Department of Neurosurgery, People's Liberation Army 115th Hospital (People's Liberation Army 956th Hospital), Linzhi, Tibet, People's Republic of China.
High hemoglobin (HGB) concentration is frequently seen in Tibetans in clinical practice; however, the impact on postsurgical prognosis in patients with Poor-grade aneurysmal subarachnoid hemorrhage (aSAH) is not precisely known. Thus, Anqi et al., sought to understand the association between high HGB level and postoperative outcome in Tibetans with poor-grade aSAH.
Results of clipping in consecutive Tibetan patients with poor-grade aSAH were analyzed retrospectively for the period January 2012 to January 2017. Based on the upper limit (160g/L) of normal hemoglobin levels, patients were divided to a high (HHC) and a normal (NHC) HGB-level cohort according to the first routine blood result on admission. Propensity score matching was used for baseline matching in the 2 cohorts. Postoperative complications in the 2 groups were compared. Prognosis after ictus, including 6-month neurological functional status and mortality at 30 days and 6 months were also assessed.
Risk of ischemia, pulmonary embolism and lower-limb deep venous thrombosis (DVT) was higher in HHC than NHC (62.88% vs. 21.64%; P < 0.001; 10.30% vs 1.31%, P < 0.005; 24.74% vs 7.21%, P < 0.001, respectively). Hospital stay also differed significantly (15.82±3.86 vs 10.37±4.80 days; P < 0.001). 150 of the 194 patients survived at 6 months. At 6-month neurological functional follow-up, 8 NHC patients had favorable modified Rankin scale (mRS) scores ≤2 at discharge, versus only 1 HHC patient, showing better outcome in NHC than HHC (8.25% vs. 1.03%; P = 0.035). In-hospital mortality was significantly greater in HHC than NHC (17.52% vs. 7.22%; P = 0.029). 30-day post-ictus mortality was 30.93% in HHC versus 14.43% in NHC (P < 0.006). There was also a significant difference in mortality at 6 months post-ictus (47.42% vs. 18.56%; P < 0.001).
High hemoglobin (HGB) level was associated with increased risk of postsurgical cerebral ischemia, pulmonary embolism and lower-limb DVT and poor prognosis in Poor-grade aneurysmal subarachnoid hemorrhage patients. Preoperative hemodilution therapy might be beneficial in reducing operative complications, reducing hospital stay and improving short-term prognosis for neurological functional recovery in aSAH patients with high hemoglobin concentration, but further detailed research is needed 1).
1: Wei L, Zhang J, Geng J, Lin C, Zhang Y, Zhang B, Tan Q, Tao Y, Ye D, Chen Z, Feng H, Zhu G. Hemoglobin Concentration Affects Hypertensive Basal Ganglia Hemorrhage After Surgery: Correlation Analysis in a High-Altitude Region. World Neurosurg. 2019 Jul;127:e835-e842. doi: 10.1016/j.wneu.2019.03.281. Epub 2019 Apr 4. PubMed PMID: 30954736.
2: Zhao JL, Du ZY, Sun YR, Yuan Q, Yu J, Wu X, Li ZQ, Wu XH, Xie R, Hu J. Intensive blood pressure control reduces the risk of progressive hemorrhage in patients with acute hypertensive intracerebral hemorrhage: A retrospective observational study. Clin Neurol Neurosurg. 2019 May;180:1-6. doi: 10.1016/j.clineuro.2019.02.021. Epub 2019 Feb 26. PubMed PMID: 30870760.
3: Danzeng QZ, Cui N, Wang H, Pan WJ, Long Y, Deji YZ, Ze C, Ren Z. Translation and validation of the Tibetan confusion assessment method for the intensive care unit. Chin Med J (Engl). 2019 May 20;132(10):1154-1158. doi: 10.1097/CM9.0000000000000168. PubMed PMID: 30829717; PubMed Central PMCID: PMC6511416.
4: Zhao JL, Du ZY, Yuan Q, Yu J, Sun YR, Wu X, Li ZQ, Wu XH, Hu J. Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Predicting the 6-Month Outcome of Patients with Traumatic Brain Injury: A Retrospective Study. World Neurosurg. 2019 Jan 3. pii: S1878-8750(18)32930-9. doi: 10.1016/j.wneu.2018.12.107. [Epub ahead of print] PubMed PMID: 30610986.
