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Serum albumin level as a predictor of outcome in traumatic brain injury: potential for treatment. |
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Serum albumin level as a predictor of outcome in traumatic brain injury: potential for treatment.
J Trauma. 2008 Apr;64(4):872-5.
Bernard F, Al-Tamimi YZ, Chatfield D, Lynch AG, Matta BF, Menon DK.
University Department of Critical Care Medicine, Hôpital du Sacré-Coeur, Montréal, Québec, Canada.
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BACKGROUND:
Serum albumin level is correlated with outcome in various clinical
situations. Albumin has multiple physiologic properties that could be
beneficial in brain injury. The Lund therapy for elevated intracranial
pressure uses albumin as part of its protocol and demonstrates
favorable outcome. We sought to find out if albumin is associated with
outcome after traumatic brain injury to justify conducting a randomized
trial. METHODS: A retrospective study of traumatic brain injury
patients was conducted. Characteristics known to influence outcome were
included in a multiple logistic regression model to analyze predictors
of poor outcome at 6 months.
RESULTS: Data were available for 138
patients. The majority of patients (65%) had a severe injury (Glasgow
Coma Scale score <9). Seventy percent of patients had a favorable
outcome. Albumin levels decrease considerably from normal values in the
first few days after injury irrespective of outcome. Albumin remained
<25 g/L for a longer period of time in patient with an unfavorable
outcome (6 days vs. 3 days, p = 0.012). Multiple logistic regression
analysis identified albumin levels, age, Glasgow Coma Scale score at
admission, and Injury Severity Score as predictors of poor outcome.
CONCLUSION: Serum albumin level seems to be an independent predictor of
poor outcome. The model also identified classic predictors of poor
outcome that tends to strengthen its adequacy. Because albumin level is
the only modifiable factor influencing outcome, it seems justified to
carry out a randomized trial of the use of albumin in the treatment of
brain injury.
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