School of Medicine and Surgery, University of Milano - Bicocca, Milan, Italy.
University of Pavia, PhD in Experimental Medicine, Pavia, Italy.
Crit Care. 2024 Jun 14;28(1):199. doi: 10.1186/s13054-024-04980-6.
Haemoglobin (Hb) thresholds and red blood cells (RBC) transfusion strategies in traumatic brain injury (TBI) are controversial. Our objective was to assess the association of Hb values with long-term outcomes in critically ill TBI patients. We conducted a secondary analysis of CENTER-TBI, a large multicentre, prospective, observational study of European TBI patients. All patients admitted to the Intensive Care Unit (ICU) with available haemoglobin data on admission and during the first week were included. During the first seven days, daily lowest haemoglobin values were considered either a continous variable or categorised as < 7.5 g/dL, between 7.5-9.5 and > 9.5 g/dL. Anaemia was defined as haemoglobin value < 9.5 g/dL. Transfusion practices were described as "restrictive" or "liberal" based on haemoglobin values before transfusion (e.g. < 7.5 g/dL or 7.5-9.5 g/dL). Our primary outcome was the Glasgow outcome scale extended (GOSE) at six months, defined as being unfavourable when < 5. Of 1590 included, 1231 had haemoglobin values available on admission. A mean Injury Severity Score (ISS) of 33 (SD 16), isolated TBI in 502 (40.7%) and a mean Hb value at ICU admission of 12.6 (SD 2.2) g/dL was observed. 121 (9.8%) patients had Hb < 9.5 g/dL, of whom 15 (1.2%) had Hb < 7.5 g/dL. 292 (18.4%) received at least one RBC transfusion with a median haemoglobin value before transfusion of 8.4 (IQR 7.7-8.5) g/dL. Considerable heterogeneity regarding threshold transfusion was observed among centres. In the multivariable logistic regression analysis, the increase of haemoglobin value was independently associated with the decrease in the occurrence of unfavourable neurological outcomes (OR 0.78; 95% CI 0.70-0.87). Congruous results were observed in patients with the lowest haemoglobin values within the first 7 days < 7.5 g/dL (OR 2.09; 95% CI 1.15-3.81) and those between 7.5 and 9.5 g/dL (OR 1.61; 95% CI 1.07-2.42) compared to haemoglobin values > 9.5 g/dL. Results were consistent when considering mortality at 6 months as an outcome. The increase of hemoglobin value was associated with the decrease of mortality (OR 0.88; 95% CI 0.76-1.00); haemoglobin values less than 7.5 g/dL was associated with an increase of mortality (OR 3.21; 95% CI 1.59-6.49). Anaemia was independently associated with long-term unfavourable neurological outcomes and mortality in critically ill TBI patients.Trial registration: CENTER-TBI is registered at ClinicalTrials.gov, NCT02210221, last update 2022-11-07.
血红蛋白（Hb）阈值和红细胞（RBC）输血策略在创伤性脑损伤（TBI）中存在争议。我们的目的是评估危重 TBI 患者的 Hb 值与长期预后的关系。我们对欧洲 TBI 患者的大型多中心前瞻性观察性研究 CENTER-TBI 进行了二次分析。所有在入住重症监护病房（ICU）时和入院后第一周内有可用血红蛋白数据的患者均被纳入。在最初的七天内，将每日最低血红蛋白值视为连续变量或分为<7.5 g/dL、7.5-9.5 g/dL 和>9.5 g/dL。贫血定义为血红蛋白值<9.5 g/dL。根据输血前的血红蛋白值（例如<7.5 g/dL 或 7.5-9.5 g/dL）将输血实践描述为“限制”或“宽松”。我们的主要结局是六个月时的格拉斯哥预后量表扩展（GOSE），定义为<5 时为不良结局。在纳入的 1590 例患者中，有 1231 例患者在入院时可获得血红蛋白值。平均损伤严重程度评分（ISS）为 33（标准差 16），单纯性 TBI 为 502 例（40.7%），入院时平均血红蛋白值为 12.6（标准差 2.2）g/dL。121（9.8%）例患者的血红蛋白<9.5 g/dL，其中 15（1.2%）例患者的血红蛋白<7.5 g/dL。292（18.4%）例患者至少接受了一次 RBC 输血，输血前的血红蛋白中位数为 8.4（IQR 7.7-8.5）g/dL。观察到中心之间在阈值输血方面存在相当大的异质性。在多变量逻辑回归分析中，血红蛋白值的增加与不良神经结局发生率的降低独立相关（OR 0.78；95%CI 0.70-0.87）。在入院后最初 7 天内最低血红蛋白值<7.5 g/dL 的患者（OR 2.09；95%CI 1.15-3.81）和血红蛋白值在 7.5-9.5 g/dL 之间的患者（OR 1.61；95%CI 1.07-2.42）与血红蛋白值>9.5 g/dL 的患者相比，观察到类似的结果。当将 6 个月时的死亡率作为结局时，结果是一致的。血红蛋白值的增加与死亡率的降低相关（OR 0.88；95%CI 0.76-1.00）；血红蛋白值<7.5 g/dL 与死亡率增加相关（OR 3.21；95%CI 1.59-6.49）。贫血与危重 TBI 患者的长期不良神经结局和死亡率独立相关。
CENTER-TBI 在 ClinicalTrials.gov 注册，NCT02210221，最新更新日期为 2022-11-07。