5: Du CN, Yang MF, Zhang Q, Jin XQ, Yan C, Huang YW. Establishment and Verification of the Hematoma Expansion Prediction Score of Intracerebral Hemorrhage in the Qinghai-Tibetan Plateau. World Neurosurg. 2019 Mar;123:e465-e473. doi: 10.1016/j.wneu.2018.11.189. Epub 2018 Nov 27. PubMed PMID: 30500588.
6: Wei L, Zhang B, Zhang J, Tan Q, Zhang Y, Fan Y, Wang F, Tao Y, Chen Z, Lin C, Zhu G. Application of a Grading System in the Treatment of Frontal Lobe Contusion in High-Altitude Regions. World Neurosurg. 2018 Aug;116:e975-e982. doi: 10.1016/j.wneu.2018.05.144. Epub 2018 May 29. PubMed PMID: 29857217.
7: Chen R, Xiao A, You C, Ma L. Spontaneous Intracerebral Hemorrhage in a Plateau Area: A Study Based on the Tibetan Population. World Neurosurg. 2018 Aug;116:e769-e774. doi: 10.1016/j.wneu.2018.05.090. Epub 2018 May 19. PubMed PMID: 29787871.
8: Sun S, He J, Zhang Y, Xiao R, Yan M, Ren Y, Zhu Y, Jin T, Xia Y. Genetic polymorphisms in the ALDH2 gene and the risk of ischemic stroke in a Chinese han population. Oncotarget. 2017 Oct 10;8(60):101936-101943. doi: 10.18632/oncotarget.21803. eCollection 2017 Nov 24. PubMed PMID: 29254215; PubMed Central PMCID: PMC5731925.
9: Ye DP, Zhang SL, Xu QH, Wei LJ. A case of Galen vein thrombosis occurring after bilateral acetabular fractures in the Tibet plateau - what can we learn? Chin J Traumatol. 2017 Oct;20(5):308-310. doi: 10.1016/j.cjtee.2017.05.001. Epub 2017 Jul 3. PubMed PMID: 28802782; PubMed Central PMCID: PMC5831045.
10: Chen R, Xiao A, Li H, Ma L, Lin S, You C. Blood blister-like aneurysms in Tibetans: A retrospective observational study. Clin Neurol Neurosurg. 2017 May;156:18-23. doi: 10.1016/j.clineuro.2017.03.004. Epub 2017 Mar 6. PubMed PMID: 28288394.
11: Hsu SW, Chang TC, Wu YK, Lin KT, Shi LS, Lee SY. Rhodiola crenulata extract counteracts the effect of hypobaric hypoxia in rat heart via redirection of the nitric oxide and arginase 1 pathway. BMC Complement Altern Med. 2017 Jan 7;17(1):29. doi: 10.1186/s12906-016-1524-z. PubMed PMID: 28061780; PubMed Central PMCID: PMC5219729.
12: Sun J, Tian Y, Jiang RC, Dong XL, Wang Y, Wu WB, Wu KX, Zhang JN. [Study on the difference of blood coagulation function in patients with traumatic brain injury in plain and plateau area]. Zhonghua Yi Xue Za Zhi. 2016 Oct 25;96(39):3125-3128. doi: 10.3760/cma.j.issn.0376-2491.2016.39.002. Chinese. PubMed PMID: 27852408.
13: Zuo L, Garcia-Milian R, Guo X, Zhong C, Tan Y, Wang Z, Wang J, Wang X, Kang L, Lu L, Chen X, Li CR, Luo X. Replicated Risk Nicotinic Cholinergic Receptor Genes for Nicotine Dependence. Genes (Basel). 2016 Nov 7;7(11). pii: E95. PubMed PMID: 27827986; PubMed Central PMCID: PMC5126781.
14: Xiao A, Chen R, Li H, Ma L, Lin S, Hu X, You C. Primary Hemorrhagic Neurovascular Diseases in Tibetans: A Retrospective Observational Study. World Neurosurg. 2016 Dec;96:423-428. doi: 10.1016/j.wneu.2016.09.015. Epub 2016 Sep 17. PubMed PMID: 27647028.
