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.

中文翻译：

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脑出血后的红细胞输注和结果

背景

低红细胞 (RBC) 水平与更严重的脑出血 (ICH) 结果相关。然而，鉴于红细胞输注、合并症和疾病严重程度的重叠，红细胞输注与 ICH 结果的关系尚不清楚。我们调查了 RBC 输血与 ICH 结果的关系，同时考虑了合并症和疾病严重程度。

方法

使用 ICD-9-CM 代码从全国住院患者样本中确定了 2002 年至 2011 年间的 ICH 住院和 RBC 输血暴露。Logistic 回归用于研究在调整人口统计学、基线合并症和疾病严重程度标志物后 RBC 输血与结果之间的关系。还进行了按合并症负担和疾病严重程度分层的额外敏感性分析。

结果

在 597,046 例 ICH 住院患者中，22,904 例（4%）接受了红细胞输注。RBC 输血与更高的院内死亡率相关（调整后的 OR：1.22 [95%CI：1.10-1.35]）。在敏感性分析中，无论合并症负担如何，RBC 输血都会导致较差的结果，但这种关系的减弱随着合并症的降低而显着（调整后的 OR 1.43 [95%CI: 1.34-1.51] vs 1.18 [95%CI: 1.10-1.29]） ）。在没有机械通气的情况下（调整后的 OR 0.88 [95%CI：0.83-1.13]）和需要脑室造口引流的病例（调整后的 OR 1.05 [95%CI：0.97-1.10]），RBC 输血与不良预后无关。

结论

在具有全国代表性的大型样本中，RBC 输血与 ICH 不良结局相关。然而，这种关系因合并症和疾病严重程度而异。需要额外的前瞻性研究来评估 ICH 中 RBC 输血的直接风险和益处。