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Anemia and brain oxygen after severe traumatic brain injury

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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.

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Acknowledgments

Supported by grants from the Swiss National Science Foundation (grant no. 320030_138191) and the European Society of Intensive Care Medicine (ECCRN Clinical Research Award 2010) (to M.O.), and the Integra Foundation and the Mary Elisabeth Groff Surgical and Medical Research Trust (to P.D.L.).

Conflicts of interest

Eileen Maloney-Wilensky and Peter D. Le Roux are members of Integra Lifesciences Speaker’s Bureau. Integra Lifesciences, however, had no involvement of any kind in the present study.

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Authors and Affiliations

  1. Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA

    Mauro Oddo, Joshua M. Levine, Monisha Kumar, Suzanne Frangos, Eileen Maloney-Wilensky & Peter D. Le Roux

  2. Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA

    Joshua M. Levine & Monisha Kumar

  3. Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA

    Joshua M. Levine & Monisha Kumar

  4. Department of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland

    Mauro Oddo

  5. Faculty of Biology and Medicine, Institute of Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University Hospital, 1011, Lausanne, Switzerland

    Katia Iglesias

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  1. Mauro Oddo
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  2. Joshua M. Levine
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  7. Peter D. Le Roux
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Correspondence to Mauro Oddo.

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Oddo, M., Levine, J.M., Kumar, M. et al. Anemia and brain oxygen after severe traumatic brain injury. Intensive Care Med 38, 1497–1504 (2012). https://doi.org/10.1007/s00134-012-2593-1

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  • DOI: https://doi.org/10.1007/s00134-012-2593-1

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