Higher haemoglobin levels and dedicated trauma admission are associated with survival after severe traumatic brain injury

Baltazar, Gerard A.; Pate, Amy; Panigrahi, Benita; Sharp, Audrey; Smith, Michael L.; Chendrasekhar, Akella

doi:10.3109/02699052.2015.1004558

Cited by 8 publications

(5 citation statements)

References 16 publications

(17 reference statements)

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“…A low serum albumin level is yet reported to be a predictor of mortality in most populations [ 8 – 15 ] and, as expected, we found that albumin predicts short-term mortality also in MCS patients. Furthermore, it has long been recognised that pressure ulcers are a major cause of morbidity, mortality as well as an healthcare burden globally.…”

Section: Discussionsupporting

confidence: 89%

“…Nevertheless serum albumin has been shown to be associated with pressure ulcers and mortality in different clinical settings [ 8 – 15 , 33 – 35 ], it is well accepted that the serum albumin level could be affected by a variety of factors and could represent an inflammatory marker [ 36 ]. Malnourished patients most frequently have inflammation [ 37 , 38 ].…”

Section: Discussionmentioning

confidence: 99%

“…Hypoalbuminemia has been shown to increase mortality in different clinical settings [ 8 – 10 ], including ischemic stroke [ 11 , 12 ] and traumatic brain injury [ 13 – 15 ] while a decreased hemoglobin level was significantly associated with pressure ulcer formation in individual with traumatic brain injury [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Nutritional parameters predicting pressure ulcers and short-term mortality in patients with minimal conscious state as a result of traumatic and non-traumatic acquired brain injury

et al. 2015

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BackgroundThe association between malnutrition and worse outcomes as pressure ulcers and mortality is well established in a variety of setting. Currently none investigation was conducted in patients with long-term consequences of the acquired brain injury in which recovery from brain injury could be influenced by secondary complications. The aim of this study was to investigate the association between various nutritional status parameters (in particular albumin) and pressure ulcers formation and short-term mortality in minimal conscious state patients.MethodsIn this prospective, observational study of 5-months duration, a 30 patients sample admitted to a Neurological Institute was considered. All patients underwent a complete medical examination. Anthropometric parameters like mid-arm circumference and mid-arm muscle circumference and nutritional parameters as serum albumin and blood hemoglobin concentration were assessed.ResultsAt univariate and logistic regression analysis, mid-arm circumference (p = 0.04; beta = −0.89), mid-arm muscle circumference (p = 0.050; beta = −1.29), hemoglobin (p = 0.04, beta −1.1) and albumin (p = 0.04, beta −7.91) were inversely associated with pressure ulcers. The area under the ROC curve for albumin to predict sores was 0.76 (p = 0.02) and mortality was 0.83 (p = 0.03). Patient with lower albumin had significantly higher short-term mortality than those with higher serum albumin (p = 0.03; χ2 test = 6.47).ConclusionAlbumin, haemoglobin and mid-arm circumference are inversely associated with pressure ulcers. Albumin is a prognostic index in MCS patients. Since albumin and haemoglobin could be affected by a variety of factors, this association suggests to optimize nutrition and investigate on other mechanism leading to mortality and pressure ulcers.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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Nutritional parameters predicting pressure ulcers and short-term mortality in patients with minimal conscious state as a result of traumatic and non-traumatic acquired brain injury

et al. 2015

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“…Despite the fact that moderate anemia was associated with diminished PbtO 2 in TBI patients, cohort studies have not demonstrated a consistent relationship between anemia and poor clinical outcome (Table ). 11,[19][20][21][22][23][24][25][26][27][28][29][30][31][32] This, to some extent, is due to the differences in the definition and measurement of anemia, study methodology, and study population. Moreover, caution must be exercised when interpreting observational findings, as anemia may be the reflection of severe illness, prolonged ICU stay, and/or poor baseline physiological reserve, and as such, the relationship between anemia and poor outcomes might be one of association rather than of causation.…”

Section: Traumatic Brain Injurymentioning

confidence: 99%

Anemia and Optimal Transfusion Thresholds in Brain-Injured Patients: A Narrative Review of the Literature

Ma,

Bebawy

2023

Anesthesia &Amp; Analgesia

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Anemia is a highly prevalent condition that may compromise oxygen delivery to vital organs, especially among the critically ill. Although current evidence supports the adoption of a restrictive transfusion strategy and threshold among the nonbleeding critically ill patient, it remains unclear whether this practice should apply to the brain-injured patient, given the predisposition to cerebral ischemia in this patient population, in which even nonprofound anemia may exert a detrimental effect on clinical outcomes. The purpose of this review is to provide an overview of the pathophysiological changes related to impaired cerebral oxygenation in the brain-injured patient and to present the available evidence on the effect of anemia and varying transfusion thresholds on the clinical outcomes of patients with acute brain injury.

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“…Traumatic brain injury (TBI), which is a risk factor for depression, cognitive impairment, and hypopituitarism, entails decreased levels of circulating GH and IGF-I and has links to circulating and brain Hb. For example, among patients with severe TBI, lower levels of Hb are consistently associated with lower survival rates ( 127 ) and poor outcomes ( 128 ). While anemia frequently occurs after TBI, the associations with outcome and the effects of blood transfusions are rather inconsistent [for a review, see ( 129 )].…”

Section: Gh/igf-i and Various Brain Diseases In Relation To Hbmentioning

confidence: 99%

Growth Hormone and Neuronal Hemoglobin in the Brain—Roles in Neuroprotection and Neurodegenerative Diseases

et al. 2021

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In recent years, evidence for hemoglobin (Hb) synthesis in both animal and human brains has been accumulating. While circulating Hb originating from cerebral hemorrhage or other conditions is toxic, there is also substantial production of neuronal Hb, which is influenced by conditions such as ischemia and regulated by growth hormone (GH), insulin-like growth factor-I (IGF-I), and other growth factors. In this review, we discuss the possible functions of circulating and brain Hb, mainly the neuronal form, with respect to the neuroprotective activities of GH and IGF-I against ischemia and neurodegenerative diseases. The molecular pathways that link Hb to the GH/IGF-I system are also reviewed, although the limited number of reports on this topic suggests a need for further studies. In summary, GH and/or IGF-I appear to be significant determinants of systemic and local brain Hb concentrations through mediating responses to oxygen and metabolic demand, as part of the neuroprotective effects exerted by GH and IGF-I. The nature and quantity of the latter deserve further exploration in specific experiments.

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Higher haemoglobin levels and dedicated trauma admission are associated with survival after severe traumatic brain injury

Abstract: Among patients with severe TBI, higher haemoglobin levels and maintenance as a dedicated trauma admission are associated with higher survival to discharge.

Cited by 8 publications

References 16 publications

Nutritional parameters predicting pressure ulcers and short-term mortality in patients with minimal conscious state as a result of traumatic and non-traumatic acquired brain injury

Nutritional parameters predicting pressure ulcers and short-term mortality in patients with minimal conscious state as a result of traumatic and non-traumatic acquired brain injury

Anemia and Optimal Transfusion Thresholds in Brain-Injured Patients: A Narrative Review of the Literature

Growth Hormone and Neuronal Hemoglobin in the Brain—Roles in Neuroprotection and Neurodegenerative Diseases

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