The association between anemia and neurological outcome in hypoxic ischemic brain injury after cardiac arrest

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• 作者：Andrew Wormsbecker^a ; ^{awormsbecker@gmail.com} ; Mypinder S. Sekhon^a ; ^{mypindersekhon@gmail.com} ; Donald E. Griesdale^a ; ^b ; ^c ; ^{donald.griesdale@vch.ca} ; Katie Wiskar^a ; ^{katiewiskar@gmail.com} ; Barret Rush^a ; ^d ; ^{bar890@mail.harvard.edu}
• 关键词：Hypoxic ischemic brain injury ; Hemoglobin ; Cardiac arrest ; Anemia
• 刊名：Resuscitation
• 出版年：2017
• 出版时间：March 2017
• 年：2017
• 卷：112
• 期：Complete
• 页码：11-16
• 全文大小：485 K
• 卷排序：112

文摘

To examine the relationship between daily mean hemoglobin concentration and neurological outcome in hypoxic ischemic brain injury (HIBI) following cardiac arrest.MethodsWe conducted a single center retrospective observational study using a database of HIBI patients between March 2009 and December 2014. We included all adults admitted to the intensive care unit following an in-hospital or out-of-hospital cardiac arrest. The primary outcome was neurological outcome measured by the Cerebral Performance Category (CPC) at hospital discharge. Multivariable logistic regression was used to analyze the association of mean hemoglobin concentration over 48 h and 7 days after the onset of HIBI and discharge CPC. Favorable and unfavorable neurological outcome was dichotomized for a discharge CPC 1–2 vs 3–5, respectively.Results118 patients were included in the analysis. Patients with a favorable neurological outcome had higher mean 7-day hemoglobin (115 g/L vs 107 g/L; p = 0.05) compared to those with unfavorable outcome. Multivariate logistic regression controlling for age, time to return of spontaneous circulation and blood transfusion demonstrated that lower mean 48-h hemoglobin concentration was associated with unfavorable outcome (OR 0.69 per 10 unit change in Hgb, 95% CI 0.54–0.88, p < 0.01). A repeated analysis using mean Hgb for the first 7 days yielded similar results for unfavorable outcome (OR 0.75 per 10 unit change in Hgb, 95% CI 0.57–0.97, p = 0.03).ConclusionsLower mean hemoglobin concentration in the first 48 h and 7 days following HIBI is associated with a higher odds of unfavorable outcome at hospital discharge. Further study to examine this association is warranted.