Castella Alberto, Attanasio Laila, Schuind Sophie, Peluso Lorenzo, Annoni Filippo, Vincent Jean-Louis, Creteur Jacques, Taccone Fabio Silvio, Gouvêa Bogossian Elisa
Department of Intensive Care, Erasme Hospital-Université Libre de Bruxelles, Route de Lennik, 808, 1070 Brussels, Belgium.
Department of Neurosurgery, Erasme Hospital-Université Libre de Bruxelles, Route de Lennik, 808, 1070 Brussels, Belgium.
Clin Neurol Neurosurg. 2021 Jul;206:106676. doi: 10.1016/j.clineuro.2021.106676. Epub 2021 May 10.
The benefits of correcting anemia using red blood cell transfusion (RBCT) after subarachnoid hemorrhage (SAH) are controversial. We aimed to evaluate the role of anemia and RBCT on neurological outcome after SAH using a restrictive transfusion policy.
We reviewed our institutional database of adult patients admitted to the Department of Intensive Care (ICU) after non-traumatic SAH over a 5-year period. We recorded hemoglobin (Hb) levels daily for a maximum of 20 days, as well as the use of RBCT. Unfavorable neurological outcome (UO) was defined as a Glasgow Outcome Score of 1-3 at 3 months.
Among 270 eligible patients, UO was observed in 40% of them. Patients with UO had lower Hb over time and received RBCT more frequently than others (15/109, 14% vs. 6/161, 4% - p < 0.01). Pre-RBCT median Hb values were similar in UO and FO patients (6.9 [6.6-7.1] vs. 7.3 [6.3-8.1] g/dL - p = 0.21). The optimal discriminative Hb threshold for UO was 9 g/dL. In a multivariable analysis, neither anemia nor RBCT were independently associated with UO.
In this retrospective single center study using a restrictive strategy of RBCT in SAH patients was not associated with worse outcome in 3 months.
蛛网膜下腔出血（SAH）后使用红细胞输血（RBCT）纠正贫血的益处存在争议。我们旨在采用限制性输血策略评估贫血和RBCT对SAH后神经功能结局的作用。
我们回顾了5年间入住重症监护病房（ICU）的非创伤性SAH成年患者的机构数据库。我们每天记录血红蛋白（Hb）水平，最长记录20天，以及RBCT的使用情况。不良神经功能结局（UO）定义为3个月时格拉斯哥结局评分1-3分。
在270例符合条件的患者中，40%观察到UO。UO患者的Hb随时间降低，且比其他患者更频繁接受RBCT（15/109，14%对6/161，4% - p<0.01）。RBCT前UO和非UO患者的Hb中位数相似（6.9[6.6-7.1]对7.3[6.3-8.1]g/dL - p = 0.21）。UO的最佳鉴别Hb阈值为9 g/dL。在多变量分析中，贫血和RBCT均与UO无独立关联。
在这项回顾性单中心研究中，对SAH患者采用RBCT的限制性策略与3个月时较差结局无关。
