Erythropoiesis stimulating agent administration improves survival after severe traumatic brain injury: a matched case control study.
OBJECTIVE
Erythropoiesis stimulating agent (ESA) administration may reduce mortality in severe traumatic brain injury (sTBI).


BACKGROUND
It has been established that the administration of ESA in critically ill trauma victims has been associated with improved outcomes. Recent experimental and clinical data showed neuroprotective effects of ESA, however, the literature regarding impact on outcome in sTBI is lacking.


METHODS
: A retrospective matched case control study in patients with sTBI [head Abbreviated Injury Scale (AIS), >or=3] receiving ESA while in the surgical intensive care unit from January 1, 1996 to December 31, 2007 (n = 89), were matched 1 to 2 (n = 178) by age, gender, mechanism of injury, Glasgow Coma Scale, presence of hypotension on admission, Injury Severity Score, AIS for all body regions, and presence of anemia with patients who did not receive the agent. Each case's controls were chosen to have surgical intensive care unit length of stay more than or equal to the time from admission to first dose of ESA. The primary outcome measure in this study was mortality.


RESULTS
Cases and controls had similar age, gender, mechanisms of injury, incidence of hypotension, Glasgow Coma Scale on admission, Injury Severity Score, and AIS for all body regions. Although the ESA+ patients experienced protracted hospital length of stay and comparable surgical intensive care unit free days, they demonstrated a significantly lower in-hospital mortality in comparison to controls at 7.9% versus 24.2%, respectively (OR: 0.27; 95% CI = 0.12-0.62; P = 0.001).


CONCLUSIONS
Erythropoiesis stimulating agent administration in sTBI is associated with a significant in-hospital survival advantage without increase in morbidity. Prospective validation of our findings is warranted.
University of Southern California-Keck School of Medicine, Department of Surgery-Division of Acute Care Surgery (Emergency Surgery, Trauma, and Surgical Critical Care), Los Angeles County General Hospital (LAC + USC), 1200 North State St, C4E100, Los Angeles, CA 90033, USA. peep.talving@surgery.usc.edu
Peep
P
Talving
Thomas
T
Lustenberger
Leslie
L
Kobayashi
Kenji
K
Inaba
Galinos
G
Barmparas
Beat
B
Schnüriger
Lydia
L
Lam
Linda S
LS
Chan
Demetrios
D
Demetriades
D015998:Abbreviated Injury Scale; D000328:Adult; D001930:Brain Injuries / Q000097:blood / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D016022:Case-Control Studies; D003422:Critical Care; D000068256:Darbepoetin alfa; D004921:Erythropoietin / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D005260:Female; D015600:Glasgow Coma Scale; D006397:Hematinics / Q000008:administration & dosage*; D006454:Hemoglobins / Q000032:analysis; D017052:Hospital Mortality; D006801:Humans; D007279:Injections, Subcutaneous; D007902:Length of Stay; D008297:Male; D018696:Neuroprotective Agents / Q000627:therapeutic use; D011994:Recombinant Proteins; D015996:Survival Rate
D006397:Hematinics; D006454:Hemoglobins; D018696:Neuroprotective Agents; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068256:Darbepoetin alfa