Neurologic Critical Care

Higher hemoglobin is associated with improved outcome after subarachnoid hemorrhage*

Naidech, Andrew M. MD, MSPH; Jovanovic, Borko PhD; Wartenberg, Katja E. MD; Parra, Augusto MD, MPH; Ostapkovich, Noeleen MS; Connolly, E Sander MD; Mayer, Stephan A. MD, FCCM; Commichau, Christopher MD

Author Information

From the Neurological Institute, Columbia University, New York, NY (AMN, KEW, AP, NO, ESC, SAM, CC); and the Department of Preventive Medicine, Northwestern University, Chicago, IL (BJ).

Current address for Dr. Naidech: Northwestern University, 710 N. Lake Shore Drive, 11th Floor, Chicago, IL 60611.

Current address for Dr. Commichau: University of Vermont, Burlington, VT.

Current address for Dr. Wartenberg: Germany.

Current address for Dr. Parra: Department of Neurosurgery, The University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78229.

Dr. Naidech owned <500 stock shares of erythropoietin makers Johnson & Johnson and Amgen while this research was conducted but sold them before publication for unrelated reasons. Erythropoietin was not used in this research, but is discussed. Dr. Naidech holds a cerebrovascular fellowship grant from the NeuroCritical Care Society, sponsored by NovoNordisk, to perform a safety and feasibility trial (registered at www.stroketrials.org) of higher goal hemoglobin after subarachnoid hemorrhage. Dr. Connolly previously has received grant support from the National Institutes of Health. The remaining authors have not disclosed any potential conflicts of interest.

Supported, in part, by grant-in-aid 9750432N from the American Heart Association (SAM).

For information regarding this article, E-mail: [email protected]

Critical Care Medicine 35(10):p 2383-2389, October 2007. | DOI: 10.1097/01.CCM.0000284516.17580.2C

Abstract

Objective:

There are few data regarding anemia and transfusion after subarachnoid hemorrhage (SAH). We addressed the hypothesis that higher hemoglobin (HGB) levels are associated with less death and disability after SAH.

Design:

Prospective registry with automated data retrieval.

Patients:

Six hundred eleven patients enrolled in the Columbia University SAH Outcomes Project between August 1996 and June 2002.

Setting:

Neurologic intensive care unit.

Interventions:

Patients were treated according to standard management protocols.

Measurements and Main Results:

We electronically retrieved all HGB readings during the acute hospital stay for 611 consecutively admitted SAH patients. Outcomes were measured with the modified Rankin Scale at 14 days or discharge, and at 3 months. Patients who were independent (modified Rankin Scale, 0–3) at discharge or 14 days had higher mean (11.7 ± 1.5 vs. 10.9 ± 1.2, p < .001) and nadir (9.9 ± 2.1 vs. 8.6 ± 1.8, p < .001) HGB, and had higher HGB values every day in the hospital. There were similar results when patients were stratified by mortality. Higher HGB was associated with reduced risk of poor outcome (modified Rankin Scale, 4–6) at 14 days/discharge and 3 months after correcting for Hunt and Hess grade, age, history of diabetes, and cerebral infarction. Length of stay and HGB interacted such that lower HGB has a more pronounced effect with length of stay > 14 days.

Conclusions:

Higher HGB values are associated with improved outcomes after SAH at 14 days/discharge and 3 months. In contrast to general critical care patients, SAH patients may benefit from higher HGB. Determination of the optimal goal HGB after SAH will require separate prospective research.