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Critical Care
Published in: Critical Care 4/2012

Open Access 01-08-2012 | Research

Association of hemoglobin concentration and mortality in critically ill patients with severe traumatic brain injury

Authors: Mypinder S Sekhon, Nielson McLean, William R Henderson, Dean R Chittock, Donald EG Griesdale

Published in: Critical Care | Issue 4/2012

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Abstract

Introduction

The critical care management of traumatic brain injury focuses on preventing secondary ischemic injury. Cerebral oxygen delivery is dependent upon the cerebral perfusion pressure and the oxygen content of blood, which is principally determined by hemoglobin. Despite its importance to the cerebral oxygen delivery, the precise hemoglobin concentration to provide adequate oxygen delivery to injured neuronal tissue in TBI patients is controversial with limited evidence to provide transfusion thresholds.

Methods

We conducted a retrospective cohort study of severe TBI patients, investigating the association between mean 7-day hemoglobin concentration and hospital mortality. Demographic, physiologic, intensive care interventions, clinical outcomes and daily hemoglobin concentrations were recorded for all patients. Patients were all cared for at a tertiary, level 1 trauma center in a mixed medical and surgical intensive unit. Patients were divided into quartiles based on their mean 7-day hemoglobin concentration: < 90 g/L, 90 - 99 g/L, 100 - 109 g/L and > 110 g/L. Multivariable log-binomial regression was used to model the association between mean daily hemoglobin concentration and hospital mortality.

Results

Two hundred seventy-three patients with traumatic brain injury were identified and 169 were included in the analysis based on inclusion/exclusion criteria. Of these, 77% of the patients were male, with a mean age of 38 (SD 17) years and a median best GCS of 6 (IQR 5 - 7). One hundred fifteen patients (68%) received a red blood cell (RBC) transfusion. In RBCs administered in the ICU, the median pre-transfusion hemoglobin was 79 g/L (IQR 73 - 85). Thirty-seven patients (22%) died in hospital. Multivariable analysis revealed that mean 7-day hemoglobin concentration < 90 g/L was independently associated with an increased risk of hospital mortality (RR 3.1, 95% CI 1.5 - 6.3, p = 0.03). Other variables associated with increased mortality on multivariable regression were insertion of external ventricular drain, age and decreased GCS. Red blood cell transfusion was not associated with mortality following multivariable adjustment.

Conclusions

A mean 7-day hemoglobin concentration of < 90g/L is associated with increased hospital mortality in patients with severe traumatic brain injury.
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Metadata
Title
Association of hemoglobin concentration and mortality in critically ill patients with severe traumatic brain injury
Authors
Mypinder S Sekhon
Nielson McLean
William R Henderson
Dean R Chittock
Donald EG Griesdale
Publication date
01-08-2012
Publisher
BioMed Central
Published in
Critical Care / Issue 4/2012
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc11431

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