Okoye O, Inaba K, Kennedy M, Salim A, Talving P, Plurad D, Lam L, Demetriades D
Division of Trauma Surgery and Surgical Critical Care (Acute Care Surgery), University of Southern California, 2051 Marengo Street, Room C5L100, Los Angeles, CA, 90033-4525, USA.
Eur J Trauma Emerg Surg. 2013 Dec;39(6):627-33. doi: 10.1007/s00068-013-0307-1. Epub 2013 Jun 18.
The impact of anemia and restrictive transfusion strategies in traumatic brain injury (TBI) is unclear. The purpose of this study was to examine the outcome of varying degrees of anemia in patients who have sustained a TBI.
We performed a retrospective study of all adult patients with isolated blunt TBI admitted between January 2003 and June 2010. The impact of increasing severity of anemia (Hb ≤8, ≤9, or ≤10 g/dl measured on three consecutive draws within the first 7 days of admission) and transfusions on complications, length of stay, and mortality was examined using univariate and multivariate analysis.
Of the 31,648 patients with blunt trauma admitted to the trauma service during the study period, 812 had an isolated TBI, among which 196 (24.1 %) met at least one of the anemia thresholds within the first 7 days [78 % male, mean age 47 ± 23 years, Injury Severity Score 16 ± 8, and head Abbreviated Injury Scale 3.3 ± 1.0]. Using a logistic regression model, anemia even as low as 8 g/dl was not associated with an increase in mortality [AOR8 = 0.8 (0.2, 3.2), p = 0.771; AOR9 = 0.8 (0.4, 1.6), p = 0.531; AOR10 = 0.6 (0.3, 1.3), p = 0.233] or complications. However, for all patients, the transfusion of packed red blood cells was associated with a significant increase in septic complications [AOR = 3.2 (1.5, 13.7), p = 0.030].
The presence of anemia in patients with TBI as low as 8 g/dl was not associated with increased mortality or complications, while the transfusion of red blood cells was associated with a significant increase in septic complications. Prospective evaluation of an optimal transfusion trigger in head-injured patients is warranted.
贫血和限制性输血策略在创伤性脑损伤（TBI）中的影响尚不清楚。本研究的目的是探讨TBI患者不同程度贫血的预后情况。
我们对2003年1月至2010年6月期间收治的所有成年单纯钝性TBI患者进行了一项回顾性研究。采用单因素和多因素分析，研究贫血严重程度增加（入院后前7天内连续3次测得血红蛋白≤8、≤9或≤10g/dl）及输血对并发症、住院时间和死亡率的影响。
在研究期间创伤服务部门收治的31648例钝性创伤患者中，812例为单纯TBI，其中196例（24.1%）在入院后前7天内至少达到一项贫血阈值[男性占78%，平均年龄47±23岁，损伤严重程度评分16±8，头部简明损伤定级标准评分为3.3±1.0]。使用逻辑回归模型，即使血红蛋白低至8g/dl的贫血也与死亡率增加无关[AOR8 = 0.8（0.2，3.2），p = 0.771；AOR9 = 0.8（0.4，1.6），p = 0.531；AOR10 = 0.6（0.3，1.3），p = 0.233]，也与并发症无关。然而，对于所有患者，输注浓缩红细胞与脓毒症并发症显著增加相关[AOR = 3.2（1.5，13.7），p = 0.030]。
TBI患者中血红蛋白低至8g/dl的贫血与死亡率或并发症增加无关，而输注红细胞与脓毒症并发症显著增加相关。有必要对头外伤患者的最佳输血触发因素进行前瞻性评估。
