BACKGROUND: Accumulating data suggest that anemia worsens outcomes in critically ill patients, including those with subarachnoid and intracerebral hemorrhage (ICH). Although packed red blood cell (PRBC) transfusion appears to increase brain tissue oxygen, it is unknown whether such transfusions, which are commonly administered in patients with intracranial hemorrhage, alter outcome.
OBJECTIVE: Following up on our observation that anemia is associated with poor outcome in patients with ICH, we investigated whether PRBC transfusion was associated with any benefit.
METHODS: Five hundred forty-six consecutive subjects were identified from an ongoing single-center, prospective cohort study of nontraumatic ICH over a 6-year period. Clinical and radiographic characteristics, laboratory values including admission and daily mean hemoglobin values, and all instances of PRBC transfusion were recorded. Aggressiveness of care was assessed by whether the patient had a “do not resuscitate” order activated during hospitalization. The primary endpoint was 30-day survival.
RESULTS: Anemia was present in 144 of 546 patients (26%) on admission and developed subsequently in an additional 250, leaving just 152 of 546 patients (28%) who never developed anemia. PRBC transfusion was administered to 100 patients (18%) during their hospital stay, 98% of whom were anemic. In multivariable analysis, PRBC transfusion was associated with improved survival at 30 days (odds ratio: 2.76; 95% confidence interval: 1.45-5.26; P = .002).
CONCLUSION: Anemia develops in the majority of patients with ICH at some point during their hospitalization. PRBC transfusion was associated with improved outcome in these patients.
*Department of Neurology, Division of Stroke and Neurocritical Care, University of Maryland Medical Center, Baltimore, Maryland; ‡Center for Human Genetic Research, §Department of Medicine, ‖Division of Neurocritical Care and Emergency Neurology, ¶Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; #Department of Neurology, Stroke and Neurocritical Care Division, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; **Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
Received, April 8, 2010.
Accepted, September 27, 2010.
Correspondence: Kevin N. Sheth, MD, Department of Neurology, University of Maryland Medical Center, 110 S. Paca Street, 3rd Floor, Baltimore, MD 21201. E-mail: firstname.lastname@example.org