Efficacy of restrictive versus liberal transfusion strategies in patients with traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials
Abstract Background The effects of restrictive versus liberal transfusion strategies in critically ill patients with traumatic brain injury (TBI) and anemia, particularly in adult patients with moderate to severe TBI, remain inconclusive. Therefore, this systematic review and meta-analysis aim to ev...
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SpringerOpen
2024-11-01
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| Series: | Annals of Intensive Care |
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| Online Access: | https://doi.org/10.1186/s13613-024-01411-1 |
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| author | Xiang Yuan Sen Zhang Jun Wan Cheng Chen Peng Wang Shijie Fan Yuyang Liu Jingxian Yang Jiayi Hou Qiaoyu You Xiao Li Kuilin Li Ziyan Xiang Yang Rao Yu Zhang |
| author_facet | Xiang Yuan Sen Zhang Jun Wan Cheng Chen Peng Wang Shijie Fan Yuyang Liu Jingxian Yang Jiayi Hou Qiaoyu You Xiao Li Kuilin Li Ziyan Xiang Yang Rao Yu Zhang |
| author_sort | Xiang Yuan |
| collection | DOAJ |
| description | Abstract Background The effects of restrictive versus liberal transfusion strategies in critically ill patients with traumatic brain injury (TBI) and anemia, particularly in adult patients with moderate to severe TBI, remain inconclusive. Therefore, this systematic review and meta-analysis aim to evaluate the comparative impact of restrictive and liberal red blood cell transfusion strategies among critically ill adult patients with moderate to severe TBI. Methods We conducted a search of PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from their inception through October 20, 2024, to identify randomized controlled trials that compared restrictive (transfusions at a hemoglobin level of ≤ 7 g/dL) and liberal (transfusions at a hemoglobin level of ≤ 9–10 g/dL) transfusion strategies in adult patients with TBI. The primary outcome was mortality, with secondary outcomes including an unfavorable neurological outcome at six months, as determined by the Glasgow Outcome Scale (GOS < 4; or Glasgow Outcome Scale-Extended [GOSE] < 6), and the number of units of packed red blood cells (pRBCs) transfused. Results Five randomized controlled trials involving 1,528 patients were included in the analysis. The results showed that restrictive transfusion, compared to liberal transfusion, had no impact on mortality (RR 1.00, 95% CI 0.80 to 1.24, I2 = 0%) or unfavorable neurological outcome at 6 months (RR 1.06, 95% CI 0.94 to 1.20, I2 = 47%). Restrictive transfusion was associated with a reduction in the number of units of pRBCs transfused (MD -2.62, 95% CI -3.33 to -1.90, I2 = 63%). Conclusion In patients with TBI, a restrictive transfusion strategy did not reduce the risk of mortality or unfavorable neurological outcome compared with a liberal transfusion strategy. |
| format | Article |
| id | doaj-art-1d008effc33f48ec8caef19ea5d10c1b |
| institution | DOAJ |
| issn | 2110-5820 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj-art-1d008effc33f48ec8caef19ea5d10c1b2025-08-20T02:49:18ZengSpringerOpenAnnals of Intensive Care2110-58202024-11-011411810.1186/s13613-024-01411-1Efficacy of restrictive versus liberal transfusion strategies in patients with traumatic brain injury: a systematic review and meta-analysis of randomized controlled trialsXiang Yuan0Sen Zhang1Jun Wan2Cheng Chen3Peng Wang4Shijie Fan5Yuyang Liu6Jingxian Yang7Jiayi Hou8Qiaoyu You9Xiao Li10Kuilin Li11Ziyan Xiang12Yang Rao13Yu Zhang14Department of Neurosurgery, Affiliated Hospital of Chengdu UniversityDepartment of critical care medicine, Affiliated Hospital of Chengdu UniversityCenter for Evidence-based Medicine, Affiliated Hospital of Chengdu UniversityDepartment of Neurosurgery, Affiliated Hospital of Chengdu UniversityDepartment of Neurosurgery, West China Hospital, Sichuan UniversityDepartment of critical care medicine, Affiliated Hospital of Chengdu UniversityDepartment of critical care