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Hematocrit drift and outcomes in surgical patients with aneurysmal subarachnoid hemorrhage

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Abstract

Background

There is a paucity of conclusive evidence regarding the impact of downward drift in hematocrit levels among patients who have undergone surgical clipping for aneurysmal subarachnoid hemorrhage (aSAH). This study endeavors to explore the potential association between hematocrit drift and mortality in this specific patient population.

Methods

A cohort study was conducted, encompassing adult patients diagnosed with aSAH at a university hospital. The primary endpoint was follow-up mortality. Propensity score matching was employed to align patients based on their baseline characteristics. Discrimination capacity across various models was assessed and compared using net reclassification improvement (NRI).

Results

Among the 671 patients with aSAH in the study period, 118 patients (17.6%) experienced an in-hospital hematocrit drift of more than 25%. Following adjustment with multivariate regression analysis, patients with elevated hematocrit drift demonstrated significantly increased odds of mortality (aOR: 2.12, 95% CI: 1.14 to 3.97; P = 0.019). Matching analysis yielded similar results (aOR: 2.07, 95% CI: 1.05 to 4.10; P = 0.036). The inclusion of hematocrit drift significantly improved the NRI (P < 0.0001) for mortality prediction. When in-hospital hematocrit drift was served as a continuous variable, each 10% increase in hematocrit drift corresponded to an adjusted odds ratio of 1.31 (95% CI 1.08–1.61; P = 0.008) for mortality.

Conclusions

In conclusion, the findings from this comprehensive cohort study indicate that a downward hematocrit drift exceeding 25% independently predicts mortality in surgical patients with aSAH. These findings underscore the significance of monitoring hematocrit and managing anemia in this patient population.

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Data availability

Original data is available from the corresponding author with reasonable request.

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Funding

The research was funded by the National Natural Science Foundation of China (Grant No. 82371318).

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Authors and Affiliations

  1. Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China

    Xing Wang, Wuqian Chen, Xingyu Qiu, Chao You & Lu Ma

  2. Information Center, West China Hospital, Sichuan University, Chengdu, China

    Jiulin Guo

Authors
  1. Xing Wang
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  2. Wuqian Chen
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  3. Xingyu Qiu
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  4. Jiulin Guo
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  5. Chao You
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  6. Lu Ma
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Contributions

XW and LM conceived the study and designed the protocol.

XW and JG acquired the data.

XW and WC analyzed the data.

XW and XQ wrote the first draft of the paper.

XW, XQ, JG, WC, CY, and LM critically revised successive drafts of the paper and approved the final version.

Corresponding author

Correspondence to Lu Ma.

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Ethics approval

The institutional review board of the ethics committee of West China Hospital approved the study (2023072).

Consent to participate

The institutional review board of the ethics committee of West China Hospital granted a waiver of informed consent due to the minimal risk posed to patients.

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Not applicable.

Competing interests

The authors declare that they have no conflict of interest.

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Wang, X., Chen, W., Qiu, X. et al. Hematocrit drift and outcomes in surgical patients with aneurysmal subarachnoid hemorrhage. Acta Neurochir 166, 202 (2024). https://doi.org/10.1007/s00701-024-06097-9

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