Abstract
IntroductionPrevious 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.MethodsWe 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.ResultsThe 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).ConclusionsThere 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0515-z) contains supplementary material, which is available to authorized users.
Highlights
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)
Study selection Two reviewers (YZ and CL) independently reviewed and extracted studies abided by the following inclusion criteria: (1) studies on adult subjects, or patients aged older than 16 years, (2) studies enrolling subjects from ICUs, (3) studies dividing subjects into two groups according to whether they received transfusion or not, and reporting results focused on allcause in-hospital mortality rate
For hospitalized ICU patients, in-hospital mortality is a short-term mortality, as Vincent et al investigated that transfused patients admitted to ICU had a mean hospital length of stay (LOS) of 15.8 (9.0) days [2], and Sakr et al found that the hospital LOS of surgical ICU patient was from 9 to 19 days, with a mean value of 12 days [21]
Summary
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). A meta-analysis published in 2008 demonstrated an association between RBC transfusion and mortality in critically ill patients: 12 published studies were included, and the pooled odds ratio (OR) was 1.7 (95% confidence interval (CI), 1.4 to 1.9) [20]. Sakr et al reported a decreased risk of in-hospital death in blood-transfused surgical ICU patients (relative risk (RR) 0.96, 95%CI 0.95 to 0.98), especially in patients aged from 66 to 80 years, in patients admitted to the ICU after noncardiovascular surgery, in patients with severe sepsis and in patients with high simplified acute physiology score II (SAPS II) or sepsis-related organ failure assessment (SOFA) scores [21]. Another transfusion practice is using ‘fresh’ transfused RBCs instead of ‘old’
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