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Darbepoietin improves outcomes of severe traumatic brain injury

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Administration of an erythropoiesis-stimulating agent or ESA (in this case, darbepoietin) to patients with severe traumatic brain injury (STBI) improves survival without increasing morbidity, a California team reports in the Archives of Surgery for March.

“The current prospective validation of ESA effects in STBI confirms our previous findings,” comment Dr. Peep Talving and colleagues at University of Southern California–Keck School of Medicine, in Los Angeles.

They explain that ESAs have been shown to have neuroprotective effects, and their institution previously reported significant survival benefit in a retrospective series of 89 patients who received ESA compared to 178 matched counterparts not receiving ESA following STBI.

The current study is a prospective evaluation of outcomes in 566 such patients admitted to the surgical intensive care unit. At the discretion of the attending physicians, 81 patients received 0.4 mcg/kg darbepoietin weekly starting within 2 weeks of hospital admission, while 485 did not receive any ESA.

Propensity scoring produced 75 matched pairs of patients. In-hospital mortality was 9.3% in the patients given ESA and 25.3% in those who were not, which translated to an odds ratio of 0.25 (p=0.012), the team reports.

Rates of acute respiratory distress syndrome, acute renal failure, and pneumonia were no different among those who did or did not receive ESA, the authors found. “In particular, there was no statistically significant discrepancy in the incidence of deep venous thrombosis (1.3% vs 0.0%; p>0.99) and pulmonary embolism (1.3% vs 0.0%; p>0.99),” they note.

The mean Glasgow Coma Scale score at discharge from the SICU was 11.8 for patients who received ESA vs 10.9 for patients who did not (p=0.17), Dr. Talving and colleagues note.

Overall, they conclude, “Our results suggest the need for a large randomized, controlled validation of ESA effects in patients with STBI.”

SOURCE:
Arch Surg 2012;147:251-255.