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 2018More...
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
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