Research Reports - Citicoline in severe traumatic brain injury: indications for improved outcome

Wien Klin Wochenschr. 2017 Jul 27. doi: 10.1007/s00508-017-1240-9. [Epub ahead of

Trimmel H(1), Majdan M(2), Wodak A(3), Herzer G(3), Csomor D(3), Brazinova A(4).

Goal-oriented management of traumatic brain injury (TBI) can save the lives
and/or improve the long-term outcome of millions of affected patients worldwide.
Additionally, enhancing quality of life will save enormous socio-economic costs;
however, promising TBI treatment strategies with neuroprotective agents, such as
citicoline (CDP-choline), lacked evidence or produced contradictory results in
clinical trials. During a prehospital TBI project to optimize early TBI care
within 14 Austrian trauma centers, data on 778 TBI patients were prospectively
collected. As preceding evaluations suggested a beneficial outcome in TBI
patients treated at the Wiener Neustadt Hospital (WNH), we aimed to investigate
the potential role of citicoline administration, solely applied in WNH, in those
patients. In a retrospective subgroup analysis we compared 67 patients from WNH
with citicoline administration and 67 matched patients from other Austrian
centers without citicoline use. Patients with Glasgow Coma Scale score <13 on
site and/or Abbreviated Injury Scale of the region "head" >2 were included. Our
analysis revealed significantly reduced rates of intensive care unit (ICU)
mortality (5% vs. 24%, p < 0.01), in-hospital mortality (9% vs. 24%, p = 0.035)
and 6‑month mortality (13% vs. 28%, p = 0.031), as well as of unfavorable outcome
(34% vs. 57%, p = 0.015) and observed vs. expected ratio for mortality (0.42 vs.
0.84) in the WNH (citicoline receivers) group. Despite the limitations of
a retrospective subgroup analysis our findings suggest a possible correlation
between early and consequent citicoline administration and beneficial outcomes.
Therefore, we aim to set up an initiative for a prospective, multicenter
randomized controlled trial with citicoline in sTBI (severe TBI) patients.

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