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J Crit Care. 2018 Jun;45:133-139. doi: 10.1016/j.jcrc.2018.01.023. Epub 2018 Jan 31.

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

Author information

1
CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Université Laval, Z-207, 1401, 18e rue, Québec, QC G1J 1Z4, Canada; Department of Social and Preventive Medicine, Université Laval, 1050, avenue de la Médecine, Québec, QC G1V 0A6, Canada. Electronic address: amelie.boutin.2@ulaval.ca.
2
CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Université Laval, Z-207, 1401, 18e rue, Québec, QC G1J 1Z4, Canada; Department of Social and Preventive Medicine, Université Laval, 1050, avenue de la Médecine, Québec, QC G1V 0A6, Canada. Electronic address: lynne.moore@fmed.ulaval.ca.
3
Department of Critical Care, Dalhousie University, Suite 377, Bethune Building, 1276 South Park Street, Halifax, NS B3H 2Y9, Canada. Electronic address: dr.robert.green@dal.ca.
4
Department of Internal Medicine, Sections of Critical Care Medicine of Haematology and of Medical Oncology, University of Manitoba, Room GC430, 820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada. Electronic address: ryan.zarychanski@cancercare.mb.ca.
5
Department of Critical Care, Dalhousie University, Suite 377, Bethune Building, 1276 South Park Street, Halifax, NS B3H 2Y9, Canada. Electronic address: mete.erdogan@nshealth.ca.
6
CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Université Laval, Z-207, 1401, 18e rue, Québec, QC G1J 1Z4, Canada; Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, 1050, avenue de la Médecine, Québec, QC G1V 0A6, Canada; Department of Medicine, Université Laval, 1050, avenue de la Médecine, Québec, QC G1V 0A6, Canada. Electronic address: francois.lauzier@med.ulaval.ca.
7
Department of Critical Care Medicine, The Ottawa Hospital, 206-501 Smyth Road, Ottawa, ON K1H 8L6, Canada; Clinical Epidemiology Unit, Ottawa Hospital Research Institute, 511-501 Smyth Road, Ottawa, ON K1H 8L6, Canada. Electronic address: senglish@toh.ca.
8
Clinical Epidemiology Unit, Ottawa Hospital Research Institute, 511-501 Smyth Road, Ottawa, ON K1H 8L6, Canada. Electronic address: dafergusson@ohri.ca.
9
Department of Critical Care, Dalhousie University, Suite 377, Bethune Building, 1276 South Park Street, Halifax, NS B3H 2Y9, Canada. Electronic address: michaelb.butler@nshealth.ca.
10
Department of Critical Care Medicine, The Ottawa Hospital, 206-501 Smyth Road, Ottawa, ON K1H 8L6, Canada; Clinical Epidemiology Unit, Ottawa Hospital Research Institute, 511-501 Smyth Road, Ottawa, ON K1H 8L6, Canada. Electronic address: lmcintyre@ohri.ca.
11
Department of Medicine, Centre Hospitalier Universitaire de Montréal, 3840 Rue Saint-Urbain, Montréal, QC H2W 1T8, Canada.
12
CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Université Laval, Z-207, 1401, 18e rue, Québec, QC G1J 1Z4, Canada; Department of Surgery, Division of Neurosurgery, Université Laval, 1050, avenue de la Médecine, Québec, QC G1V 0A6, Canada. Electronic address: paule.lessard-bonaventure.1@ulaval.ca.
13
CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Université Laval, Z-207, 1401, 18e rue, Québec, QC G1J 1Z4, Canada. Electronic address: caroline.leger@crchudequebec.ulaval.ca.
14
CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Université Laval, Z-207, 1401, 18e rue, Québec, QC G1J 1Z4, Canada; Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, 1050, avenue de la Médecine, Québec, QC G1V 0A6, Canada. Electronic address: philippe.desjardins.1@ulaval.ca.
15
Department of Anesthesia, Vancouver, University of British Columbia, 217-2176 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada. Electronic address: donald.griesdale@vch.ca.
16
Department of Pediatrics, Critical Care Medicine, Université de Montréal, 1001 Boulevard Décarie, Montréal, QC H4A 3J1, Canada. Electronic address: jacques_lacroix@ssss.gouv.qc.ca.
17
CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Université Laval, Z-207, 1401, 18e rue, Québec, QC G1J 1Z4, Canada; Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, 1050, avenue de la Médecine, Québec, QC G1V 0A6, Canada. Electronic address: alexis.turgeon@fmed.ulaval.ca.

Abstract

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 81g/L (IQR 67-100), while median nadir Hb among non-transfused patients was 110g/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 1.35-8.56]; trauma complications RR: 1.65 [95% CI 1.31-2.08]; 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.

KEYWORDS:

Complications; Hemoglobin; Mortality; Red blood cell; Transfusion; Traumatic brain injury

PMID:
29459342
DOI:
10.1016/j.jcrc.2018.01.023
[Indexed for MEDLINE]

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