15: Jin TB, Du S, Zhu XK, Li G, Ouyang Y, He N, Zhang Z, Zhang Y, Kang L, Yuan D. Polymorphism in the IL4R gene and clinical features are associated with glioma prognosis: Analyses of case-cohort studies. Medicine (Baltimore). 2016 Aug;95(31):e4231. doi: 10.1097/MD.0000000000004231. PubMed PMID: 27495027; PubMed Central PMCID: PMC4979781.
16: Duanmu WS, Cao L, Chen JY, Ge HF, Hu R, Feng H. Ischemic postconditioning protects against ischemic brain injury by up-regulation of acid-sensing ion channel 2a. Neural Regen Res. 2016 Apr;11(4):641-5. doi: 10.4103/1673-5374.180751. PubMed PMID: 27212927; PubMed Central PMCID: PMC4870923.
17: Du JY, Yuan F, Zhao LY, Zhu J, Huang YY, Zhang GS, Wei Y, Liu Y, Yi Q, Tu YS, Zhong X, Sun FY, Sun HS, Guan YY, Chen WL, Wang GL. Suppression of Kv1.5 protects against endothelial apoptosis induced by palmitate and in type 2 diabetes mice. Life Sci. 2017 Jan 1;168:28-37. doi: 10.1016/j.lfs.2015.12.054. Epub 2016 Jan 5. PubMed PMID: 26764232.
18: Wei L, Chen Z, Xi Q, Wen C, Ye D, Chen X, Zhu G. Elevated Hemoglobin Concentration Affects Acute Severe Head Trauma After Recovery from Surgery of Neurologic Function in the Tibetan Plateau. World Neurosurg. 2016 Feb;86:181-5. doi: 10.1016/j.wneu.2015.09.070. Epub 2015 Sep 30. PubMed PMID: 26431734.
19: Yu AY, Xu QH, Hu SL, Li F, Chen YJ, Yin Y, Zhu G, Lin JK, Feng H. Characteristics of a rat model of an open craniocerebral injury at simulated high altitude. Neuroreport. 2014 Nov 12;25(16):1272-80. doi: 10.1097/WNR.0000000000000259. PubMed PMID: 25191925; PubMed Central PMCID: PMC4222709.
20: Duan WR, Lu J, Xie YK. Mechanisms of topical analgesics in relieving pain in an animal model of muscular inflammation. Pain Med. 2013 Sep;14(9):1381-7. doi: 10.1111/pme.12199. Epub 2013 Jul 19. PubMed PMID: 23870161.
21: Gesang D, Zhao JZ, Zhang D, Wang S, Zhao YL, Wang R. [Studying change of regional cerebral blood flow after superficial temporal artery-middle cerebral artery anastomosis during acute stage in patients with Moyamoya disease]. Zhonghua Yi Xue Za Zhi. 2012 Aug 7;92(29):2046-9. Chinese. PubMed PMID: 23253806.
22: Lu Z, Zhai L, Wang H, Che Q, Wang D, Feng F, Zhao Z, Yu H. Novel families of antimicrobial peptides with multiple functions from skin of Xizang plateau frog, Nanorana parkeri. Biochimie. 2010 May;92(5):475-81. doi: 10.1016/j.biochi.2010.01.025. Epub 2010 Feb 12. PubMed PMID: 20153801.
23: Zhao JZ, Zhou LF, Zhou DB, Wang RZ, Wang M, Wang DJ, Wang S, Yuan G, Kang S, Ji N, Zhao YL, Ye X. Computed tomography-guided aspiration versus key-hole craniotomy for spontaneous putaminal haemorrhage: a prospective comparison of minimally invasive procedures. Hong Kong Med J. 2009 Aug;15(4):274-9. PubMed PMID: 19652234.
24: Clarke C. Amchhi Inji-ne, the English doctor: part 2. Wilderness Environ Med. 2000 Spring;11(1):47-51. PubMed PMID: 10731908.
25: Clarke C. Amchhi inji-ne, the English doctor: Part 1. Wilderness Environ Med. 1999 Winter;10(4):256-60. PubMed PMID: 10628288.
Wu WQ. Neurosurgery in Tibet. Surg Neurol. 1981 Jun;15(6):419-21. PubMed PMID: 7280952.