Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/33290
Title: The effect of recombinant erythropoietin on long-term outcome after moderate-to-severe traumatic brain injury.
Austin Authors: Skrifvars, Markus B;Luethi, Nora;Bailey, Michael;French, Craig;Nichol, Alistair;Trapani, Tony;McArthur, Colin;Arabi, Yaseen M;Bendel, Stepani;Cooper, David J;Bellomo, Rinaldo 
Affiliation: Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, PB 340, 00029 HUS, Helsinki, Finland.
Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Department of Intensive Care, Western Health, Melbourne, VIC, Australia.
Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.;School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland.
Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand.
Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
Department of Anesthesiology and Intensive Care, Kuopio University Hospital and University of Eastern, Kuopio, Finland.
Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Intensive Care
Issue Date: 5-Jul-2023
Date: 2023
Publication information: Intensive Care Medicine 2023-07-05; 49(7)
Abstract: Recombinant erythropoietin (EPO) administered for traumatic brain injury (TBI) may increase short-term survival, but the long-term effect is unknown. We conducted a pre-planned long-term follow-up of patients in the multicentre erythropoietin in TBI trial (2010-2015). We invited survivors to follow-up and evaluated survival and functional outcome with the Glasgow Outcome Scale-Extended (GOSE) (categories 5-8 = good outcome), and secondly, with good outcome determined relative to baseline function (sliding scale). We used survival analysis to assess time to death and absolute risk differences (ARD) to assess favorable outcomes. We categorized TBI severity with the International Mission for Prognosis and Analysis of Clinical Trials in TBI model. Heterogeneity of treatment effects were assessed with interaction p-values based on the following a priori defined subgroups, the severity of TBI, and the presence of an intracranial mass lesion and multi-trauma in addition to TBI. Of 603 patients in the original trial, 487 patients had survival data; 356 were included in the follow-up at a median of 6 years from injury. There was no difference between treatment groups for patient survival [EPO vs placebo hazard ratio (HR) (95% confidence interval (CI) 0.73 (0.47-1.14) p = 0.17]. Good outcome rates were 110/175 (63%) in the EPO group vs 100/181 (55%) in the placebo group (ARD 8%, 95% CI [Formula: see text] 3 to 18%, p = 0.14). When good outcome was determined relative to baseline risk, the EPO groups had better GOSE (sliding scale ARD 12%, 95% CI 2-22%, p = 0.02). When considering long-term patient survival, there was no evidence for heterogeneity of treatment effect (HTE) according to severity of TBI (p = 0.85), presence of an intracranial mass lesion (p = 0.48), or whether the patient had multi-trauma in addition to TBI (p = 0.08). Similarly, no evidence of treatment heterogeneity was seen for the effect of EPO on functional outcome. EPO neither decreased overall long-term mortality nor improved functional outcome in moderate or severe TBI patients treated in the intensive care unit (ICU). The limited sample size makes it difficult to make final conclusions about the use of EPO in TBI.
URI: https://ahro.austin.org.au/austinjspui/handle/1/33290
DOI: 10.1007/s00134-023-07141-5
ORCID: 0000-0002-0341-0262
Journal: Intensive Care Medicine
PubMed URL: 37405413
ISSN: 1432-1238
Type: Journal Article
Subjects: Erythropoietin
Neurological outcome
Traumatic brain injury
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