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Anemia and brain oxygen after severe traumatic brain injury

Mauro Oddo| Joshua M. Levine| Monisha Kumar| Katia Iglesias| Suzanne Frangos| Eileen Maloney-Wilensky| Peter D. Le Roux
Original
Volume 38, Issue 9 / September , 2012

Pages 1497 - 1504

Abstract

Purpose

To investigate the relationship between hemoglobin (Hgb) and brain tissue oxygen tension (PbtO2) after severe traumatic brain injury (TBI) and to examine its impact on outcome.

Methods

This was a retrospective analysis of a prospective cohort of severe TBI patients whose PbtO2 was monitored. The relationship between Hgb—categorized into four quartiles (≤9; 9–10; 10.1–11; >11 g/dl)—and PbtO2 was analyzed using mixed-effects models. Anemia with compromised PbtO2 was defined as episodes of Hgb ≤ 9 g/dl with simultaneous PbtO2 < 20 mmHg. Outcome was assessed at 30 days using the Glasgow outcome score (GOS), dichotomized as favorable (GOS 4–5) vs. unfavorable (GOS 1–3).

Results

We analyzed 474 simultaneous Hgb and PbtO2 samples from 80 patients (mean age 44 ± 20 years, median GCS 4 (3–7)). Using Hgb > 11 g/dl as the reference level, and controlling for important physiologic covariates (CPP, PaO2, PaCO2), Hgb ≤ 9 g/dl was the only Hgb level that was associated with lower PbtO2 (coefficient −6.53 (95 % CI −9.13; −3.94), p < 0.001). Anemia with simultaneous PbtO2 < 20 mmHg, but not anemia alone, increased the risk of unfavorable outcome (odds ratio 6.24 (95 % CI 1.61; 24.22), p = 0.008), controlling for age, GCS, Marshall CT grade, and APACHE II score.

Conclusions

In this cohort of severe TBI patients whose PbtO2 was monitored, a Hgb level no greater than 9 g/dl was associated with compromised PbtO2. Anemia with simultaneous compromised PbtO2, but not anemia alone, was a risk factor for unfavorable outcome, irrespective of injury severity.

Keywords

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