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27.07.2017 | original article | Ausgabe 1-2/2018

Wiener klinische Wochenschrift 1-2/2018

Citicoline in severe traumatic brain injury: indications for improved outcome

A retrospective matched pair analysis from 14 Austrian trauma centers

Wiener klinische Wochenschrift > Ausgabe 1-2/2018
Helmut Trimmel, Marek Majdan, Andrea Wodak, Guenther Herzer, Daniel Csomor, Alexandra Brazinova
Wichtige Hinweise
Author contributions H. Trimmel concepted, initiated and designed the study, collected, analyzed and interpreted data, drafted and critically revised the manuscript. M. Majdan performed the statistical analysis, contributed to data interpretation and helped to draft and revise the manuscript. A. Wodak, G. Herzer and D. Csomor contributed to data acquisition and data analysis, and helped to revise the manuscript. A. Brazinova conceived the INRO prehospital TBI project, participated in its design, coordination and data analysis, and critically revised the manuscript. All authors read and approved the final manuscript.


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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S1 Fig. Flow diagram of participating Austrian centers and patients from the INRO prehospital database. (*lost to follow up due to incomplete dataset. AIS abbreviated injury scale, GCS Glasgow coma scale, INRO International Neurotrauma Research Organization, WNH Wiener Neustadt Hospital)
S2 Fig. Pressure parameters and heart rate of survivors and non-survivors under citicoline therapy. (CPP cerebral perfusion pressure, HR heart rate, ICP intracranial pressure, MAP mean arterial pressure)
S3 Fig. Mean S100B levels of survivors and non-survivors under citicoline therapy by day of treatment. S100B µg
S1 Table. Patterns of citicoline use at WNH
S2 Table. Laboratory parameters of citicoline patients by clinical outcome
S3 Table. Medication parameters of citicoline patients at WNH
S4 Table. Preliminary RCT study design for continuous and early citicoline in sTBI in Austria
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