Anemia is Associated with Metabolic Distress and Brain Tissue Hypoxia After Subarachnoid Hemorrhage

Kurtz, Pedro; Schmidt, J. Michael; Claassen, Jan; Carrera, Emmanuel; Fernandez, Luis; Helbok, Raimund; Presciutti, Mary; Stuart, R. Morgan; Connolly, E. Sander; Badjatia, Neeraj; Mayer, Stephan A.; Lee, Ki-Won

doi:10.1007/s12028-010-9357-y

Cited by 71 publications

(37 citation statements)

References 40 publications

(54 reference statements)

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“…Depending on the definition applied, anemia has been identified in 40-50% of SAH patients and only 16% maintain Hb > 11 g/dL [27,54,55,67]. The mean drop in Hb after SAH is 3 g/dL, and anemia develops after a mean of 3.5 days [27].…”

Section: Summary Of the Literaturementioning

confidence: 99%

“…For example, using cerebral microdialysis in 20 poor-grade SAH patients, Hb B 9 g/dL was identified as an independent factor associated with cerebral tissue injury [53]. In a similar study in which patients requiring FiO 2 > 60% were excluded, Kurtz et al linked Hb < 10 g/dL with cell energy dysfunction [54]. Consistent with this, mathematical modeling based on animal experiments of brain ischemia suggests that Hb < 10 g/dL is associated with brain hypoxia [71].…”

Section: Summary Of the Literaturementioning

confidence: 99%

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Anemia and Transfusion After Subarachnoid Hemorrhage

Roux

2011

Neurocrit Care

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Delayed cerebral ischemia after subarachnoid hemorrhage (SAH) may be affected by a number of factors, including cerebral blood flow and oxygen delivery. Anemia affects about half of patients with SAH and is associated with worse outcome. Anemia also may contribute to the development of or exacerbate delayed cerebral ischemia. This review was designed to examine the prevalence and impact of anemia in patients with SAH and to evaluate the effects of transfusion. A literature search was made to identify original research on anemia and transfusion in SAH patients. A total of 27 articles were identified that addressed the effects of red blood cell transfusion (RBCT) on brain physiology, anemia in SAH, and clinical management with RBCT or erythropoietin. Most studies provided retrospectively analyzed data of very low-quality according to the GRADE criteria. While RBCT can have beneficial effects on brain physiology, RBCT may be associated with medical complications, infection, vasospasm, and poor outcome after SAH. The effects may vary with disease severity or the presence of vasospasm, but it remains unclear whether RBCTs are a marker of disease severity or a cause of worse outcome. Erythropoietin data are limited. The literature review further suggests that the results of the Transfusion Requirements in Critical Care Trial and subsequent observational studies on RBCT in general critical care do not apply to SAH patients and that randomized trials to address the role of RBCT in SAH are required.

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Section: Summary Of the Literaturementioning

confidence: 99%

Section: Summary Of the Literaturementioning

confidence: 99%

Anemia and Transfusion After Subarachnoid Hemorrhage

Roux

2011

Neurocrit Care

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“…The second largest group of publications comprises aneurysmal subarachnoid hemorrhage (SAH) [6,7,[41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59].…”

Section: Humanmentioning

confidence: 99%

“…There are publications also from Australia [38,[198][199][200], Austria [53,85], Brazil [58], Canada [93,118,132,135,139], China [9, 201,202], Croatia [203], the Czech Republic [204], Denmark [134]; Finland [134], France [43,77,114,205,206], Greece [207], Hungary [141], India [208], Japan [140,146,167,209], Portugal [64]; Russia [210,211], Singapore [2,4,10,16,74,212,213]; Serbia [214]; South Africa [26,28,35], South Korea [127], Sweden [90,134,215], Switzerland [11,216,217]...…”

Section: Clinical Applicationsmentioning

confidence: 99%

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Systematic and Comprehensive Literature Review of Publications on Direct Cerebral Oxygenation Monitoring

