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Background The Saline versus Albumin Fluid Evaluation study suggested that patients with traumatic brain injury resuscitated with albumin had a higher mortality rate than those resuscitated with saline. We conducted a post hoc follow-up study of patients with traumatic brain injury who were enrolled in the study.
Methods For patients with traumatic brain injury (i.e., a history of trauma, evidence of head trauma on a computed tomographic [CT] scan, and a score of
Results We followed 460 patients, of whom 231 (50.2%) received albumin and 229 (49.8%) received saline. The subgroup of patients with GCS scores of 3 to 8 were classified as having severe brain injury (160 [69.3%] in the albumin group and 158 [69.0%] in the saline group). Demographic characteristics and indexes of severity of brain injury were similar at baseline. At 24 months, 71 of 214 patients in the albumin group (33.2%) had died, as compared with 42 of 206 in the saline group (20.4%) (relative risk, 1.63; 95% confidence interval [CI], 1.17 to 2.26; P=0.003). Among patients with severe brain injury, 61 of 146 patients in the albumin group (41.8%) died, as compared with 32 of 144 in the saline group (22.2%) (relative risk, 1.88; 95% CI, 1.31 to 2.70; P<0.001); among patients with GCS scores of 9 to 12, death occurred in 8 of 50 patients in the albumin group (16.0%) and 8 of 37 in the saline group (21.6%) (relative risk, 0.74; 95% CI, 0.31 to 1.79; P=0.50).
Conclusions In this post hoc study of critically ill patients with traumatic brain injury, fluid resuscitation with albumin was associated with higher mortality rates than was resuscitation with saline. (Current Controlled Trials number, ISRCTN76588266
[controlled-trials.com]
.)
13 on the Glasgow Coma Scale [GCS]), we recorded baseline characteristics from case-report forms, clinical records, and CT scans and determined vital status and functional neurologic outcomes 24 months after randomization.
Source Information
The Saline versus Albumin Fluid Evaluation (SAFE) study is a collaboration of the Australian and New Zealand Intensive Care Society Clinical Trials Group, the Australian Red Cross Blood Service, and the George Institute for International Health. The writing committee of the SAFE–Traumatic Brain Injury study (John Myburgh, M.D., Ph.D., D. James Cooper, M.D., Simon Finfer, M.D., Rinaldo Bellomo, M.D., Robyn Norton, Ph.D., M.P.H., Nicole Bishop, B.Sc., Sing Kai Lo, Ph.D., and Shirley Vallance, R.N.) takes responsibility for the content and integrity of this article.
Address reprint requests to Dr. Myburgh at ANZICS Clinical Trials Group, Level 3, 10 Ievers Terrace, Carlton, VIC 3053, Australia, or at j.myburgh{at}unsw.edu.au.
Related Letters:
Saline or Albumin for Fluid Resuscitation in Traumatic Brain Injury
Jacob M., Chappell D., Bilotta F., Rosa G., Myburgh J. A., Cooper D. J., Finfer S., the SAFE Study Investigators
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N Engl J Med 2007;
357:2634-2636, Dec 20, 2007.
Correspondence
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