort | Maryam Said |
| collection | DOAJ |
| description | Objective: Previous reports indicate a negative impact of anemia on the outcome of an aneurysmal subarachnoid hemorrhage (SAH). We aimed to identify the outcome-relevant severity of post-SAH anemia. Methods: SAH cases treated at our institution between 01/2005 and 06/2016 were included (<i>n</i> = 640). The onset, duration, and severity (nadir hemoglobin (nHB) level) of anemia during the initial hospital stay were recorded. Study endpoints were new cerebral infarctions, a poor outcome six months post-SAH (modified Rankin scale > 3), and in-hospital mortality. To assess independent associations with the study endpoints, different multivariable regression models were performed, adjusted for relevant patient and baseline SAH characteristics as well as anemia-associated clinical events during the SAH. Results: The rates of anemia were 83.3%, 67.7%, 40.0%, 15.9%, and 4.5% for an nHB < 11 g/dL, < 10 g/dL, < 9 g/dL, < 8 g/dL, and < 7 g/dL, respectively. The higher the anemia severity, the later was the onset (post-SAH days 2, 4, 5.4, 7.6 and 8, <i>p</i> < 0.0001) and the shorter the duration (8 days, 6 days, 4 days, 3 days, and 2 days, <i>p</i> < 0.0001) of anemia. In the final multivariable analysis, only an nHB < 9 g/dL was independently associated with all study endpoints: adjusted odds ratio 1.7/3.22/2.44 for cerebral infarctions/in-hospital mortality/poor outcome. The timing (post-SAH day 3.9 vs. 6, <i>p</i> = 0.001) and duration (3 vs. 5 days, <i>p</i> = 0.041) of anemia with an nHB < 9 g/dL showed inverse associations with the risk of in-hospital mortality, but not with other study endpoints. Conclusions: Anemia is very common in SAH patients affecting four of five individuals during their hospital stay. An nHB decline to < 9 g/dL was strongly associated with all study endpoints, independent of baseline characteristics and SAH-related clinical events. Our data encourage further prospective evaluations of the value of different transfusion strategies in the functional outcomes of SAH patients. |
| first_indexed | 2024-03-09T18:58:47Z |
| format | Article |
| id | doaj.art-90e2cef87d0e4e56a428073ca76ba6a7 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T18:58:47Z |
| publishDate | 2022-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-90e2cef87d0e4e56a428073ca76ba6a72023-11-24T05:14:48ZengMDPI AGJournal of Clinical Medicine2077-03832022-10-011121625810.3390/jcm11216258Impact of Anemia Severity on the Outcome of an Aneurysmal Subarachnoid HemorrhageMaryam Said0Thiemo Florin Dinger1Meltem Gümüs2Laurèl Rauschenbach3Mehdi Chihi4Jan Rodemerk5Veronika Lenz6Marvin Darkwah Oppong7Anne-Kathrin Uerschels8Philipp Dammann9Karsten Henning Wrede10Ulrich Sure11Ramazan Jabbarli12Department of Neurosurgery and Spine Surgery, University Hospital of Essen, 45147 Essen, GermanyDepartment of Neurosurgery and Spine Surgery, University Hospital of Essen, 45147 Essen, GermanyDepartment of Neurosurgery and Spine Surgery, University Hospital of Essen, 45147 Essen, GermanyDepartment of Neurosurgery and Spine Surgery, University Hospital of Essen, 45147 Essen, GermanyDepartment of Neurosurgery and Spine Surgery, University Hospital of Essen, 45147 Essen, GermanyDepartment of Neurosurgery and Spine Surgery, University Hospital of Essen, 45147 Essen, GermanyInstitute of Transfusion Medicine, University Hospital of Essen, 45147 Essen, GermanyDepartment of Neurosurgery and Spine Surgery, University Hospital of Essen, 45147 Essen, GermanyDepartment of Neurosurgery and Spine Surgery, University Hospital of Essen, 45147 Essen, GermanyDepartment of Neurosurgery