Low neurologic intensive care unit hemoglobin as a predictor for intra-arterial vasospasm therapy and poor discharge modified Rankin Scale in aneurysmal subarachnoid haemorrhage-induced cerebral vasospasm

• Published in: Journal of neurointerventional surgery Vol. 7; no. 6; pp. 438 - 442
• Main Authors: Bell, Donnie L, Kimberly, W Taylor, Yoo, Albert J, Leslie-Mazwi, Thabele M, Rabinov, James D, Bell, Jania E, Mehta, Brijesh P, Hirsch, Joshua A
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.06.2015
• Subjects: Adult; Aged; Cross-Sectional Studies; Endovascular Procedures - statistics & numerical data; Female; Hemoglobins - analysis; Humans; Intensive Care Units; Intracranial Aneurysm - blood; Intracranial Aneurysm - complications; Male; Middle Aged; Patient Discharge; Prognosis; Retrospective Studies; Severity of Illness Index; Subarachnoid Hemorrhage - blood; Subarachnoid Hemorrhage - complications; Subarachnoid Hemorrhage - etiology; Vasospasm, Intracranial - blood; Vasospasm, Intracranial - etiology; Vasospasm, Intracranial - therapy; Subarachnoid; Hemorrhage; Aneurysm
• ISSN: 1759-8478; 1759-8486
• DOI: 10.1136/neurintsurg-2014-011164

Background Intra-arterial vasospasm therapy (IAVT) with vasodilators, balloon angioplasty, and cerebral blood flow augmentation devices are therapies for aneurysmal subarachnoid hemorrhage-induced symptomatic cerebral vasospasm refractory to maximal medical management. Our aim was to identify clinical factors predictive of IAVT and/or poor outcome. Methods A cross-sectional retrospective analysis was performed of 130 patients with aneurysmal subarachnoid hemorrhage including patients without and with symptomatic cerebral vasospasm requiring IAVT. The data were analysed by Student t test, univariate analysis and binary logistic regression. Results The mean±SD patient age was 54±12.2 years, admission hemoglobin was 13.6±1.5 g/dL, and neurologic intensive care unit (NICU) hemoglobin 11±1.4 g/dL. The median Hunt and Hess grade was 2 (range 1,4), Fisher grade 3 (range 3,3), and discharge modified Rankin Scale (mRS) 0.5 (range 0,2). Lower mean NICU hemoglobin was found in patients receiving IAVT than in those not receiving IAVT (M=10.4±0.9 g/dL vs M=11.2±1.4 g/dL, t(115)=−2.52, p=0.01). Further, lower mean NICU hemoglobin was associated with increased IAVT (ρ=−0.3, p<0.01) and higher discharge mRS (ρ=−0.5, p<0.01). In binary logistic regression, lower mean NICU hemoglobin was an independent predictor of IAVT (OR 0.6, 95% CI 0.4 to 0.9, p<0.05) as well as poor discharge mRS (OR 0.6, 95% CI 0.4 to 0.9, p<0.05). Hunt and Hess grade was also an independent predictor of these outcomes. Conclusions Lower mean hemoglobin during the acute phase of aneurysmal subarachnoid hemorrhage-induced cerebral vasospasm is an independent predictor of IAVT and poor discharge mRS. This relationship warrants further evaluation.