David J Roh1, Fernanda Carvalho Poyraz2, Jessica Magid-Bernstein3, Mitchell S V Elkind4, Sachin Agarwal5, Soojin Park6, Jan Claassen7, E Sander Connolly8, Eldad Hod9, Santosh B Murthy10. 1. Vagelos College of Physicians and Surgeons, Department of Neurology, Columbia University, 177 Fort Washington Ave, New York, NY, United States. Electronic address: dr2753@cumc.columbia.edu. 2. Vagelos College of Physicians and Surgeons, Department of Neurology, Columbia University, 177 Fort Washington Ave, New York, NY, United States. Electronic address: fdc2107@cumc.columbia.edu. 3. Vagelos College of Physicians and Surgeons, Department of Neurology, Columbia University, 177 Fort Washington Ave, New York, NY, United States. Electronic address: jm4286@cumc.columbia.edu. 4. Vagelos College of Physicians and Surgeons, Department of Neurology, Columbia University, 177 Fort Washington Ave, New York, NY, United States; Mailman School of Public Health, Columbia University, New York, NY, United States. Electronic address: mse13@columbia.edu. 5. Vagelos College of Physicians and Surgeons, Department of Neurology, Columbia University, 177 Fort Washington Ave, New York, NY, United States. Electronic address: sa2512@cumc.columbia.edu. 6. Vagelos College of Physicians and Surgeons, Department of Neurology, Columbia University, 177 Fort Washington Ave, New York, NY, United States. Electronic address: sp3291@cumc.columbia.edu. 7. Vagelos College of Physicians and Surgeons, Department of Neurology, Columbia University, 177 Fort Washington Ave, New York, NY, United States. Electronic address: jc1439@cumc.columbia.edu. 8. Vagelos College of Physicians and Surgeons, Department of Neurosurgery, Columbia University, New York, NY, United States. Electronic address: esc5@cumc.columbia.edu. 9. Vagelos College of Physicians and Surgeons, Department of Pathology and Cell Biology, Columbia University, New York, NY, United States. Electronic address: eh2217@cumc.columbia.edu. 10. Clinical and Translational Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medical College, New York, NY, United States. Electronic address: sam9200@med.cornell.edu.
Abstract
BACKGROUND: Low red blood cell (RBC) levels are associated with worse intracerebral hemorrhage (ICH) outcomes. However, relationships of RBC transfusions on ICH outcomes are unclear given the overlap of RBC transfusion, comorbidities, and disease severity. We investigated RBC transfusion relationships on ICH outcomes while accounting for comorbidities and disease severity. METHODS: ICH hospitalizations between 2002 and 2011 and RBC transfusion exposure were identified from the Nationwide Inpatient Sample using ICD-9-CM codes. Logistic regression was used to study the relationship between RBC transfusion on outcomes after adjusting for demographics, baseline comorbidities, and markers of disease severity. Additional sensitivity analyses stratified by comorbidity burden and disease severity were performed. RESULTS: Of 597,046 ICH hospitalizations, RBC transfusions were administered in 22,904 (4%). RBC transfusion was associated with higher odds of in-hospital mortality (adjusted OR: 1.22 [95%CI: 1.10-1.35]). In sensitivity analyses, RBC transfusions resulted in poor outcomes regardless of the comorbidity burden, but attenuation in this relationship was notable with lower comorbidities (adjusted OR 1.43 [95%CI: 1.34-1.51] vs 1.18 [95%CI: 1.10-1.29]). There were no associations of RBC transfusions with poor outcomes in hospitalizations without mechanical ventilation (adjusted OR 0.88 [95%CI: 0.83-1.13]) and in cases requiring ventriculostomy drains (adjusted OR 1.05 [95%CI: 0.97-1.10]). CONCLUSIONS: In a large, nationally representative sample, RBC transfusion was associated with poor ICH outcomes. However, there were variations in this relationship based on comorbidities and disease severity. Additional prospective studies are required to assess direct risks and benefits from RBC transfusions in ICH.
BACKGROUND: Low red blood cell (RBC) levels are associated with worse intracerebral hemorrhage (ICH) outcomes. However, relationships of RBC transfusions on ICH outcomes are unclear given the overlap of RBC transfusion, comorbidities, and disease severity. We investigated RBC transfusion relationships on ICH outcomes while accounting for comorbidities and disease severity. METHODS:ICH hospitalizations between 2002 and 2011 and RBC transfusion exposure were identified from the Nationwide Inpatient Sample using ICD-9-CM codes. Logistic regression was used to study the relationship between RBC transfusion on outcomes after adjusting for demographics, baseline comorbidities, and markers of disease severity. Additional sensitivity analyses stratified by comorbidity burden and disease severity were performed. RESULTS: Of 597,046 ICH hospitalizations, RBC transfusions were administered in 22,904 (4%). RBC transfusion was associated with higher odds of in-hospital mortality (adjusted OR: 1.22 [95%CI: 1.10-1.35]). In sensitivity analyses, RBC transfusions resulted in poor outcomes regardless of the comorbidity burden, but attenuation in this relationship was notable with lower comorbidities (adjusted OR 1.43 [95%CI: 1.34-1.51] vs 1.18 [95%CI: 1.10-1.29]). There were no associations of RBC transfusions with poor outcomes in hospitalizations without mechanical ventilation (adjusted OR 0.88 [95%CI: 0.83-1.13]) and in cases requiring ventriculostomy drains (adjusted OR 1.05 [95%CI: 0.97-1.10]). CONCLUSIONS: In a large, nationally representative sample, RBC transfusion was associated with poor ICH outcomes. However, there were variations in this relationship based on comorbidities and disease severity. Additional prospective studies are required to assess direct risks and benefits from RBC transfusions in ICH.
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