and Spine Surgery, University Hospital of Essen, 45147 Essen, GermanyDepartment of Neurosurgery and Spine Surgery, University Hospital of Essen, 45147 Essen, GermanyDepartment of Neurosurgery and Spine Surgery, University Hospital of Essen, 45147 Essen, GermanyDepartment of Neurosurgery and Spine Surgery, University Hospital of Essen, 45147 Essen, GermanyObjective: Previous reports indicate a negative impact of anemia on the outcome of an aneurysmal subarachnoid hemorrhage (SAH). We aimed to identify the outcome-relevant severity of post-SAH anemia. Methods: SAH cases treated at our institution between 01/2005 and 06/2016 were included (<i>n</i> = 640). The onset, duration, and severity (nadir hemoglobin (nHB) level) of anemia during the initial hospital stay were recorded. Study endpoints were new cerebral infarctions, a poor outcome six months post-SAH (modified Rankin scale > 3), and in-hospital mortality. To assess independent associations with the study endpoints, different multivariable regression models were performed, adjusted for relevant patient and baseline SAH characteristics as well as anemia-associated clinical events during the SAH. Results: The rates of anemia were 83.3%, 67.7%, 40.0%, 15.9%, and 4.5% for an nHB < 11 g/dL, < 10 g/dL, < 9 g/dL, < 8 g/dL, and < 7 g/dL, respectively. The higher the anemia severity, the later was the onset (post-SAH days 2, 4, 5.4, 7.6 and 8, <i>p</i> < 0.0001) and the shorter the duration (8 days, 6 days, 4 days, 3 days, and 2 days, <i>p</i> < 0.0001) of anemia. In the final multivariable analysis, only an nHB < 9 g/dL was independently associated with all study endpoints: adjusted odds ratio 1.7/3.22/2.44 for cerebral infarctions/in-hospital mortality/poor outcome. The timing (post-SAH day 3.9 vs. 6, <i>p</i> = 0.001) and duration (3 vs. 5 days, <i>p</i> = 0.041) of anemia with an nHB < 9 g/dL showed inverse associations with the risk of in-hospital mortality, but not with other study endpoints. Conclusions: Anemia is very common in SAH patients affecting four of five individuals during their hospital stay. An nHB decline to < 9 g/dL was strongly associated with all study endpoints, independent of baseline characteristics and SAH-related clinical events. Our data encourage further prospective evaluations of the value of different transfusion strategies in the functional outcomes of SAH patients.https://www.mdpi.com/2077-0383/11/21/6258subarachnoid hemorrhageanemiaoutcomerisk factors |
| spellingShingle | Maryam Said Thiemo Florin Dinger Meltem Gümüs Laurèl Rauschenbach Mehdi Chihi Jan Rodemerk Veronika Lenz Marvin Darkwah Oppong Anne-Kathrin Uerschels Philipp Dammann Karsten Henning Wrede Ulrich Sure Ramazan Jabbarli Impact of Anemia Severity on the Outcome of an Aneurysmal Subarachnoid Hemorrhage Journal of Clinical Medicine subarachnoid hemorrhage anemia outcome risk factors |
| title | Impact of Anemia Severity on the Outcome of an Aneurysmal Subarachnoid Hemorrhage |
| title_full | Impact of Anemia Severity on the Outcome of an Aneurysmal Subarachnoid Hemorrhage |
| title_fullStr | Impact of Anemia Severity on the Outcome of an Aneurysmal Subarachnoid Hemorrhage |
| title_full_unstemmed | Impact of Anemia Severity on the Outcome of an Aneurysmal Subarachnoid Hemorrhage |
| title_short | Impact of Anemia Severity on the Outcome of an Aneurysmal Subarachnoid Hemorrhage |
| title_sort | impact of anemia severity on the outcome of an aneurysmal subarachnoid hemorrhage |
| topic | subarachnoid hemorrhage anemia outcome risk factors |
| url | https://www.mdpi.com/2077-0383/11/21/6258 |
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