ارتباط بين غلظت هموگلوبين و مورتاليتي در بيماران تروماي مغزي بستري در بخش مراقبت‌هاي ويژه

Association of Hemoglobin Concentration with Mortality in Critically III Patients Suffering from Traumatic Brain Injury

زمينه و هدف: آسيب تروماتيك مغز يكي از علل مهم مورتاليتي و موربيديتي دركل جهان و دومين علت مرگ در ايران مي باشد. حدود نيمي از اين بيماران هموگلوبين كمتر از 9 گرم بر دسي ليتر در هفته ي اول پذيرش دارند. با توجه به آسيب ثانويه ي بافت مغز ناشي از آنمي و با در نظر گرفتن عوارض انتقال خون بر آن شديم تا ارتباط بين غلظت هموگلوبين و مورتاليتي را در بيماران تروماي مغزي بررسي كنيم. روش بررسي: يك مطالعه كوهورت رتروسپكتيو روي بيماران آسيب تروماتيك مغزي انجام شد. اطلاعات دموگرافيك، پيامدهاي فيزيولوژيك و باليني و هموگلوبين، روزانه از پرونده هاي بيماران استخراج گرديد. از 168 بيمار با آسيب تروماتيك مغزي بر اساس معيارهاي ورود و خروج، 117 بيمار وارد مطالعه شدند. بيماران بر اساس غلظت ميانگين هموگلوبين 7 روزه به 4 گروه تقسيم گرديدند. جهت مدل سازي ارتباط بين غلظت ميانگين هموگلوبين 7 روزه و مورتاليتي بيمارستاني از رگرسيون لجستيك استفاده شد. يافته ها: 104نفر از بيماران مرد بودند. بين ميانگين سني، جنس و تعداد روزهاي اتصال به ونتيلاتور بين گروه ها اختلاف آماري معناداري وجود نداشت. در بين چهار گروه، ميزان مورتاليتي، تعداد واحدهاي خون دريافتي و تعداد روزهاي بستري اختلاف آماري معنادار بود. آناليز چند متغيري داده ها نشان داد كه متوسط غلظت هموگلوبين زير 9 گرم بر دسي ليتر در ارتباط مستقل با افزايش مورتاليتي بيمارستاني است. نتيجه گيري: غلظت ميانگين هموگلوبين 7 روزه ي زير 9 گرم بر دسي ليتر بيماران با آسيب تروماتيك مغزي در ارتباط مستقل با افزايش مورتاليتي بيمارستاني است.

Background and Objective: Traumatic brain injury is one of the main causes of mortality and morbidity worldwide and the second leading cause of death in Iran. About half of patients with traumatic brain injury have hemoglobin of less than 9 g/dL during the first week of admission. With regard to the secondary damage to brain tissues caused by anemia and blood transfusion complications, we decided to assess the association between hemoglobin concentration and mortality in patients with traumatic brain injury. Materials and Methods: A retrospective cohort study was conducted with patients suffering from traumatic brain injury. Demographics, physiologic data, clinical outcomes and daily hemoglobin concentrations were obtained from patientsrsquo history records. 168 patients with traumatic brain injury were identified and 117 were included in the analysis based on inclusion/exclusion criteria. Patients were assigned to 4 groups based on their mean 7day hemoglobin concentration. Logistic regression was used to model the association between mean daily hemoglobin concentration and hospital mortality. Results: 104 of 117 patients were male. Age, gender and days of mechanical ventilation did not show statistically significant differences among groups. Significant differences were observed in mortality rates, the number of transfused units and number of days of hospitalization among four groups. Multivariable analysis revealed that mean 7day hemoglobin concentration lt 9g/dL was independently associated with an increased risk of hospital mortality. Conclusion: A mean 7day hemoglobin concentration of lt 9g/dL is associated with increased hospital mortality in patients with traumatic brain injury. Keywords: Traumatic brain injury, Hemoglobin, Mortality, Intensive care unit Background and Objective: Traumatic brain injury is one of the main causes of mortality and morbidity worldwide and the second leading cause of death in Iran. About half of patients with traumatic brain injury have hemoglobin of less than 9 g/dL during the first week of admission. With regard to the secondary damage to brain tissues caused by anemia and blood transfusion complications, we decided to assess the association between hemoglobin concentration and mortality in patients with traumatic brain injury. Materials and Methods: A retrospective cohort study was conducted with patients suffering from traumatic brain injury. Demographics, physiologic data, clinical outcomes and daily hemoglobin concentrations were obtained from patientsrsquo history records. 168 patients with traumatic brain injury were identified and 117 were included in the analysis based on inclusion/exclusion criteria. Patients were assigned to 4 groups based on their mean 7day hemoglobin concentration. Logistic regression was used to model the association between mean daily hemoglobin concentration and hospital mortality. Results: 104 of 117 patients were male. Age, gender and days of mechanical ventilation did not show statistically significant differences among groups. Significant differences were observed in mortality rates, the number of transfused units and number of days of hospitalization among four groups. Multivariable analysis revealed that mean 7day hemoglobin concentration lt 9g/dL was independently associated with an increased risk of hospital mortality. Conclusion: A mean 7day hemoglobin concentration of lt 9g/dL is associated with increased hospital mortality in patients with traumatic brain injury.