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Войти в исследования Influence of multiple trauma on the effect of transfusion strategies in patients with traumatic brain injury: a sub-study of the HEMOTION trial.
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Bouras Marwan, Lauzier François, Fergusson Dean A, Neveu Xavier, Clayton Lucy, Patton Marie-Pier, Costerousse Olivier, English Shane W, Docherty Annemarie, Malbouisson Luiz M S, Zarychanski Ryan, Moore Lynne, Lessard Bonaventure Paule, Laroche Vincent, Verret Michael, Scales Damon C, Adhikari Neill K J, Greenbaum Jonathan, Kramer Andreas, Garnelo Rey Vanesa, Ball Ian, Khwaja Kosar, Wise Matt, Harvey Daniel, Chabanne Russell, Pottecher Julien, Rhodes Jonathan, Rigamonti Andrea, Burns Karen E A, Griesdale Donald E, Kutsogiannis Demetrios James, Green Robert, Boyd J Gordon, Zeiler Frederick, Gomez Alwyn, Charbonney Emmanuel, Astles Timothy, Sy Eric, Turgeon Alexis F, HEMOTION Trial investigators, the Canadian Critical Care Trials Group, the Canadian Perioperative Anesthesia Clinical Trials Group, the Canadian Traumatic Brain Injury Research Consortium
Аннотация
METHODS: We included all HEMOTION trial participants (n = 742) and defined multiple trauma using three definitions: (1) extracranial injury with Injury Severity Score (ISS) > 15; (2) extracranial injury requiring emergency extracranial surgery; (3) spinal injury with neurological deficit. The primary outcome was the 6-month Glasgow Outcome Scale Extended (GOS-E). We tested interactions between transfusion strategy and multiple trauma status using sliding dichotomy and hierarchical Poisson regression, with sensitivity analyses using classical dichotomy (GOS-E ≤ 4) and proportional odds models. Secondary outcomes included mortality, quality of life (EQ-5D-5L, QOLIBRI), functional independence (FIM), and depression (PHQ-9).
RESULTS: We found no interaction between multiple trauma status and transfusion strategies on the 6-month GOS-E across all three definitions. The adjusted relative risk (RR) of an unfavourable outcome with the liberal strategy was 0.87 (95% CI 0.71-1.07) for patients with ISS > 15, 0.79 (0.59-1.05) for emergency extracranial surgery, and 0.99 (0.42-2.33) for spinal cord injury. Sensitivity analyses suggested a potential interaction for patients undergoing emergency extracranial surgery (p-interaction = 0.02 for proportional odds analysis; 0.05 for classical dichotomy). A liberal strategy was associated with better FIM, EQ-5D-5L, and Qolibri scores for definitions 1 and 2, but not 3, with no consistent interaction. Mortality and PHQ-9 did not differ.
CONCLUSION: Multiple trauma status was not associated with the effect of liberal vs. restrictive transfusion strategies on the GOS-E. Patients requiring emergency extracranial surgery may warrant further investigation.