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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
  1. Donnie L Bell1,2,
  2. W Taylor Kimberly2,3,
  3. Albert J Yoo1,2,
  4. Thabele M Leslie-Mazwi2,4,
  5. James D Rabinov1,2,
  6. Jania E Bell,
  7. Brijesh P Mehta2,4,
  8. Joshua A Hirsch1,2
  1. 1Department of Radiology, Neuroendovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2Harvard Medical School, Boston, Massachusetts, USA
  3. 3Department of Neurology, Neurocritical Care, Massachusetts General Hospital, Boston, Massachusetts, USA
  4. 4Department of Neurology and Radiology, Neurocritical Care and Neuroendovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Donnie L Bell, Massachusetts General Hospital, Department of Radiology, Neuroendovascular Program, 55 Fruit Street, GRB 241, Boston, MA 02114, USA; dbell3{at}partners.org

Abstract

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.

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