Research Reports - Therapeutic effect of erythropoietin in patients with traumatic brain injury

 J Neurosurg. 2016 Jul 1:1-8. [Epub ahead of print]

Liu WC(1), Wen L(1), Xie T(2), Wang H(1), Gong JB(1), Yang XF(1).

OBJECTIVE Erythropoietin (EPO) exerts a neuroprotective effect in animal models
of traumatic brain injury (TBI). However, its effectiveness in human patients
with TBI is unclear. In this study, the authors conducted the first meta-analysis
to assess the effectiveness and safety of EPO in patients with TBI. METHODS In
December 2015, a systematic search was performed of PubMed, Web of Science,
MEDLINE, Embase, the Cochrane Library databases, and Google Scholar. Only
English-language publications of randomized controlled trials (RCTs) using EPO in
patients with TBI were selected for analysis. The assessed outcomes included
mortality, favorable neurological outcome, hospital stay, and associated adverse
effects. Continuous variables were presented as mean difference (MD) with a 95%
confidence interval (CI). Dichotomous variables were presented as risk ratio (RR)
or risk difference (RD) with a 95% CI. Statistical heterogeneity was examined
using both I(2) and chi-square tests. RESULTS Of the 346 studies identified in
the search, 5 RCTs involving 915 patients met the inclusion criteria. The overall
results demonstrated that EPO significantly reduced mortality (RR 0.69, 95% CI
0.49-0.96, p = 0.03) and shortened the hospitalization time (MD -7.59, 95% CI
-9.71 to -5.46, p < 0.0001) for patients with TBI. Pooled results of favorable
outcome (RR 1.00, 95% CI 0.88-1.15, p = 0.97) and deep vein thrombosis (DVT; RD
0.00, 95% CI -0.05 to 0.05, p = 1.00) did not show a significant difference.
CONCLUSIONS The authors suggested that EPO is beneficial for patients with TBI in
terms of reducing mortality and shortening hospitalization time without
increasing the risk of DVT. However, its effect on improving favorable
neurological outcomes did not reach statistical significance. Therefore, more
well-designed RCTs are necessary to ascertain the optimum dosage and time window
of EPO treatment for patients with TBI. 

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