Association of red blood cell transfusion and in-hospital mortality in patients admitted to intensive care unit: a systematic review and meta-analysis

Abstract

Introduction: Previous research has debated whether red blood cell (RBC) transfusion is associated with decreased or increased mortality in patients admitted to the intensive care unit (ICU). We conducted a systematic review and meta-analysis to assess the relationship of RBC transfusion with in-hospital mortality in ICU patients. Methods: We carried out a literature search on Medline (1950 through May 2013), Web of Science (1986 through May 2013 and Embase (1980 through May 2013. We included all prospective and retrospective studies on the association between RBC transfusion and in-hospital mortality in ICU patients. The relative risk for the overall pooled effects was estimated by random effects model. Sensitivity analyses were conducted to assess potential bias. Results: The meta-analysis included 28,797 participants from 18 studies. The pooled relative risk for transfused versus nontransfused ICU patients was 1.431 (95% CI, 1.105 to 1.854). In sensitivity analyses, the pooled relative risk was 1.211 (95% CI, 0.975 to 1.505) if excluding studies without adjustment for confounders, 1.178 (95% CI, 0.937 to 1.481) if excluding studies with relative high risk of bias, and 0.901 (95% CI, 0.622 to 1.305) if excluding studies without reporting hazard ratio (HR) or relative risk (RR) as an effect size measure. Subgroup analyses revealed increased risks in studies enrolling patients from all ICU admissions (RR 1.513, 95%CI 1.123 to 2.039), studies without reporting information on leukoreduction (RR 1.851, 95%CI 1.229 to 2.786), studies reporting unadjusted effect estimates (RR 3.933, 95%CI 2.107 to 7.343), and studies using odds ratio as an effect measure (RR 1.465, 95%CI 1.049 to 2.045). Meta-regression analyses showed that RBC transfusion could decrease risk of mortality in older patients (slope coefficient −0.0417, 95%CI −0.0680 to −0.0154). Conclusions: There is lack of strong evidence to support the notion that ICU patients who receive RBC transfusion have an increased risk of in-hospital death. In studies adjusted for confounders, we found that RBC transfusion does not increase the risk of in-hospital mortality in ICU patients. Type of patient, information on leukoreduction, statistical method, mean age of patient enrolled and publication year of the article may account for the disagreement between previous studies.

Associations of Anemia With Outcomes in Patients With Spontaneous Intracerebral Hemorrhage: A Meta-Analysis

“…We conduct a thorough literature search but found only one retrospective cohort study of 546 patients investigated whether PRBC transfusion was associated with better outcome in ICH (34), suggesting that PRBC transfusion was associated with improved survival at 30 days. The application of PRBC transfusion was limited for its risks outweighing the benefits (35, 36), despite that Zheng et al recently conducted meta-analysis to assess the relationship of PRBC transfusion with in-hospital mortality in ICU patients and suggested that PRBC transfusion might not be associated with an increased risk of in-hospital death (37). Although hemoglobin concentrations as low as 70 g/L are well tolerated in the general ICU patients (38), animal studies and human physiologic and observational studies supported that such a severe degree of anemia could be harmful in the neurocritical care patients due to the high sensitivity of brain to oxygen.…”

Evaluación de la incidencia de aislamiento de<i> Acinetobacter baumannii</i> y su relación con la transfusión de productos sanguíneos en terapia intensiva

“…7 Alrededor de 60% de los pacientes que ingresan a la unidad de cuidados intensivos (UCI) tienen un nivel basal de hemoglobina < 12 g/dL, y 30% < 9 g/dL, lo que se traduce en disminución de la capacidad de suministro de oxígeno tisular, con la subsecuente hipoxia y asociación con malos resultados. 8 En este contexto, la transfusión de eritrocitos ha sido uno de los tratamientos predominantes en la práctica médica. 7 Por otra parte, en las últimas décadas se ha acumulado un conjunto de pruebas que mencionan varios efectos adversos relacionados con la transfusión, particularmente tras la exposición alogénica -llámese inmunosupresión, riesgo de infección, reacciones transfusionales y afecciones como ALI y TRALI-; incluso, puede estar asociada a mayor mortalidad, aunque en general, el riesgo de morbimortalidad es bajo y ha disminuido en años recientes.…”

“…7 Por otra parte, en las últimas décadas se ha acumulado un conjunto de pruebas que mencionan varios efectos adversos relacionados con la transfusión, particularmente tras la exposición alogénica -llámese inmunosupresión, riesgo de infección, reacciones transfusionales y afecciones como ALI y TRALI-; incluso, puede estar asociada a mayor mortalidad, aunque en general, el riesgo de morbimortalidad es bajo y ha disminuido en años recientes. 7,8 A propósito del riesgo de infección, desde 1986 existe evidencia de dicha asociación; sin embargo, gran parte de la literatura se ha enfocado en unidades de trauma y quirúrgicas, aunque también se encuentra en unidades médicas. La transmisión directa de agentes infecciosos con la transfusión alogénica de glóbulos rojos es bastante baja en países desarrollados, por lo que se ha propuesto que la inmunomodulación puede estar involucrada en dicho riesgo.…”