ABSTRACT
OBJECTIVE: To evaluate the best level of albumin and hemoglobin for the patients with uncomplicated severe traumatic brain injury (TBI). METHODS: A retrospective cohort study was conducted. One hundred and sixty-eight patients with uncomplicated severe TBI admitted to intensive care unit (ICU) of Anhui Provincial Hospital were enrolled. The relationship between albumin and hemoglobin level within 3 days after admission and prognosis was analyzed. Mean 3-day albumin level was obtained, and then the patients were divided into <25, 25-28, 29-31 and ≥32 g/L groups according to quartiles based on mean albumin, and also were divided into <90, 90-99, 100-109 and≥110 g/L groups according to the mean hemoglobin concentration. Multivariable log-binomial regression was used to model the association between mean albumin and hemoglobin concentration and prognosis. RESULTS: One hundred and nine patients were enrolled based on inclusion/exclusion criteria. Among them, 32 patients (29.4%) received a red blood cell (RBC) transfusion, and 24 patients (22.0%) were given albumin treatment. According to the average level of albumin, there were significant differences in mortality among <25, 25-28, 29-31 and ≥32 g/L groups [85.2%(23/27), 59.3%(16/27), 32.1%(9/28), 44.4%(12/27), respectively, P=0.001]. According to the hemoglobin level, there was no significant difference in mortality rate among <90, 90-99, 100-109 and ≥110 g/L groups[61.8%(34/55), 43.8%(7/16), 53.3%(8/15), 47.8%(11/23), respectively, P>0.05]. When using the albumin level, Glasgow coma score (GCS), age and time of onset for logistic analysis, albumin level and age had influence on the mortality of patients, and mortality rate was generally decreased with an increase in albumin. But when the levels of albumin was ≥32 g/L, the risk of death was higher than in the 29-31 g/L group[relative risk (RR) of albumin 29-31 g/L=0.070, 95% confidence interval (95%CI) 0.015-0.331, P=0.001; RR of albumin≥32 g/L=0.153, 95%CI 0.035-0.663, P=0.012; RR of age=0.691, 95%CI 0.526-0.907, P=0.008]. When the hemoglobin level, GCS, age and time of onset were used for logistic regression analysis, only GCS entered the regression model (RR=0.696,95%CI 0.550-0.880, P=0.002), illustrating that the hemoglobin level had no significant influence on mortality, and mortality rate declined with an increase in GCS. CONCLUSIONS: The most favorable level of albumin for uncomplicated severe traumatic brain injury is 29-31 g/L. There is no difference in mortality rate when hemoglobin >90 g/L.
