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Liberal versus restrictive red blood cell transfusion strategy in sepsis or septic shock: a systematic review and meta-analysis of randomized trials.
Crit Care. 2019 Jul 25; 23(1):262.CC

Abstract

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

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

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 (I2 = 61.0%, χ2 = 5.13, p = 0.08). For secondary outcomes, only two RCTs were included. There were no significant differences in secondary outcomes between the two groups.

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

This present study was registered in the PROSPERO database (CRD42018108578).

Authors+Show Affiliations

Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan. yhirano@juntendo-urayasu.jp.Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan.Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan.Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan.Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

31345236

Citation

Hirano, Yohei, et al. "Liberal Versus Restrictive Red Blood Cell Transfusion Strategy in Sepsis or Septic Shock: a Systematic Review and Meta-analysis of Randomized Trials." Critical Care (London, England), vol. 23, no. 1, 2019, p. 262.
Hirano Y, Miyoshi Y, Kondo Y, et al. Liberal versus restrictive red blood cell transfusion strategy in sepsis or septic shock: a systematic review and meta-analysis of randomized trials. Crit Care. 2019;23(1):262.
Hirano, Y., Miyoshi, Y., Kondo, Y., Okamoto, K., & Tanaka, H. (2019). Liberal versus restrictive red blood cell transfusion strategy in sepsis or septic shock: a systematic review and meta-analysis of randomized trials. Critical Care (London, England), 23(1), 262. https://doi.org/10.1186/s13054-019-2543-1
Hirano Y, et al. Liberal Versus Restrictive Red Blood Cell Transfusion Strategy in Sepsis or Septic Shock: a Systematic Review and Meta-analysis of Randomized Trials. Crit Care. 2019 Jul 25;23(1):262. PubMed PMID: 31345236.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Liberal versus restrictive red blood cell transfusion strategy in sepsis or septic shock: a systematic review and meta-analysis of randomized trials. AU - Hirano,Yohei, AU - Miyoshi,Yukari, AU - Kondo,Yutaka, AU - Okamoto,Ken, AU - Tanaka,Hiroshi, Y1 - 2019/07/25/ PY - 2019/03/16/received PY - 2019/07/16/accepted PY - 2019/7/27/entrez PY - 2019/7/28/pubmed PY - 2020/2/11/medline KW - Hemoglobin KW - Mortality KW - Sepsis KW - Septic shock KW - Threshold KW - Transfusion SP - 262 EP - 262 JF - Critical care (London, England) JO - Crit Care VL - 23 IS - 1 N2 - 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: 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: 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 (I2 = 61.0%, χ2 = 5.13, p = 0.08). For secondary outcomes, only two RCTs were included. There were no significant differences in secondary outcomes between the two groups. 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: This present study was registered in the PROSPERO database (CRD42018108578). SN - 1466-609X UR - https://www.unboundmedicine.com/medline/citation/31345236/Liberal_versus_restrictive_red_blood_cell_transfusion_strategy_in_sepsis_or_septic_shock:_a_systematic_review_and_meta_analysis_of_randomized_trials_ L2 - https://ccforum.biomedcentral.com/articles/10.1186/s13054-019-2543-1 DB - PRIME DP - Unbound Medicine ER -