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Hemoglobin Area and Time Index Above 90 g/L are Associated with Improved 6-Month Functional Outcomes in Patients with Severe Traumatic Brain Injury

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Abstract

Purpose

There is conflicting data on the relationship between anemia and outcomes in patients with traumatic brain injuries (TBI). The objective of this study was to determine if the proportion of time and area under the hemoglobin-time curve of ≥90 g/L are independently associated with 6-month functional outcomes.

Methods

Retrospective cohort study of 116 patients with a severe TBI who underwent invasive neuromonitoring between June 2006 and December 2013. Hemoglobin area (HAI) and time (HTI) indices were calculated by dividing the total area, or time, under the hemoglobin-time curve at 90 g/L or above by the total duration of monitoring. Multivariable log-binomial regression was used to model the association between HAI or HTI and 6 month favorable neurologic outcome (Glasgow Outcome Score 4 or 5).

Results

Patients had a mean age of 38 years (SD 16) with a median admission Glasgow Coma Scale of 6 (IQR 4–7). There were 1523 hemoglobin measurements and 523 monitoring days. Patients had a hemoglobin ≥90 g/L for a median of 70 % (IQR 37–100) of the time. Each 10 g/L increase in HAI (RR 1.23, 95 %CI 1.04–1.44, P = 0.011), and 10 % increase in HTI (1.10, 95 %CI 1.04–1.16, P < 0.001) were associated with improved neurologic outcome. Thirty-one patients (27 %) received a transfusion with the median pre-transfusion hemoglobin being 81 g/L (IQR 76–87).

Conclusions

In patients with severe TBI, increased area under the curve and percentage of time that the hemoglobin concentration was ≥90 g/L, were associated with improved neurologic outcomes.

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Acknowledgments

We would like to acknowledge the staff of the Neurocritical Care Unit at Addenbrooke’s Hospital for their support in the completion of this study.

Conflicts of interest

The authors declare that they have no conflict of interest.

Funding

Dr. Griesdale is funded by the VGH & UBC Hospital Foundation Best of Health Fund.

Author information

Authors and Affiliations

  1. Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Room 2438, Jim Pattison Pavilion, 2nd Floor, 855 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada

    Donald E. Griesdale, Mypinder S. Sekhon, Indeep S. Sekhon & William R. Henderson

  2. Department of Anesthesia, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada

    Donald E. Griesdale

  3. Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada

    Donald E. Griesdale

  4. Neurocritical Care Unit, Addenbrooke’s Hospital, Cambridge University Hospitals Trust, Cambridge University, Cambridge, U K

    David K. Menon, Andrea Lavinio, Joseph Donnelly, Chiara Robba, Andrew Taylor & Arun K. Gupta

  5. Division of Critical Care, Department of Anesthesiology and Critical Care Medicine, Université Laval, Quebec City, QC, Canada

    Alexis F. Turgeon

  6. Population Health and Optimal Health Practices Unit, CHU de Québec Research Center, Université Laval, Quebec City, QC, Canada

    Alexis F. Turgeon

Authors
  1. Donald E. Griesdale
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  2. Mypinder S. Sekhon
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  3. David K. Menon
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  4. Andrea Lavinio
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  7. Indeep S. Sekhon
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  8. Andrew Taylor
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  9. William R. Henderson
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  11. Arun K. Gupta
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Corresponding author

Correspondence to Donald E. Griesdale.

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Griesdale, D.E., Sekhon, M.S., Menon, D.K. et al. Hemoglobin Area and Time Index Above 90 g/L are Associated with Improved 6-Month Functional Outcomes in Patients with Severe Traumatic Brain Injury. Neurocrit Care 23, 78–84 (2015). https://doi.org/10.1007/s12028-014-0096-3

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  • DOI: https://doi.org/10.1007/s12028-014-0096-3

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