Impact of transfusion on patients with sepsis admitted in intensive care unit: a systematic review and meta-analysis

Abstract

Red blood cell transfusion (RBCT) threshold in patients with sepsis remains a matter of controversy. A threshold of 7 g/dL for stabilized patients with sepsis is commonly proposed, although debated. The aim of the study was to compare the benefit and harm of restrictive versus liberal RBCT strategies in order to guide physicians on RBCT strategies in patients with severe sepsis or septic shock. Four outcomes were assessed: death, nosocomial infection (NI), acute lung injury (ALI) and acute kidney injury (AKI). Studies assessing RBCT strategies or RBCT impact on outcome and including intensive care unit (ICU) patients with sepsis were assessed. Two systematic reviews were achieved: first for the randomized controlled studies (RCTs) and second for the observational studies. MEDLINE, EMBASE, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Clinical Trials.gov were analyzed up to March 01, 2015. Der Simonian and Laird random-effects models were used to report pooled odds ratios (ORs). Subgroup analyses and meta-regressions were performed to explore studies heterogeneity. One RCT was finally included. The restrictive RBCT strategy was not associated with harm or benefit compared to liberal strategy. Twelve cohort studies were included, of which nine focused on mortality rate. RBCT was not associated with increased mortality rate (overall pooled OR was 1.10 [0.75, 1.60]; I 2 = 57%, p = 0.03), but was associated with the occurrence of NI (2 studies: pooled OR 1.25 [1.04–1.50]; I 2 = 0%, p = 0.97), the occurrence of ALI (1 study: OR 2.75 [1.22–6.37]; p = 0.016) and the occurrence of AKI (1 study: OR 5.22 [2.1–15.8]; p = 0.001). Because there was only one RCT, the final meta-analyses were only based on the cohort studies. As a result, the safety of a RBCT restrictive strategy was confirmed, although only one study specifically focused on ICU patients with sepsis. Then, RBCT was not associated with increased mortality rate, but was associated with increased in occurrence of NI, ALI and AKI. Nevertheless, the data on RBCT in patients with sepsis are sparse and the high heterogeneity between studies prevents from drawing any definitive conclusions.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-016-0226-5) contains supplementary material, which is available to authorized users.

Update of Sepsis in the Intensive Care Unit

“…A recent meta-analysis regarding restrictive versus liberal transfusion strategies in sepsis confirmed the safety of the restrictive strategy regarding mortality (in hospital and at 28 and 90 days) [95] . RBC transfusion was associated with greater rates of nosocomial infections, acute lung injury, and AKI.…”

“…Based on these recent publications [92,93,95] , 2 relevant RCTs [94,96] , and the SSC 2016 guidelines [17] , the use of the restrictive strategy for stable patients with sepsis is recommended because it is safe, and the age of RBCs does not affect mortality.…”

Clinical characteristics, risk factors, immune status and prognosis of secondary infection of sepsis: a retrospective observational study

“…It's also proved by previous studies that the need for mechanical ventilation of critical ill patients incurred high prevalence of ventilator-associated pneumonia, which accounted for nearly half of nosocomial infections [3,4,37]. Blood transfusion was also a potential risk factor due to the effect of transfusion-related immune modulation (TRIM) as reveal by previous studies [38][39][40][41]. Nevertheless, mechanical ventilation and blood transfusion were only found to be risk factors in univariate analysis of our study, but not multivariate analysis.…”

Factors associated with major adverse kidney events in patients who underwent veno-arterial extracorporeal membrane oxygenation

“…There is a growing body of evidence that acute iron overload can cause serious adverse events such as clinically relevant AKI [24]. In adults, the association of RBC packs transfusion and AKI has been extensively described in cardiac surgery with CBP [25] and in other settings [26].…”