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Is Hemoglobin Below 7.0 g/dl an Optimal Trigger for Allogenic Red Blood Cell Transfusion in Patients Admitted to Intensive Care Units? A Meta-Analysis and Systematic Review

49 Pages Posted: 4 Oct 2018

See all articles by Ren-qi Yao

Ren-qi Yao

Government of the People's Republic of China - Changhai Hospital

Chao Ren

Government of the People's Republic of China - Chinese PLA General Hospital

Zi-cheng Zhang

Government of the People's Republic of China - Changhai Hospital

Yi-bing Zhu

Capital Medical University

Zhao-Fan Xia

Government of the People's Republic of China - Department of Burn Surgery

Yong-Ming Yao

Government of the People's Republic of China - Trauma Research Center

More...

Abstract

Background: Allogenic red blood cell (RBC) transfusion remains a commonly used and crucial treatment for patients admitted to intensive care units. Every year, approximately 75 million units of blood are reportedly obtained worldwide; this figure suggests the need for the cautious use of RBCs due to the substantial cost and supply shortage.

Data Sources: We performed systematical searches for relevant randomized controlled studies in the Cochrane Library, EMBASE, and PubMed databases up to May 1, 2018. The clinical outcomes, including short-term mortality, length of hospital stay, length of ICU stay, myocardial infarction(MI), and ischemic events, were screened and analyzed after data collection. We applied odds ratios (ORs) to analyze dichotomous outcomes and mean differences to analyze continuous outcomes with a random effects model.

Results: Nine RCTs with 3551 patients were included. Compared with a more liberal threshold, an RBC transfusion threshold < 7 g/dl hemoglobin showed no significant difference in short-term mortality (OR: 0.92, 95% CI: 0.70-1.20; P=0.52; I2=47%), length of ICU stay (MD: -0.05, 95% CI: -0.70-0.61, P=0.89, I2=0%), MI (OR: 0.56, 95% CI: 0.30-1.04, P=0.07; I2=0%), or ischemic events (OR, 0.80; 95% CI, 0.43-1.48; P=0.48; I2=51%). However, the length of hospital stay was shorter in the group with the threshold < 7 g/dl than that with the more liberal threshold.

Conclusions: An RBC transfusion threshold < 7 g/dl hemoglobin is incapable of decreasing short-term mortality in ICU patients according to currently published evidence. Further studies are needed to for determine the optimal RBC transfusion strategy.

Funding Statement: This work was supported by grants from the National Natural Science Foundation (No. 81730057) and the National Key Research and Development Program of China (No. 2017YFC1103302).

Declaration of Interests: The authors have declared that no conflicts of interest exist.

Ethics Approval Statement: This systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement.

Keywords: Red Bblood Cells, Transfusion, Hemoglobin, Intensive Care Units, Septic Shock

Suggested Citation

Yao, Ren-qi and Ren, Chao and Zhang, Zi-cheng and Zhu, Yi-bing and Xia, Zhao-Fan and Yao, Yong-Ming, Is Hemoglobin Below 7.0 g/dl an Optimal Trigger for Allogenic Red Blood Cell Transfusion in Patients Admitted to Intensive Care Units? A Meta-Analysis and Systematic Review (September 17, 2018). Available at SSRN: https://ssrn.com/abstract=3251494 or http://dx.doi.org/10.2139/ssrn.3251494

Ren-qi Yao

Government of the People's Republic of China - Changhai Hospital

China

Chao Ren

Government of the People's Republic of China - Chinese PLA General Hospital

Beijing, 100853
China

Zi-cheng Zhang

Government of the People's Republic of China - Changhai Hospital

China

Yi-bing Zhu

Capital Medical University

China

Zhao-Fan Xia

Government of the People's Republic of China - Department of Burn Surgery ( email )

168 Changhai Road
Shanghai, 200433
China

Yong-Ming Yao (Contact Author)

Government of the People's Republic of China - Trauma Research Center ( email )

51 Fu-Cheng Road
Beijing, 100048
China

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