Mortality outcomes in patients transfused with fresher versus older red blood cells: a meta‐analysis

Vox Sanguinis - Tập 112 Số 3 - Trang 268-278 - 2017
Chatree Chai‐Adisaksopha1,2, Paul Alexander1,2, Gordon Guyatt1,2, Mark Crowther1,2,3, Nancy M. Heddle4,1,3,3,5, P.J. Devereaux1,2,6, Martin Ellis7, David Roxby8, Daniel I. Sessler9, John W. Eikelboom2,6,10
1Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
2Department of Medicine, McMaster University, Hamilton, ON, Canada
3Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
4Centre for Innovation, Canadian Blood Services, Hamilton, ON, Canada
5McMaster Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada
6Population Health Research Institute, Hamilton, ON, Canada
7Meir Medical Centre Kfar Saba and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
8SA Pathology Transfusion Service, Flinders Medical Centre and Flinders University, Adelaide, SA, Australia
9Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
10Thrombosis & Atherosclerosis Research Institute Hamilton ON Canada

Tóm tắt

Background

Among transfused patients, the effect of the duration of red blood cell storage on mortality remains unclear. This study aims to compare the mortality of patients who were transfused with fresher versus older red blood cells.

Methods

We performed an updated systematic search in the CENTRAL, MEDLINE, EMBASE and CINAHL databases, from January 2015 to October 2016. RCTs of hospitalized patients of any age comparing transfusion of fresher versus older red blood cells were eligible. We used a random‐effects model to calculate pooled risk ratios (RRs) with corresponding 95% confidence interval (CI).

Results

We identified 14 randomized trials that enrolled 26 374 participants. All‐cause mortality occurred in 1219 of 9531 (12·8%) patients who received a transfusion of fresher red blood cells and 1810 of 16 843 (10·7%) in those who received older red blood cells (RR: 1·04, 95% CI: 0·98–1·12, P = 0·90, I2 = 0%, high certainty for ruling out benefit of fresh blood, moderate certainty for ruling out harm of fresh blood). In six studies, in‐hospital death occurred in 691 of 7479 (9·2%) patients receiving fresher red cells and 1291 of 14 757 (8·8%) receiving older red cells (RR: 1·06, 95% CI: 0·97–1·15, P = 0·81, I2 = 0%, high certainty for ruling out benefit of fresh blood, moderate certainty for ruling out harm of fresh blood).

Conclusion

Transfusion of fresher red blood cells does not reduce overall or in‐hospital mortality when compared with older red blood cells. Our results support the practice of transfusing patients with the oldest red blood cells available in the blood bank.

Từ khóa


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Vox Sanguinis

Tập 112 Số 3

268-278

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