Red blood cell transfusion strategy in traumatic brain injury patients: a systematic review and meta-analysis
Abstract Background The optimal red blood cell transfusion (RBCT) strategy for traumatic brain injury (TBI) patients remains a topic of debate. This systematic review and meta-analysis aimed to compare the outcomes of a liberal transfusion strategy versus a restrictive strategy in critically ill pat...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-04-01
|
| Series: | European Journal of Medical Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40001-025-02498-3 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850153923869933568 |
|---|---|
| author | Jing Wang Xiang-Hui Li Jiang-Quan Yu Rui-Qiang Zheng |
| author_facet | Jing Wang Xiang-Hui Li Jiang-Quan Yu Rui-Qiang Zheng |
| author_sort | Jing Wang |
| collection | DOAJ |
| description | Abstract Background The optimal red blood cell transfusion (RBCT) strategy for traumatic brain injury (TBI) patients remains a topic of debate. This systematic review and meta-analysis aimed to compare the outcomes of a liberal transfusion strategy versus a restrictive strategy in critically ill patients with TBI. Methods PubMed, Web of Science, Embase, and Cochrane Library were searched from inception to November 17, 2024. We included randomized controlled trials (RCTs) of critically ill adult patients with TBI, reporting data on RBCT strategies. The outcomes included intensive care unit (ICU) mortality, long-term mortality, unfavorable functional outcomes, and the incidence of adverse events, such as transfused acute respiratory distress syndrome (TARDS) and venous thromboembolism. We also performed subgroup analyses comparing the association between disease severity and long-term mortality. This review was submitted to PROSPERO (Registration number: CRD42024558797). Results In the results, our analysis revealed that compared to a restrictive transfusion strategy, a liberal strategy did not significantly reduce the risk of ICU mortality (RR: 0.74; 95% CI 0.28–1.91; P = 0.53) and long-term mortality (RR: 1.02; 95% CI 0.83–1.25; P = 0.87), but it was able to reduce the risk of unfavorable functional outcomes (RR: 0.90; 95% CI 0.82–0.98; P = 0.01), although there may be a false positive error. In addition, the liberal transfusion strategy was associated with a higher incidence of Transfused Acute Respiratory Distress Syndrome (TARDS) (RR: 1.78; 95% CI 1.06–2.98; P = 0.03). Conclusions In critically ill patients with TBI, a liberal RBCT strategy appears to improve functional outcomes but carries the risk of false positive errors. In addition, this strategy does not seem to improve survival and may increase the risk of TARDS. Despite this, there remains insufficient evidence to recommend either strategy in this population. |
| format | Article |
| id | doaj-art-697d002af5fa4e10b113012e5a1e99f5 |
| institution | OA Journals |
| issn | 2047-783X |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
| record_format | Article |
| series | European Journal of Medical Research |
| spelling | doaj-art-697d002af5fa4e10b113012e5a1e99f52025-08-20T02:25:35ZengBMCEuropean Journal of Medical Research2047-783X2025-04-0130111110.1186/s40001-025-02498-3Red blood cell transfusion strategy in traumatic brain injury patients: a systematic review and meta-analysisJing Wang0Xiang-Hui Li1Jiang-Quan Yu2Rui-Qiang Zheng3Medical College, Yangzhou University, Department of Intensive Care Unit, Northern Jiangsu People’s Hospital Affiliated to Yangzhou UniversityDepartment of Intensive Care Unit, Northern Jiangsu People’s Hospital Affiliated to Yangzhou UniversityDepartment of Intensive Care Unit, Northern Jiangsu People’s Hospital Affiliated to Yangzhou UniversityDepartment of Intensive Care Unit, Northern Jiangsu People’s Hospital Affiliated to Yangzhou UniversityAbstract Background The optimal red blood cell transfusion (RBCT) strategy for traumatic brain injury (TBI) patients remains a topic of debate. This systematic review and meta-analysis aimed to compare the outcomes of a liberal transfusion strategy versus a restrictive strategy in critically ill patients with TBI. Methods PubMed, Web of Science, Embase, and Cochrane Library were searched from inception to November 17, 2024. We included randomized controlled trials (RCTs) of critically ill adult patients with TBI, reporting data on RBCT strategies. The outcomes included intensive care unit (ICU) mortality, long-term mortality, unfavorable functional outcomes, and the incidence of adverse events, such as transfused acute respiratory distress syndrome (TARDS) and venous thromboembolism. We also performed subgroup analyses comparing the association between disease severity and long-term mortality. This review was submitted to PROSPERO (Registration number: CRD42024558797). Results In the results, our analysis revealed that compared to a restrictive transfusion strategy, a liberal strategy did not significantly reduce the risk of ICU mortality (RR: 0.74; 95% CI 0.28–1.91; P = 0.53) and long-term mortality (RR: 1.02; 95% CI 0.83–1.25; P = 0.87), but it was able to reduce the risk of unfavorable functional outcomes (RR: 0.90; 95% CI 0.82–0.98; P = 0.01), although there may be a false positive error. In addition, the liberal transfusion strategy was associated with a higher incidence of Transfused Acute Respiratory Distress Syndrome (TARDS) (RR: 1.78; 95% CI 1.06–2.98; P = 0.03). Conclusions In critically ill patients with TBI, a liberal RBCT strategy appears to improve functional outcomes but carries the risk of false positive errors. In addition, this strategy does not seem to improve survival and may increase the risk of TARDS. Despite this, there remains insufficient evidence to recommend either strategy in this population.https://doi.org/10.1186/s40001-025-02498-3Traumatic brain injuryRed blood cell transfusionMortalityTransfused acute respiratory distress syndromeMeta-analysis |
| spellingShingle | Jing Wang Xiang-Hui Li Jiang-Quan Yu Rui-Qiang Zheng Red blood cell transfusion strategy in traumatic brain injury patients: a systematic review and meta-analysis European Journal of Medical Research Traumatic brain injury Red blood cell transfusion Mortality Transfused acute respiratory distress syndrome Meta-analysis |
| title | Red blood cell transfusion strategy in traumatic brain injury patients: a systematic review and meta-analysis |
| title_full | Red blood cell transfusion strategy in traumatic brain injury patients: a systematic review and meta-analysis |
| title_fullStr | Red blood cell transfusion strategy in traumatic brain injury patients: a systematic review and meta-analysis |
| title_full_unstemmed | Red blood cell transfusion strategy in traumatic brain injury patients: a systematic review and meta-analysis |
| title_short | Red blood cell transfusion strategy in traumatic brain injury patients: a systematic review and meta-analysis |
| title_sort | red blood cell transfusion strategy in traumatic brain injury patients a systematic review and meta analysis |
| topic | Traumatic brain injury Red blood cell transfusion Mortality Transfused acute respiratory distress syndrome Meta-analysis |
| url | https://doi.org/10.1186/s40001-025-02498-3 |
| work_keys_str_mv | AT jingwang redbloodcelltransfusionstrategyintraumaticbraininjurypatientsasystematicreviewandmetaanalysis AT xianghuili redbloodcelltransfusionstrategyintraumaticbraininjurypatientsasystematicreviewandmetaanalysis AT jiangquanyu redbloodcelltransfusionstrategyintraumaticbraininjurypatientsasystematicreviewandmetaanalysis AT ruiqiangzheng redbloodcelltransfusionstrategyintraumaticbraininjurypatientsasystematicreviewandmetaanalysis |