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Effects of Red Blood Cell Transfusion on Long-Term Disability of Patients with Traumatic Brain Injury

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Abstract

Background

This 3-year prospective study examined the association between red blood cell transfusion (RBCT) and 1-year neurocognitive and disability levels in 309 patients with traumatic brain injury (TBI) admitted to the neurological intensive care unit (NICU).

Methods

Using a telephone interview-based survey, functional outcomes were assessed by the Glasgow Outcome Scale (GOS), Rancho Los Amigos Levels of Cognitive Functioning Scale (RLCFS), and Disability Rating Scale (DRS) and dichotomized as favorable and unfavorable (dependent variable). The adjusted influence of RBCT on unfavorable results was assessed by conventional logistic regression, controlling for illness severity and propensity score (introduced as a continuous variable and by propensity score-matched patients).

Results

Overall, 164 (53 %) patients received ≥1 unit of RBCT during their NICU stay. One year postinjury, transfused patients exhibited significantly higher unfavorable GOS (46.0 vs. 22.0 %), RLCFS (37.4 vs. 15.4 %), and DRS (39.6 vs. 18.7 %) scores than nontransfused patients. Although transfused patients were more severely ill upon admission, their adjusted odds ratios (95 % confidence intervals) for unfavorable GOS, RLCFS, and DRS scores were 2.5 (1.2–5.1), 3.0 (1.4–6.3), and 2.3 (1.1–4.8), respectively. These odds ratios remained largely unmodified when the calculated propensity score was incorporated as an independent continuous variable into the multivariate analysis. Furthermore, in 76 pairs of propensity score-matched patients, the rate of an unfavorable RLCFS score at the 1-year (but not 6-month) follow-up was significantly higher in transfused than nontransfused patients [3.0 (1.1–8.2)].

Conclusion

Our results strongly suggest an independent association between RBCT and unfavorable long-term functional outcomes of patients with TBI.

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Abbreviations

CTS:

Computed tomographic scan

GCS:

Glasgow Coma Scale

GOS:

Glasgow Outcome Scale

Hb:

Hemoglobin

IMPACT:

International Mission for Prognosis and Analysis of Clinical Trial

IQR:

Interquartile range

RLCFS:

Rancho Level of Cognitive Functioning Scale

DRS:

Disability Rating Scale

TBI:

Traumatic brain injury

NICU:

Neurological intensive care unit

RBCT:

Red blood cell transfusion

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Acknowledgments

This study was partially supported by MAPFRE foundation (Mutualidad de la Agrupación de Propietarios de Fincas Rústicas de España).

Author information

Authors and Affiliations

  1. Critical Care Division, Instituto de Biomedicina IBIS, Hospital Universitario ‘‘Virgen del Rocío’’, Avda/Manuel Siurot, s/n, 41013, Seville, Spain

    Santiago R. Leal-Noval, Victoria Arellano-Orden, Antonio Alcántara, Rosario Amaya-Villar, Manuel Casado-Méndez & Francisco Murillo-Cabezas

  2. Neuropsychology Division, Instituto de Biomedicina IBIS, Hospital Universitario ‘‘Virgen del Rocío’’, Seville, Spain

    Ángela Muñoz-Serrano

  3. Statistics and Design Division, Hospital de Valme, Seville, Spain

    Aurelio Cayuela

  4. Perioperative Transfusion Medicine, University of Málaga, Málaga, Spain

    Manuel Muñoz-Gómez

  5. Transfusion Service, Hospital Universitario ‘‘Virgen del Rocío’’, Seville, Spain

    Antonio Recio

Authors
  1. Santiago R. Leal-Noval
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  2. Ángela Muñoz-Serrano
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  3. Victoria Arellano-Orden
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  4. Aurelio Cayuela
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  5. Manuel Muñoz-Gómez
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  6. Antonio Recio
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  7. Antonio Alcántara
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  8. Rosario Amaya-Villar
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  9. Manuel Casado-Méndez
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  10. Francisco Murillo-Cabezas
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Corresponding author

Correspondence to Santiago R. Leal-Noval.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The institutional review board approved this study and waived the need for informed consent.

Additional information

Registered on: https://www.fundacionmapfre.org/fundacion/es_es/images/fallo-ayudas-2008_tcm164-27583.pdf.

Electronic supplementary material

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12028_2015_220_MOESM1_ESM.docx

Fig. 4. Receiver operating curve for propensity score model. Area under the curve = 0.81 (0.76–0.85). Supplementary material 1 (DOCX 38 kb)

Supplementary material 2 (DOCX 15 kb)

Supplementary material 3 (DOCX 21 kb)

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Leal-Noval, S.R., Muñoz-Serrano, Á., Arellano-Orden, V. et al. Effects of Red Blood Cell Transfusion on Long-Term Disability of Patients with Traumatic Brain Injury. Neurocrit Care 24, 371–380 (2016). https://doi.org/10.1007/s12028-015-0220-z

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  • DOI: https://doi.org/10.1007/s12028-015-0220-z

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