title: A meta-analysis of the effect of different neuroprotective drugs in management of patients with traumatic brain injury.
abstract: Traumatic brain injury is a major problem worldwide. Our objective is to synthesize available evidence in the literature concerning the effectiveness of neuroprotective drugs (cerebrolysin, citicoline, and piracetam) on Glasgow outcome score (GOS), cognitive performance, and survival in traumatic brain injury patients. Comprehensive search of electronic databases, search engines, and conferences proceedings; hand search journals; searching reference lists of relevant articles, theses, and local publications; and contact of authors for incomplete data were performed. Studies included patients in all age groups regardless of severity of trauma. There was no publication date restriction. Two reviewers independently extracted data from each study. Fixed effect or random effects model selection depends on results of statistical tests for heterogeneity. The literature search yielded 13 studies. Patients treated with cerebrolysin (n = 112) had favorable GOS three times more than controls (OR 3.019; 95 % CI 1.76 to 5.16; p = 0.003*). The odds of cognition improvement in the treatment group was 3.4 times more than controls (OR 3.4; 95 % CI 1.82 to 5.21; p < 0.001*). Survival of cerebrolysin-treated patients did not differ from controls (103 patients; OR = 2.81; 95 % CI 0.905 to 8.76). Citicoline did not improve GOS (1355 patients; OR 0.96; 95 % CI 0.830 to 1.129; p = 0.676), cognitive performance (4 studies; 1291 patients; OR 1.35; 95 % CI 0.58 to 3.16; p = 0.478), and survival (1037 patients; OR = 1.38; 95 % CI 0.855 to 2.239). One study showed a positive effect of piracetam on cognition. Further research with high validity is needed to reach a solid conclusion about the use of neuroprotective drugs in cases of brain injury.
authors.affiliation: Biomedical Informatics and Medical Statistics Department, Medical Research Institute, Alexandria University, 165th Al Hureya Avenue, Alexandria, 21561, Egypt. emmystatistics@gmail.com.
authors.forename: Iman
authors.initials: I
authors.lastname: El Sayed
authors.affiliation: Biomedical Informatics and Medical Statistics Department, Medical Research Institute, Alexandria University, 165th Al Hureya Avenue, Alexandria, 21561, Egypt.
authors.forename: Adel
authors.initials: A
authors.lastname: Zaki
authors.affiliation: Critical Care Medicine Department, Faculty of Medicine, Alexandria University, Sultan Hussein Street, Alexandria, Egypt.
authors.forename: Akram M
authors.initials: AM
authors.lastname: Fayed
authors.affiliation: Biomedical Informatics and Medical Statistics Department, Medical Research Institute, Alexandria University, 165th Al Hureya Avenue, Alexandria, 21561, Egypt.
authors.forename: Gihan M
authors.initials: GM
authors.lastname: Shehata
authors.affiliation: Critical Care Medicine Department, Faculty of Medicine, Alexandria University, Sultan Hussein Street, Alexandria, Egypt.
authors.forename: Sherif
authors.initials: S
authors.lastname: Abdelmonem
mesh_terms: D000328:Adult; D000596:Amino Acids / Q000009:adverse effects / Q000627:therapeutic use*; D000070642:Brain Injuries, Traumatic / Q000188:drug therapy*; D003072:Cognition Disorders / Q000175:diagnosis / Q000188:drug therapy*; D003566:Cytidine Diphosphate Choline / Q000009:adverse effects / Q000627:therapeutic use*; D023261:Glasgow Outcome Scale; D006801:Humans; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D010889:Piracetam / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000596:Amino Acids; D018696:Neuroprotective Agents; C006952:cerebrolysin; D003566:Cytidine Diphosphate Choline; D010889:Piracetam
keywords: Brain injuries; Cerebrolysin; Cerebrovascular trauma; Cytidine diphosphate choline; Piracetam; Therapy