Anemia and brain oxygen after severe traumatic brain injury.

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State: Public
Version: author
Serval ID
serval:BIB_8FF54FA762DF
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Anemia and brain oxygen after severe traumatic brain injury.
Journal
Intensive Care Medicine
Author(s)
Oddo M., Levine J.M., Kumar M., Iglesias K., Frangos S., Maloney-Wilensky E., Le Roux P.D.
ISSN
1432-1238 (Electronic)
ISSN-L
0342-4642
Publication state
Published
Issued date
2012
Peer-reviewed
Oui
Volume
38
Number
9
Pages
1497-1504
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
PURPOSE: To investigate the relationship between hemoglobin (Hgb) and brain tissue oxygen tension (PbtO(2)) after severe traumatic brain injury (TBI) and to examine its impact on outcome.
METHODS: This was a retrospective analysis of a prospective cohort of severe TBI patients whose PbtO(2) was monitored. The relationship between Hgb-categorized into four quartiles (≤9; 9-10; 10.1-11; >11 g/dl)-and PbtO(2) was analyzed using mixed-effects models. Anemia with compromised PbtO(2) was defined as episodes of Hgb ≤ 9 g/dl with simultaneous PbtO(2) < 20 mmHg. Outcome was assessed at 30 days using the Glasgow outcome score (GOS), dichotomized as favorable (GOS 4-5) vs. unfavorable (GOS 1-3).
RESULTS: We analyzed 474 simultaneous Hgb and PbtO(2) samples from 80 patients (mean age 44 ± 20 years, median GCS 4 (3-7)). Using Hgb > 11 g/dl as the reference level, and controlling for important physiologic covariates (CPP, PaO(2), PaCO(2)), Hgb ≤ 9 g/dl was the only Hgb level that was associated with lower PbtO(2) (coefficient -6.53 (95 % CI -9.13; -3.94), p < 0.001). Anemia with simultaneous PbtO(2) < 20 mmHg, but not anemia alone, increased the risk of unfavorable outcome (odds ratio 6.24 (95 % CI 1.61; 24.22), p = 0.008), controlling for age, GCS, Marshall CT grade, and APACHE II score.
CONCLUSIONS: In this cohort of severe TBI patients whose PbtO(2) was monitored, a Hgb level no greater than 9 g/dl was associated with compromised PbtO(2). Anemia with simultaneous compromised PbtO(2), but not anemia alone, was a risk factor for unfavorable outcome, irrespective of injury severity.
Keywords
APACHE, Adult, Anemia/etiology, Anemia/pathology, Brain/blood supply, Brain Injuries/complications, Brain Injuries/pathology, Confidence Intervals, Female, Glasgow Coma Scale, Hemoglobins/analysis, Humans, Male, Retrospective Studies, Risk Factors
Pubmed
Web of science
Create date
20/09/2012 19:03
Last modification date
20/08/2019 15:53
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