The impact of low hemoglobin levels and transfusion on critical care patients with severe ischemic stroke: STroke: RelevAnt Impact of HemoGlobin, Hematocrit and Transfusion (STRAIGHT)—an observational study

Abstract

PurposeOptimal management of hemoglobin (Hb) and red blood cell transfusion (RBCT) in neurologic intensive care unit (NICU) patients has not been determined yet. Here we aimed to investigate the impact of anemia and transfusion activity in patients who had acute ischemic stroke. Materials and MethodsA retrospective analysis of clinical, laboratory, and outcome data of patients with severe acute ischemic stroke treated on our NICU between 2004 and 2011 was performed. ResultsOf 109 patients, 97.2% developed anemia and 33% received RBCT. Significant correlations were found between NICU length of stay (NICU LOS) and lowest (nadir) Hb (correlation coefficient, −0.42, P < .001), Hb decrease (0.52, P < .001), nadir hematocrit (Hct; −0.43, P < .001), and Hct decrease (0.51, P < .001). Duration of mechanical ventilation (MV) was strongly associated with both nadir Hb (−0.41, P < .001) and decrease (0.42, P < .001) and nadir Hct (−0.43, P < .001) and decrease (0.40, P < .001). Red blood cell transfusion correlated with NICU LOS (0.33, P < .001) and with duration of MV (0.40, P < .001). None of these hematologic parameters correlated with in-hospital mortality or 90-day outcome.The linear regression model showed number of RBCT (0.29, P = .008), nadir Hb (−0.18, P = .049), Hb decrease (0.33, P < .001), nadir Hct (−0.18, P = .03), and Hct decrease (0.29, P < .001) to be independent predictors of NICU LOS. Duration of MV was also independently predicted by number of RBC transfusions (0.29, P < .001), nadir Hb (−0.20, P = .02), Hb decrease (0.25, P = .002), nadir Hct (−0.21, P = .015), and Hct decrease (0.26, P < .001). ConclusionsLow and further decreasing Hb and Hct levels as well as RBCT activity are associated with prolonged NICU stay and duration of MV but not with mortality or long-term outcome. Our findings do not justify using a more aggressive transfusion practice at present.