title: Effects of Red Blood Cell Transfusion on Long-Term Disability of Patients with Traumatic Brain Injury.
abstract: This 3-year prospective study examined the association between red blood cell transfusion (RBCT) and 1-year neurocognitive and disability levels in 309 patients with traumatic brain injury (TBI) admitted to the neurological intensive care unit (NICU).
  
  
  
  Using a telephone interview-based survey, functional outcomes were assessed by the Glasgow Outcome Scale (GOS), Rancho Los Amigos Levels of Cognitive Functioning Scale (RLCFS), and Disability Rating Scale (DRS) and dichotomized as favorable and unfavorable (dependent variable). The adjusted influence of RBCT on unfavorable results was assessed by conventional logistic regression, controlling for illness severity and propensity score (introduced as a continuous variable and by propensity score-matched patients).
  
  
  
  Overall, 164 (53 %) patients received ≥1 unit of RBCT during their NICU stay. One year postinjury, transfused patients exhibited significantly higher unfavorable GOS (46.0 vs. 22.0 %), RLCFS (37.4 vs. 15.4 %), and DRS (39.6 vs. 18.7 %) scores than nontransfused patients. Although transfused patients were more severely ill upon admission, their adjusted odds ratios (95 % confidence intervals) for unfavorable GOS, RLCFS, and DRS scores were 2.5 (1.2-5.1), 3.0 (1.4-6.3), and 2.3 (1.1-4.8), respectively. These odds ratios remained largely unmodified when the calculated propensity score was incorporated as an independent continuous variable into the multivariate analysis. Furthermore, in 76 pairs of propensity score-matched patients, the rate of an unfavorable RLCFS score at the 1-year (but not 6-month) follow-up was significantly higher in transfused than nontransfused patients [3.0 (1.1-8.2)].
  
  
  
  Our results strongly suggest an independent association between RBCT and unfavorable long-term functional outcomes of patients with TBI.
authors.affiliation: Critical Care Division, Instituto de Biomedicina IBIS, Hospital Universitario ''Virgen del Rocío'', Avda/Manuel Siurot, s/n, 41013, Seville, Spain. srlealnoval@gmail.com.
authors.forename: Santiago R
authors.initials: SR
authors.lastname: Leal-Noval
authors.affiliation: Neuropsychology Division, Instituto de Biomedicina IBIS, Hospital Universitario ''Virgen del Rocío'', Seville, Spain.
authors.forename: Ángela
authors.initials: Á
authors.lastname: Muñoz-Serrano
authors.affiliation: Critical Care Division, Instituto de Biomedicina IBIS, Hospital Universitario ''Virgen del Rocío'', Avda/Manuel Siurot, s/n, 41013, Seville, Spain.
authors.forename: Victoria
authors.initials: V
authors.lastname: Arellano-Orden
authors.affiliation: Statistics and Design Division, Hospital de Valme, Seville, Spain.
authors.forename: Aurelio
authors.initials: A
authors.lastname: Cayuela
authors.affiliation: Perioperative Transfusion Medicine, University of Málaga, Málaga, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Muñoz-Gómez
authors.affiliation: Transfusion Service, Hospital Universitario ''Virgen del Rocío'', Seville, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Recio
authors.affiliation: Critical Care Division, Instituto de Biomedicina IBIS, Hospital Universitario ''Virgen del Rocío'', Avda/Manuel Siurot, s/n, 41013, Seville, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Alcántara
authors.affiliation: Critical Care Division, Instituto de Biomedicina IBIS, Hospital Universitario ''Virgen del Rocío'', Avda/Manuel Siurot, s/n, 41013, Seville, Spain.
authors.forename: Rosario
authors.initials: R
authors.lastname: Amaya-Villar
authors.affiliation: Critical Care Division, Instituto de Biomedicina IBIS, Hospital Universitario ''Virgen del Rocío'', Avda/Manuel Siurot, s/n, 41013, Seville, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Casado-Méndez
authors.affiliation: Critical Care Division, Instituto de Biomedicina IBIS, Hospital Universitario ''Virgen del Rocío'', Avda/Manuel Siurot, s/n, 41013, Seville, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Murillo-Cabezas
mesh_terms: D000328:Adult; D000368:Aged; D000070642:Brain Injuries, Traumatic / Q000150:complications / Q000628:therapy*; D060825:Cognitive Dysfunction / Q000175:diagnosis* / Q000209:etiology; D017707:Erythrocyte Transfusion / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012720:Severity of Illness Index
keywords: Anemia; Disability; Hemoglobin; Neurological; Transfusion; Traumatic brain injury