Hemoglobin thresholds and red blood cell transfusion in adult patients with moderate or severe traumatic brain injuries: A retrospective cohort study

被引：17

作者：

Boutin, Amelie ^{[1
,2
]}

Moore, Lynne ^{[1
,2
]}

Green, Robert S. ^{[3
]}

Zarychanski, Ryan ^{[4
,5
,6
]}

Erdogan, Mete ^{[3
]}

Lauzier, Francois ^{[1
,7
,8
]}

English, Shane ^{[9
,10
]}

Fergusson, Dean A. ^{[10
]}

Butler, Michael ^{[3
]}

McIntyre, Lauralyn ^{[9
,10
]}

Chasse, Michael ^{[14
]}

Bonaventure, Paule Lessard ^{[1
,11
]}

Leger, Caroline ^{[1
]}

Desjardins, Philippe ^{[1
,7
]}

Griesdale, Donald ^{[12
]}

Lacroix, Jacques ^{[13
]}

Turgeon, Alexis F. ^{[1
,7
]}

机构：

[1] Univ Laval, CHU Quebec, Populat Hlth & Optimal Hlth Practices Res Unit Tr, Res Ctr, Z-207,1401,18E rue, Quebec City, PQ G1J 1Z4, Canada

[2] Univ Laval, Dept Social & Prevent Med, 1050 Ave Med, Quebec City, PQ G1V 0A6, Canada

[3] Dalhousie Univ, Dept Crit Care, Suite 377,Bethune Bldg,1276 South Pk St, Halifax, NS B3H 2Y9, Canada

[4] Univ Manitoba, Dept Internal Med, Sect Crit Care Med, Room GC430,820 Sherbrook St, Winnipeg, MB R3A 1R9, Canada

[5] Univ Manitoba, Dept Internal Med, Sect Haematol, Room GC430,820 Sherbrook St, Winnipeg, MB R3A 1R9, Canada

[6] Univ Manitoba, Dept Internal Med, Sect Med Oncol, Room GC430,820 Sherbrook St, Winnipeg, MB R3A 1R9, Canada

[7] Univ Laval, Div Crit Care Med, Dept Anesthesiol & Crit Care Med, 1050 Ave Med, Quebec City, PQ G1V 0A6, Canada

[8] Univ Laval, Dept Med, 1050 Ave Med, Quebec City, PQ G1V 0A6, Canada

[9] Ottawa Hosp, Dept Crit Care Med, 206-501 Smyth Rd, Ottawa, ON K1H 8L6, Canada

[10] Ottawa Hosp Res Inst, Clin Epidemiol Unit, 511-501 Smyth Rd, Ottawa, ON K1H 8L6, Canada

[11] Univ Laval, Dept Surg, Div Neurosurg, 1050 Ave Med, Quebec City, PQ G1V 0A6, Canada

[12] Univ British Columbia, Dept Anesthesia, 217-2176 Hlth Sci Mall, Vancouver, BC V6T 1Z3, Canada

[13] Univ Montreal, Crit Care Med, Dept Pediat, 1001 Blvd Decarie, Montreal, PQ H4A 3J1, Canada

[14] Ctr Hosp Univ Montreal, Dept Med, 3840 Rue St Urbain, Montreal, PQ H2W 1T8, Canada

来源：

JOURNAL OF CRITICAL CARE | 2018年 / 45卷

基金：

加拿大健康研究院;

关键词：

Traumatic brain injury; Red blood cell; Transfusion; Hemoglobin; Mortality; Complications; CLINICAL-PRACTICE GUIDELINE; CRITICALLY-ILL PATIENTS; MULTICENTER-COHORT; CRITICAL-CARE; HEAD-INJURY; ANEMIA; OUTCOMES; MORTALITY; INFORMATION; ADMISSION;

D O I：

10.1016/j.jcrc.2018.01.023

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Purpose: We aimed to evaluate the association between transfusion practices and clinical outcomes in patients with traumatic brain injury. Material and methods: We conducted a retrospective cohort study of adult patients with moderate or severe traumatic brain injury admitted to the intensive care unit (ICU) of a level I trauma center between 2009 and 2013. The associations between hemoglobin (Hb) level, red blood cell (RBC) transfusion and clinical outcomes were estimated using robust Poisson models and proportional hazard models with time-dependent variables, adjusted for confounders. Results: We included 215 patients. Sixty-six patients (30.7%) were transfused during ICU stay. The median pre-transfusion Hb among transfused patients was 81 g/L (IQR 67-100), while median nadir Hb among non-transfused patients was 110 g/L (IQR 93-123). Poor outcomes were significantly more frequent in patients who were transfused (mortality risk ratio [RR]: 2.15 [95% CI 1.37-3.38] and hazard ratio: 3.06 [95% CI 1.57-5.97]; neurological complications RR: 3.40 [95% CI 1.35-8.561; trauma complications RR: 1.65 [95% CI 131-2.08]; ICU length of stay geometric mean ratio: 1.42 [95% CI 1.06-1.92]). Conclusions: During ICU stay, transfused patients tended to have lower Hb levels and worse outcomes than patients who did not receive RBCs, after adjustment for confounders. (C) 2017 Elsevier Inc. All rights reserved.

引用

页码：133 / 139

页数：7

共 36 条

[1]

American College of Surgeons, 2015, ACS TQIP BEST PRACT

[2] Physiopathology of anemia and transfusion thresholds in isolated head injury [J].