Zarychanski Ryan, Turgeon Alexis F, McIntyre Lauralyn, Fergusson Dean A
Department of Epidemiology and Community Medicine, University of Ottawa, and the Ottawa Health Research Institute, Ottawa, Ont.
CMAJ. 2007 Sep 25;177(7):725-34. doi: 10.1503/cmaj.071055. Epub 2007 Sep 5.
Anemia and the need for red blood cell transfusions are common among patients admitted to intensive care units. Erythropoietin has been used to decrease the need for transfusions; however, its ability to improve clinical outcomes is unknown. We evaluated the effect of erythropoietin-receptor agonists on clinically important outcomes, including mortality, length of stay in hospital or intensive care unit, ventilator use, transfusion requirements and major adverse events.
To identify relevant studies, we searched electronic databases covering 1950 to 2007 (MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and the Scopus database). We also searched conference proceedings and grey literature sources. We selected all randomized controlled trials involving critically ill patients that compared an erythropoietin-receptor agonist with a placebo or no intervention. No language restrictions were considered. Data were extracted using a standardized extraction template. We used a fixed effects model to calculate all summary measures of treatment effects.
Of 673 identified records, 9 studies that investigated erythropoietin alpha met the eligibility criteria and were included in our analysis. Erythropoietin, compared with placebo or no intervention, had no statistically significant effect on overall mortality (odds ratio [OR] 0.86, 95% confidence interval [CI] 0.71-1.05, I2 = 0%). The treatment and control groups did not differ in the length of stay in hospital or intensive care unit, or in the duration of mechanical ventilation, in the 3 studies that reported these outcomes. Erythropoietin, compared with placebo, significantly reduced the odds of a patient receiving at least 1 transfusion (OR 0.73, 95% CI 0.64-0.84, I2 = 54.7%). The mean number of units of blood transfused per patient was decreased by 0.41 units in the erythropoietin group (95% CI 0.10-0.74, I2 = 79.2%). Most of the included studies were performed before the widespread adoption of a restrictive transfusion strategy. Only 1 study provided detailed reports of adverse events, and none of the studies systematically evaluated all patients for venous thromboembolism.
At this time, we do not recommend the routine use of erythropoietin-receptor agonists in critically ill patients. The reduction in red blood cell transfusions per patient was very small, and there is insufficient evidence to determine whether this intervention results in clinically important benefits with acceptable risks.
贫血以及对红细胞输血的需求在入住重症监护病房的患者中很常见。促红细胞生成素已被用于减少输血需求；然而，其改善临床结局的能力尚不清楚。我们评估了促红细胞生成素受体激动剂对包括死亡率、住院或重症监护病房住院时间、呼吸机使用、输血需求和主要不良事件等重要临床结局的影响。
为了识别相关研究，我们检索了涵盖1950年至2007年的电子数据库（MEDLINE、EMBASE、Cochrane对照试验中央注册库和Scopus数据库）。我们还检索了会议论文集和灰色文献来源。我们选择了所有涉及危重症患者的随机对照试验，这些试验将促红细胞生成素受体激动剂与安慰剂或不进行干预进行了比较。未考虑语言限制。使用标准化提取模板提取数据。我们使用固定效应模型计算治疗效果的所有汇总指标。
在673条识别出的记录中，9项研究促红细胞生成素α的研究符合纳入标准并被纳入我们的分析。与安慰剂或不进行干预相比，促红细胞生成素对总体死亡率没有统计学显著影响（优势比[OR]0.86，95%置信区间[CI]0.71 - 1.05，I² = 0%）。在报告了这些结局的3项研究中，治疗组和对照组在住院或重症监护病房的住院时间以及机械通气持续时间方面没有差异。与安慰剂相比，促红细胞生成素显著降低了患者接受至少1次输血的几率（OR 0.73，95% CI 0.64 - 0.84，I² = 54.7%）。促红细胞生成素组每位患者的平均输血量减少了0.41单位（95% CI 0.10 - 0.74，I² = 79.2%）。大多数纳入研究是在限制性输血策略广泛采用之前进行的。只有1项研究提供了不良事件的详细报告，并且没有研究系统地评估所有患者的静脉血栓栓塞情况。
目前，我们不建议在危重症患者中常规使用促红细胞生成素受体激动剂。每位患者红细胞输血量的减少非常小，并且没有足够的证据来确定这种干预是否能带来具有可接受风险的重要临床益处。
