Association between continuous hyperosmolar therapy and survival in patients with traumatic brain injury – a multicentre prospective cohort study and systematic review
Résumé
Background : Intracranial hypertension (ICH) is a major cause of death after traumatic brain injury (TBI). Continuoushyperosmolar therapy (CHT) has been proposed for the treatment of ICH, but its effectiveness is controversial. Wecompared the mortality and outcomes in patients with TBI with ICH treated or not with CHT.Methods:We included patients with TBI (Glasgow Coma Scale≤12 and trauma-associated lesion on braincomputed tomography (CT) scan) from the databases of the prospective multicentre trials Corti-TC, BI-VILI andATLANREA. CHT consisted of an intravenous infusion of NaCl 20% for 24 hours or more. The primary outcome wasthe risk of survival at day 90, adjusted for predefined covariates and baseline differences, allowing us to reduce thebias resulting from confounding factors in observational studies. A systematic review was conducted includingstudies published from 1966 to December 2016. Results : Among the 1086 included patients, 545 (51.7%) developed ICH (143 treated and 402 not treated withCHT). In patients with ICH, the relative risk of survival at day 90 with CHT was 1.43 (95% CI, 0.99–2.06,p= 0.05). Theadjusted hazard ratio for survival was 1.74 (95% CI, 1.36–2.23,p< 0.001) in propensity-score-adjusted analysis. At day90, favourable outcomes (Glasgow Outcome Scale 4–5) occurred in 45.2% of treated patients with ICH and in 35.8%of patients with ICH not treated with CHT (p= 0.06). A review of the literature including 1304 patients from eightstudies suggests that CHT is associated with a reduction of in-ICU mortality (intervention, 112/474 deaths (23.6%) vs.control, 244/781 deaths (31.2%); OR 1.42 (95% CI, 1.04–1.95),p= 0.03,I2= 15%). Conclusions : CHT for the treatment of posttraumatic ICH was associated with improved adjusted 90-day survival.This result was strengthened by a review of the literature.
Origine : Publication financée par une institution
