Citicoline in severe traumatic brain injury: indications for improved outcome

Abstract

Goal-oriented management of traumatic brain injury (TBI) can save the lives and/or improve the long-term outcome of millions of affected patients worldwide. Additionally, enhancing quality of life will save enormous socio-economic costs; however, promising TBI treatment strategies with neuroprotective agents, such as citicoline (CDP-choline), lacked evidence or produced contradictory results in clinical trials. During a prehospital TBI project to optimize early TBI care within 14 Austrian trauma centers, data on 778 TBI patients were prospectively collected. As preceding evaluations suggested a beneficial outcome in TBI patients treated at the Wiener Neustadt Hospital (WNH), we aimed to investigate the potential role of citicoline administration, solely applied in WNH, in those patients. In a retrospective subgroup analysis we compared 67 patients from WNH with citicoline administration and 67 matched patients from other Austrian centers without citicoline use. Patients with Glasgow Coma Scale score <13 on site and/or Abbreviated Injury Scale of the region "head" >2 were included. Our analysis revealed significantly reduced rates of intensive care unit (ICU) mortality (5% vs. 24%, p < 0.01), in-hospital mortality (9% vs. 24%, p = 0.035) and 6‑month mortality (13% vs. 28%, p = 0.031), as well as of unfavorable outcome (34% vs. 57%, p = 0.015) and observed vs. expected ratio for mortality (0.42 vs. 0.84) in the WNH (citicoline receivers) group. Despite the limitations of a retrospective subgroup analysis our findings suggest a possible correlation between early and consequent citicoline administration and beneficial outcomes. Therefore, we aim to set up an initiative for a prospective, multicenter randomized controlled trial with citicoline in sTBI (severe TBI) patients.

Application of Citicoline in Neurological Disorders: A Systematic Review

“…In the study by Trimmel et al [ 59 ], 67 patients with brain trauma were administered citicoline during their stay in the intensive care unit (ICU). The Rotterdam CT score, Glasgow Coma Scale (GCS), and the Injury Severity Score (ISS) were used to initially assess the condition of patients after trauma.…”

Citicoline Improves Human Vigilance and Visual Working Memory: The Role of Neuronal Activation and Oxidative Stress

“…Citicoline has a neuroprotective effect through the preservation of neuronal sphingomyelin, cardiolipin, and arachidonic content, as well as phosphatidylethanolamine and phosphatidylcholine. Citicoline also improves glutathione reductase activity and choline availability for acetylcholine synthesis (Trimmel et al, 2018). Moreover, citicoline prevents phospholipase A2 stimulation during ischemic stroke; thus, it attenuates free radical generations from cardiolipin catabolism.…”

Comparison of two different doses of citicoline in patients with traumatic brain injury

“…In a study investigating the effect of citicoline on patients with brain trauma, it was found that GCS in patients on the 15th day of hospitalization treated with 500mg of citicoline every 6 hours compared to the first day of hospitalization, it was associated with an increase in the degree of GCS (19). In another study investigating the patients with brain trauma with a GCS of < 13 using a 6-month follow-up, citicoline administration was reported to cause a marked decrease in mortality rate among people admitted to the ICUs (20). In an investigation including 1,213 patients with brain trauma between 2007 and 2011, no changes were observed in the GCS level in the intervention and control groups after 90 days of treatment with citicoline (two g per day) (21).…”