Liberal versus restrictive red blood cell transfusion strategy in sepsis or septic shock: a systematic review and meta-analysis of randomized trials.
Hemoglobin
Mortality
Sepsis
Septic shock
Threshold
Transfusion
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
25 Jul 2019
25 Jul 2019
Historique:
received:
16
03
2019
accepted:
16
07
2019
entrez:
27
7
2019
pubmed:
28
7
2019
medline:
11
2
2020
Statut:
epublish
Résumé
We assessed the effect of liberal versus restrictive red blood cell transfusion strategy on survival outcome in sepsis or septic shock by systematically reviewing the literature and synthesizing evidence from randomized controlled trials (RCTs). We searched the MEDLINE, Cochrane Central Register of Controlled Trials, and Web of Science databases. We included RCTs that compared mortality between a liberal transfusion strategy with a hemoglobin threshold of 9 or 10 g/dL and a restrictive transfusion strategy with a hemoglobin threshold of 7 g/dL in adults with sepsis or septic shock. Two investigators independently screened citations and conducted data extraction. The primary outcome was 28- or 30-day mortality. Secondary outcomes were 60- and 90-day mortality, use of life support at 28 days of admission, and number of patients transfused during their intensive care unit stay. DerSimonian-Laird random-effects models were used to report pooled odds ratios (ORs). A total of 1516 patients from three RCTs were included; 749 were randomly assigned to the liberal transfusion group and 767 to the restrictive strategy group. Within 28-30 days, 273 patients (36.4%) died in the liberal transfusion group, while 278 (36.2%) died in the restrictive transfusion group (pooled OR, 0.99; 95% confidence interval [CI], 0.67-1.46). For the primary outcome, heterogeneity was observed among the studies (I We could not show any difference in 28- or 30-day mortality between the liberal and restrictive transfusion strategies in sepsis or septic shock patients by meta-analysis of RCTs. Our results should be interpreted with caution due to the existence of heterogeneity. As sepsis complicates a potentially wide range of underlying diseases, further trials in carefully selected populations are anticipated. This present study was registered in the PROSPERO database (CRD42018108578).
Sections du résumé
BACKGROUND
BACKGROUND
We assessed the effect of liberal versus restrictive red blood cell transfusion strategy on survival outcome in sepsis or septic shock by systematically reviewing the literature and synthesizing evidence from randomized controlled trials (RCTs).
METHODS
METHODS
We searched the MEDLINE, Cochrane Central Register of Controlled Trials, and Web of Science databases. We included RCTs that compared mortality between a liberal transfusion strategy with a hemoglobin threshold of 9 or 10 g/dL and a restrictive transfusion strategy with a hemoglobin threshold of 7 g/dL in adults with sepsis or septic shock. Two investigators independently screened citations and conducted data extraction. The primary outcome was 28- or 30-day mortality. Secondary outcomes were 60- and 90-day mortality, use of life support at 28 days of admission, and number of patients transfused during their intensive care unit stay. DerSimonian-Laird random-effects models were used to report pooled odds ratios (ORs).
RESULTS
RESULTS
A total of 1516 patients from three RCTs were included; 749 were randomly assigned to the liberal transfusion group and 767 to the restrictive strategy group. Within 28-30 days, 273 patients (36.4%) died in the liberal transfusion group, while 278 (36.2%) died in the restrictive transfusion group (pooled OR, 0.99; 95% confidence interval [CI], 0.67-1.46). For the primary outcome, heterogeneity was observed among the studies (I
CONCLUSIONS
CONCLUSIONS
We could not show any difference in 28- or 30-day mortality between the liberal and restrictive transfusion strategies in sepsis or septic shock patients by meta-analysis of RCTs. Our results should be interpreted with caution due to the existence of heterogeneity. As sepsis complicates a potentially wide range of underlying diseases, further trials in carefully selected populations are anticipated.
TRIAL REGISTRATION
BACKGROUND
This present study was registered in the PROSPERO database (CRD42018108578).
Identifiants
pubmed: 31345236
doi: 10.1186/s13054-019-2543-1
pii: 10.1186/s13054-019-2543-1
pmc: PMC6659290
doi:
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
262Subventions
Organisme : Japan Society of the Promotion of Science
ID : 17K11593
Références
Curr Opin Hematol. 2002 Nov;9(6):521-6
pubmed: 12394176
Chest. 2005 Jan;127(1):295-307
pubmed: 15653997
Cochrane Database Syst Rev. 2006 Jan 25;(1):CD005033
pubmed: 16437512
J Clin Epidemiol. 2011 Apr;64(4):383-94
pubmed: 21195583
BMJ. 2011 Oct 18;343:d5928
pubmed: 22008217
N Engl J Med. 2011 Dec 29;365(26):2453-62
pubmed: 22168590
Br J Anaesth. 2013 May;110(5):690-701
pubmed: 23599512
J Family Med Prim Care. 2013 Jan;2(1):9-14
pubmed: 24479036
N Engl J Med. 2014 May 1;370(18):1683-93
pubmed: 24635773
N Engl J Med. 2014 Oct 9;371(15):1381-91
pubmed: 25270275
Lancet. 2015 Jul 11;386(9989):137-44
pubmed: 25956718
JAMA. 2016 Feb 23;315(8):801-10
pubmed: 26903338
BMJ. 2016 Mar 29;352:i1351
pubmed: 27026510
Cochrane Database Syst Rev. 2016 Oct 12;10:CD002042
pubmed: 27731885
BMJ Open. 2016 Dec 7;6(12):e012623
pubmed: 27927658
Ann Intensive Care. 2017 Dec;7(1):5
pubmed: 28050898
Crit Care Med. 2017 Mar;45(3):486-552
pubmed: 28098591
Crit Care Med. 2017 May;45(5):766-773
pubmed: 28240687
Ann Surg. 2017 Oct;266(4):595-602
pubmed: 28697050
Int J Mol Sci. 2017 Sep 11;18(9):null
pubmed: 28891973
N Engl J Med. 2017 Nov 30;377(22):2133-2144
pubmed: 29130845
Transfus Med. 2018 Apr;28(2):181-189
pubmed: 29369437
JAMA. 2019 Mar 12;321(10):983-997
pubmed: 30860564
N Engl J Med. 1997 Aug 21;337(8):559-61
pubmed: 9262502
BMJ. 1997 Sep 13;315(7109):629-34
pubmed: 9310563
N Engl J Med. 1999 Feb 11;340(6):409-17
pubmed: 9971864