Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/16904
Title: Erythropoietin in patients with traumatic brain injury and extracranial injury-A post hoc analysis of the erythropoietin traumatic brain injury trial
Austin Authors: Skrifvars, Markus B;Bailey, Michael;French, Craig;Presneill, Jeffrey;Nichol, Alistair;Little, Lorraine;Duranteau, Jacques;Huet, Olivier;Haddad, Samir;Arabi, Yaseen;McArthur, Colin;Cooper, D James;Bellomo, Rinaldo 
Affiliation: Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
Department of Intensive Care Helsinki, Finland
Department of Intensive Care, Western Health, Melbourne, Victoria, Australia
Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, Victoria, Australia
Département d'Anesthésie-Réanimation, Hôpital de Bicêtre, Assistance Publique des Hopitaux de Paris, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Paris
Department of Anaesthesiology and Intensive Care Medicine), CHU La Cavale Blanche, Brest, France
King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
Auckland City Hospital, Auckland, New Zealand
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Issue Date: Sep-2017
Publication information: Journal of Trauma and Acute Care Surgery 2017; 83(3): 449–456
Abstract: BACKGROUND: Erythropoietin (EPO) may reduce mortality after traumatic brain injury (TBI). Secondary brain injury is exacerbated by multiple trauma, and possibly modifiable by EPO. We hypothesized that EPO decreases mortality more in TBI patients with multiple trauma, than in patients with TBI alone. METHODS: A post hoc analysis of the EPO-TBI randomized controlled trial conducted in 2009 to 2014. To evaluate the impact of injuries outside the brain, we calculated an extracranial Injury Severity Score (ISS) that included the same components of the ISS, excluding head and face components. We defined multiple trauma as two injured body regions with an Abbreviated Injury Scale (AIS) score of 3 or higher. Cox regression analyses, allowing for potential differential responses per the presence or absence of extracranial injury defined by these injury scores, were used to assess the effect of EPO on time to mortality. RESULTS: Of 603 included patients, the median extracranial ISS was 6 (interquartile range, 1-13) and 258 (43%) had an AIS score of 3 or higher in at least two body regions. On Cox regression, EPO was associated with decreased mortality in patients with greater extracranial ISS (interaction p = 0.048) and weakly associated with differential mortality with multiple trauma (AIS score > 3 or in two regions, interaction p = 0.17). At 6 months in patients with extracranial ISS higher than 6, 10 (6.8%) of 147 EPO-treated patients compared with 26 (17%) of 154 placebo-treated patients died (risk reduction, 10%; 95% confidence interval, 2.9-17%; p = 0.007). CONCLUSION: In this post hoc analysis, EPO administration was associated with a potential differential improvement in 6-month mortality in TBI patients with more severe extracranial injury. These findings need confirmation in future clinical and experimental studies. LEVEL OF EVIDENCE: Therapeutic study, level III.
URI: http://ahro.austin.org.au/austinjspui/handle/1/16904
DOI: 10.1097/TA.0000000000001594
ORCID: 0000-0002-1650-8939
PubMed URL: https://pubmed.ncbi.nlm.nih.gov/28590358
Type: Journal Article
Appears in Collections:Journal articles

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