Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea; Graduate School, College of Medicine, Hanyang University, Seoul, Republic of Korea.
Department of Emergency Medicine, College of Medicine, Hallym University, Seoul, Republic of Korea; Graduate School, College of Medicine, Hanyang University, Seoul, Republic of Korea.
Am J Emerg Med. 2019 Jun;37(6):1101-1107. doi: 10.1016/j.ajem.2018.08.072. Epub 2018 Aug 29.
The purpose of this study was to evaluate the effects of erythropoietin (EPO) on mortality and neurological outcomes in patients with traumatic brain injury (TBI).
Electronic databases of studies published up to January 5, 2017 were searched to retrieve relevant investigations comparing the outcomes of EPO-treated patients and untreated patients following TBI. We calculated the relative risk (RR) of mortality, neurologic outcomes, and deep vein thrombosis (DVT) with corresponding 95% confidence interval (CI) using meta-analysis.
Six randomized controlled clinical trials met the eligibility criteria. In total, 1041 patients were included among the studies. EPO was found to significantly reduce the occurrence of mortality (RR 0.68 [95% CI 0.50-0.95]; P = 0.02), but did not significantly reduce poor functional outcome (RR 1.22 [95% CI 0.82-1.81]; P = 0.33). There were no significant differences in the occurrence of complications, such as DVT, between the treatment groups (RR -0.02 [95% CI -0.06-0.02]; P = 0.81).
Results of the present meta-analysis suggest that the use of EPO may prevent death following TBI without causing adverse events, such as deep vein thrombosis. However, the role of EPO in improving neurological outcome(s) remains unclear. Further well-designed, randomized controlled trials using modified protocols and involving specific patient populations are required to clarify this issue, and to verify the findings.
本研究旨在评估促红细胞生成素（EPO）对创伤性脑损伤（TBI）患者死亡率和神经结局的影响。
检索至 2017 年 1 月 5 日发表的研究电子数据库，以检索比较 EPO 治疗和未治疗 TBI 患者结局的相关研究。我们采用荟萃分析计算死亡率、神经结局和深静脉血栓形成（DVT）的相对风险（RR）及其 95%置信区间（CI）。
符合纳入标准的有 6 项随机对照临床试验。共纳入 1041 例患者。EPO 可显著降低死亡率（RR 0.68 [95% CI 0.50-0.95]；P=0.02），但对不良功能结局无明显影响（RR 1.22 [95% CI 0.82-1.81]；P=0.33）。两组间 DVT 等并发症的发生率无显著差异（RR -0.02 [95% CI -0.06-0.02]；P=0.81）。
本荟萃分析结果表明，EPO 的使用可能预防 TBI 后的死亡，且不会导致深静脉血栓等不良事件。但 EPO 在改善神经结局方面的作用尚不清楚。需要进一步设计良好、采用改良方案并纳入特定患者人群的随机对照试验，以阐明这一问题并验证上述结果。
