A Post Hoc Analysis of Osmotherapy Use in the Erythropoietin in Traumatic Brain Injury Study-Associations With Acute Kidney Injury and Mortality

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Erythropoietin in Traumatic Brain Injury (EPO-TBI) , the Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group , Skrifvars , MB , Bailey , M , Moore , E , Martensson , J , French , C , Presneill , J , Nichol , A , Little , L , Duranteau , J , Huet , O , Haddad , S , Arabi , YM , McArthur , C , Cooper , DJ , Bendel , S & Bellomo , R 2021 , ' A Post Hoc Analysis of Osmotherapy Use in the Erythropoietin in Traumatic Brain Injury Study-Associations With Acute Kidney Injury and Mortality ' , Critical Care Medicine , vol. 49 , no. 4 , pp. E394-E403 . https://doi.org/10.1097/CCM.0000000000004853

Title: A Post Hoc Analysis of Osmotherapy Use in the Erythropoietin in Traumatic Brain Injury Study-Associations With Acute Kidney Injury and Mortality
Author: Erythropoietin in Traumatic Brain Injury (EPO-TBI); the Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group; Skrifvars, MB; Bailey, M; Moore, E; Martensson, J; French, C; Presneill, J; Nichol, A; Little, L; Duranteau, J; Huet, O; Haddad, S; Arabi, YM; McArthur, C; Cooper, DJ; Bendel, S; Bellomo, R
Contributor organization: HUS Emergency Medicine and Services
Department of Diagnostics and Therapeutics
Clinicum
Anestesiologian yksikkö
Date: 2021-04
Language: eng
Number of pages: 10
Belongs to series: Critical Care Medicine
ISSN: 0090-3493
DOI: https://doi.org/10.1097/CCM.0000000000004853
URI: http://hdl.handle.net/10138/337340
Abstract: OBJECTIVES: Mannitol and hypertonic saline are used to treat raised intracerebral pressure in patients with traumatic brain injury, but their possible effects on kidney function and mortality are unknown. DESIGN: A post hoc analysis of the erythropoietin trial in traumatic brain injury (ClinicalTrials.gov NCT00987454) including daily data on mannitol and hypertonic saline use. SETTING: Twenty-nine university-affiliated teaching hospitals in seven countries. PATIENTS: A total of 568 patients treated in the ICU for 48 hours without acute kidney injury of whom 43 (7%) received mannitol and 170 (29%) hypertonic saline. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We categorized acute kidney injury stage according to the Kidney Disease Improving Global Outcome classification and defined acute kidney injury as any Kidney Disease Improving Global Outcome stage-based changes from the admission creatinine. We tested associations between early (first 2 d) mannitol and hypertonic saline and time to acute kidney injury up to ICU discharge and death up to 180 days with Cox regression analysis. Subsequently, acute kidney injury developed more often in patients receiving mannitol (35% vs 10%; p < 0.001) and hypertonic saline (23% vs 10%; p < 0.001). On competing risk analysis including factors associated with acute kidney injury, mannitol (hazard ratio, 2.3; 95% CI, 1.2-4.3; p = 0.01), but not hypertonic saline (hazard ratio, 1.6; 95% CI, 0.9-2.8; p = 0.08), was independently associated with time to acute kidney injury. In a Cox model for predicting time to death, both the use of mannitol (hazard ratio, 2.1; 95% CI, 1.1- 4.1; p = 0.03) and hypertonic saline (hazard ratio, 1.8; 95% CI, 1.02-3.2; p = 0.04) were associated with time to death. CONCLUSIONS: In this post hoc analysis of a randomized controlled trial, the early use of mannitol, but not hypertonic saline, was independently associated with an increase in acute kidney injury. Our findings suggest the need to further evaluate the use and choice of osmotherapy in traumatic brain injury.
Subject: acute kidney injury
critical care
intracranial pressure
mannitol
renal insufficiency
traumatic brain injury
HYPERTONIC SALINE
INTRACRANIAL HYPERTENSION
MANNITOL
MANAGEMENT
SERUM
EPIDEMIOLOGY
CHLORIDE
3126 Surgery, anesthesiology, intensive care, radiology
Peer reviewed: Yes
Rights: cc_by
Usage restriction: openAccess
Self-archived version: publishedVersion


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