medicine, Affiliated Hospital of Chengdu UniversityDepartment of critical care medicine, Affiliated Hospital of Chengdu UniversityDepartment of critical care medicine, Affiliated Hospital of Chengdu UniversityDepartment of critical care medicine, Affiliated Hospital of Chengdu UniversityDepartment of critical care medicine, Affiliated Hospital of Chengdu UniversityDepartment of critical care medicine, Affiliated Hospital of Chengdu UniversityDepartment of critical care medicine, Affiliated Hospital of Chengdu UniversityDepartment of critical care medicine, Affiliated Hospital of Chengdu UniversityDepartment of Neurosurgery, Affiliated Hospital of Chengdu UniversityAbstract Background The effects of restrictive versus liberal transfusion strategies in critically ill patients with traumatic brain injury (TBI) and anemia, particularly in adult patients with moderate to severe TBI, remain inconclusive. Therefore, this systematic review and meta-analysis aim to evaluate the comparative impact of restrictive and liberal red blood cell transfusion strategies among critically ill adult patients with moderate to severe TBI. Methods We conducted a search of PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from their inception through October 20, 2024, to identify randomized controlled trials that compared restrictive (transfusions at a hemoglobin level of ≤ 7 g/dL) and liberal (transfusions at a hemoglobin level of ≤ 9–10 g/dL) transfusion strategies in adult patients with TBI. The primary outcome was mortality, with secondary outcomes including an unfavorable neurological outcome at six months, as determined by the Glasgow Outcome Scale (GOS < 4; or Glasgow Outcome Scale-Extended [GOSE] < 6), and the number of units of packed red blood cells (pRBCs) transfused. Results Five randomized controlled trials involving 1,528 patients were included in the analysis. The results showed that restrictive transfusion, compared to liberal transfusion, had no impact on mortality (RR 1.00, 95% CI 0.80 to 1.24, I2 = 0%) or unfavorable neurological outcome at 6 months (RR 1.06, 95% CI 0.94 to 1.20, I2 = 47%). Restrictive transfusion was associated with a reduction in the number of units of pRBCs transfused (MD -2.62, 95% CI -3.33 to -1.90, I2 = 63%). Conclusion In patients with TBI, a restrictive transfusion strategy did not reduce the risk of mortality or unfavorable neurological outcome compared with a liberal transfusion strategy.https://doi.org/10.1186/s13613-024-01411-1Traumatic brain injuryTransfusionMeta-analysis |
| spellingShingle | Xiang Yuan Sen Zhang Jun Wan Cheng Chen Peng Wang Shijie Fan Yuyang Liu Jingxian Yang Jiayi Hou Qiaoyu You Xiao Li Kuilin Li Ziyan Xiang Yang Rao Yu Zhang Efficacy of restrictive versus liberal transfusion strategies in patients with traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials Annals of Intensive Care Traumatic brain injury Transfusion Meta-analysis |
| title | Efficacy of restrictive versus liberal transfusion strategies in patients with traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials |
| title_full | Efficacy of restrictive versus liberal transfusion strategies in patients with traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials |
| title_fullStr | Efficacy of restrictive versus liberal transfusion strategies in patients with traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials |
| title_full_unstemmed | Efficacy of restrictive versus liberal transfusion strategies in patients with traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials |
| title_short | Efficacy of restrictive versus liberal transfusion strategies in patients with traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials |
| title_sort | efficacy of restrictive versus liberal transfusion strategies in patients with traumatic brain injury a systematic review and meta analysis of randomized controlled trials |
| topic | Traumatic brain injury Transfusion Meta-analysis |
| url | https://doi.org/10.1186/s13613-024-01411-1 |
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