Erythropoiesis stimulating agent administration improves survival after severe traumatic brain injury: a matched case control study

Abstract

Objective: Erythropoiesis stimulating agent (ESA) administration may reduce mortality in severe traumatic brain injury (sTBI).

Summary background data: It has been established that the administration of ESA in critically ill trauma victims has been associated with improved outcomes. Recent experimental and clinical data showed neuroprotective effects of ESA, however, the literature regarding impact on outcome in sTBI is lacking.

Methods: : A retrospective matched case control study in patients with sTBI [head Abbreviated Injury Scale (AIS), >or=3] receiving ESA while in the surgical intensive care unit from January 1, 1996 to December 31, 2007 (n = 89), were matched 1 to 2 (n = 178) by age, gender, mechanism of injury, Glasgow Coma Scale, presence of hypotension on admission, Injury Severity Score, AIS for all body regions, and presence of anemia with patients who did not receive the agent. Each case's controls were chosen to have surgical intensive care unit length of stay more than or equal to the time from admission to first dose of ESA. The primary outcome measure in this study was mortality.

Results: Cases and controls had similar age, gender, mechanisms of injury, incidence of hypotension, Glasgow Coma Scale on admission, Injury Severity Score, and AIS for all body regions. Although the ESA+ patients experienced protracted hospital length of stay and comparable surgical intensive care unit free days, they demonstrated a significantly lower in-hospital mortality in comparison to controls at 7.9% versus 24.2%, respectively (OR: 0.27; 95% CI = 0.12-0.62; P = 0.001).

Conclusions: Erythropoiesis stimulating agent administration in sTBI is associated with a significant in-hospital survival advantage without increase in morbidity. Prospective validation of our findings is warranted.