Lang

Jaeger²

2013

TOCCMJ

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This review has been compiled to assess publications related to the clinical application of direct cerebral tissue oxygenation (pbtO2) monitoring published in international, peer-reviewed scientific journals, or major meeting reports published as journal supplements. Its goal was to extract relevant, i.e. positive and negative, information on indications, clinical application, safety issues and impact on clinical situations, as well as treatment strategies in neurosurgery, neurosurgical anaesthesiology, neurosurgical intensive care, neurology, and related specialties. For completeness' sake it also presents related basic science research and case reports. This review is an update of its previous edition published elsewhere in 2007. This review reflects publications from 2004 to 2012. Only relevant publications prior to 2004, which explicitly addressed or systematically examined the above issues, are included in this review and are listed in the reference section. Based on 349 citations it is the most comprehensive review available on direct cerebral oxygen monitoring to this date.Keywords: Review, cerebral oxygenation, raumedic, licox, neurotrend, cerebral partial pressure of oxygen, brain tissue oxygenation. METHODSThis review is based on a systematic "Medline" literature search using the following search terms: licox, neurotrend, neurovent, raumedic, brain tissue oxygen, brain tissue oxygenation, cerebral oxygenation, cerebral tissue oxygen, cerebral partial pressure of oxygen, btO2, ptiO2, pti(O)2, ptiO(2), pbrO2, PBr(O2), P(bt)O(2), P(br)O(2), PbrO(2), BTpO2, tP(O2), PbO2, PbtO2, Pbto, PbtO(2).Only few publications were not retrieved using this technique. They were, however, identified through personal communication with scientists in the field, meeting proceedings and reviewer assignments. This strategy provided sufficient certainty that relevant papers have not been missed. Unpublished meeting abstracts and published conference proceedings were excluded for this review expect for few which provided comparative studies between different probes. To address relevant matters, related to specific pbtO2 issues, selected non-peer reviewed papers published in supplements were also used only when no other peer-reviewed information was available. RESULTSThis review is based on a previous review [1]. It is currently based on 349 papers, 274 more papers compared to its previous version in 2007, which warrants the update.

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Low hemoglobin is associated with worse outcomes via larger hematoma volume in intracerebral hemorrhage due to systemic disease

Zhang

Shu

Chen

et al. 2022

MedComm

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Whether hemoglobin is associated with outcomes of a specific subtype of intracerebral hemorrhage (ICH) is unknown. A total of 4643 patients with ICH from a multicenter cohort were included in the analysis (64.0% male; mean age [SD], 58.3 [15.2] year), of whom 1319 (28.4%) had anemia on admission. The unsupervised consensus cluster method was employed to classify the patients into three clusters. The patients of cluster 3 were characterized by a high frequency of anemia (85.3%) and mainly composed of patients of systemic disease ICH subtype (SD‐ICH; 90.0%) according to the SMASH‐U etiologies. In SD‐ICH, a strong interaction effect was observed between anemia and 3‐month death (adjusted odds ratio [aOR] 4.33, 95% confidence interval [CI] 1.60–11.9, p = 0.004), and the hemoglobin levels were linearly associated with 3‐month death (aOR 0.75, 95% CI 0.60–0.92; p = 0.009), which was partially mediated by larger baseline hematoma volume ( p = 0.008). This study demonstrated a strong linear association between low hemoglobin levels and worse outcomes in SD‐ICH, suggesting that hemoglobin‐elevating therapy might be extensively needed in a specific subtype of ICH.

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Anemia is Associated with Metabolic Distress and Brain Tissue Hypoxia After Subarachnoid Hemorrhage

Abstract: Anemia is associated with a progressively increased risk of cerebral metabolic distress and brain tissue hypoxia after subarachnoid hemorrhage.

Cited by 71 publications

References 40 publications

Anemia and Transfusion After Subarachnoid Hemorrhage

Anemia and Transfusion After Subarachnoid Hemorrhage

Systematic and Comprehensive Literature Review of Publications on Direct Cerebral Oxygenation Monitoring

Low hemoglobin is associated with worse outcomes via larger hematoma volume in intracerebral hemorrhage due to systemic disease

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