Abstract Details

Title Association of Hemoglobin Trend and Outcome in Aneurysmal Subarachnoid Hemorrhage: A Single Center Cohort Study

Topic Neuro Trauma and Critical Care

Presentation(s) P1 - Poster Session 1 (9:00 AM-5:00 PM)

Poster/Presentation
Number 365

Objective

To evaluate predictors of hemoglobin (Hb) trend and its association with outcomes in patients with aneurysmal subarachnoid hemorrhage (aSAH).

Background Anemia has been linked to delayed cerebral ischemia and worse outcome in patients with aSAH. However, the association of Hb trend with outcomes is unclear.

Design/Methods We conducted a retrospective cohort study of aSAH patients admitted to a single academic center from 2016 to 2021. Multiple linear regression analysis was used to identify factors associated with Hb difference from admission to discharge. Binary logistic regression analysis was used to test the association of Hb values with outcome measures including vasospasm and worse functional outcome defined as modified Rankin scale 4-6 at 3 months after discharge.

Results We included 312 patients with confirmed aneurysmal etiology (mean age 57 years, SD13.6; 62% female; 70% white). Mean Hb on admission was 13.5 g/dl (SD 1.7) and on discharge was 11.1 g/dl (SD 2). Forty-three patients (14%) required blood transfusions. Greater Hb drop from admission to discharge was independently associated with higher risk of vasospasm (OR 1.16, 95% CI 1.02-1.30; p=0.018) but not worse outcome after adjustment for age, sex, Hb on admission, Hunt and Hess grades, modified Fisher scales. Predictors of Hb drop were lower Hb on admission (beta=0.61, p<0.001), longer ICU length of stay (0.5 mg/dl drop per 10 days, p<0.001), female sex (beta=0.66, p=0.008) and higher Hunt and Hess grades (beta=0.34 per grade, p=001) but age, inpatient surgeries and modified Fisher scales were not associated with Hb drop.

Conclusions Greater hemoglobin drop can be associated with higher risk of vasospasm but not necessarily worse outcome which can possibly be related to blood transfusions. Longer ICU length of stay can increase risk of Hb drop. Further studies are needed to use Hb trend to guide transfusion threshold in these patients.

Authors/Disclosures
Asghar Shah PRESENTER	No disclosure on file
Ryan Snow (Warren Alpert Medical School of Brown University)	Mr. Snow has nothing to disclose.
Christoph Stretz, MD, FAAN (Rhode Island Hospital, Department of Neurology)	The institution of Dr. Stretz has received research support from American Heart Association. The institution of Dr. Stretz has received research support from Duke University Medical Center/NIH. The institution of Dr. Stretz has received research support from University of Cincinnati/NINDS.
Nicholas S. Potter, MD, PhD (Rhode Island Hospital)	Dr. Potter has nothing to disclose.
Linda C. Wendell, MD, FAAN (Mount Auburn Hospital)	Dr. Wendell has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various. An immediate family member of Dr. Wendell has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various. Dr. Wendell has stock in Apple. An immediate family member of Dr. Wendell has stock in Apple.
Bradford B. Thompson, MD (St. Elizabeth’s Medical Center)	Dr. Thompson has nothing to disclose.
Jesse Menville	Ms. Menville has nothing to disclose.
Karen L. Furie, MD (RIH/Alpert Medical School of Brown Univ)	The institution of Dr. Furie has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Janssen/BMS. Dr. Furie has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for BMJ/JNNP. The institution of Dr. Furie has received research support from NINDS.
Ali Mahta, MD (Brown University)	Dr. Mahta has received research support from Brown University Health.

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