Efficacy and safety of erythropoietin for traumatic brain injury
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RESEARCH ARTICLE
Open Access
Efficacy and safety of erythropoietin for traumatic brain injury Motao Liu1,2,3†, Amy J. Wang4†, Yu Chen5†, Gexin Zhao6, Zhifeng Jiang7, Xinbang Wang8, Dongliang Shi9, Tiansong Zhang10, Bomin Sun1,2, Hua He11*, Ziv Williams4,12 and Kejia Hu1,2,4,12*
Abstract Background: Recent studies regarding the effects of erythropoietin (EPO) for treating traumatic brain injury (TBI) have been inconsistent. This study conducts a meta-analysis of randomized controlled trials (RCTs) to assess the safety and efficacy of EPO for TBI patients at various follow-up time points. Methods: A literature search was performed using PubMed, Web of Science, MEDLINE, Embase, Google Scholar and the Cochrane Library for RCTs studying EPO in TBI patients published through March 2019. Non-English manuscripts and non-human studies were excluded. The assessed outcomes include mortality, neurological recovery and associated adverse effects. Dichotomous variables are presented as risk ratios (RR) with a 95% confidence interval (CI). Results: A total of seven RCTs involving 1197 TBI patients (611 treated with EPO, 586 treated with placebo) were included in this study. Compared to the placebo arm, treatment with EPO did not improve acute hospital mortality or short-term mortality. However, there was a significant improvement in mid-term (6 months) follow-up survival rates. EPO administration was not associated with neurological function improvement. Regarding adverse effects, EPO treatment did not increase the incidence of thromboembolic events or other associated adverse events. Conclusions: This meta-analysis indicates a slight mortality benefit for TBI patients treated with EPO at mid-term followup. EPO does not improve in-hospital mortality, nor does it increase adverse events including thrombotic, cardiovascular and other associated complications. Our analysis did not demonstrate a significant beneficial effect of EPO intervention on the recovery of neurological function. Future RCTs are required to further characterize the use of EPO in TBI. Keywords: Erythropoietin, Traumatic brain injury, Mortality, Neurological function improvement, Adverse events, Meta-analysis
Background Traumatic brain injury (TBI) is a major cause of death and lifelong disability around the world, and predominantly affects younger and middle-aged people [1]. The United States Center for Disease Control estimates that * Correspondence: [email protected]; [email protected] † Motao Liu, Amy J. Wang and Yu Chen contributed equally to this work and should be considered co-first authors. 11 Department of Neurosurgery, Third Affiliated Hospital, Second Military Medical University, Shanghai 200438, China 1 Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Second Ruijin Street, Shanghai 200025, China Full list of author information is available at the end of the article
TBI results in more than 280,000 hospitalizations and 2.2 million emergency department visits, and contributes to the death
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