红细胞输注与动脉瘤性蛛网膜下腔出血的死亡率影响：一项系统评价和Meta分析方案
Red blood cell transfusion and mortality effect in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis protocol.
作者信息
English Shane W, Chassé Michaël, Turgeon Alexis F, Tinmouth Alan, Boutin Amélie, Pagliarello Giuseppe, Fergusson Dean, McIntyre Lauralyn
机构信息
Department of Medicine (Critical Care), The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Rm F202, Ottawa, ON, K1Y 4E9, Canada.
Centre for Transfusion Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada.
出版信息
Syst Rev. 2015 Apr 3;4:41. doi: 10.1186/s13643-015-0035-1.
BACKGROUND
Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating disease that leads to important morbidity and mortality in a young patient population. Anemia following aSAH is common and may be exacerbated by the treatments instituted by clinicians as part of standard care. The role and optimal thresholds for red blood cell (RBC) transfusion in this patient population remains unknown.
METHODS/DESIGN: We will conduct a systematic review of the literature using MEDLINE, EMBASE, and EBM Reviews (including Cochrane Central databases) using a comprehensive search strategy for observational and interventional studies of RBC transfusion in aSAH. Our primary objective is to evaluate the association of RBC transfusion with mortality in aSAH patients. Secondary objectives include a) determining associations between RBC transfusion and poor neurologic outcome, b) defining an optimal RBC transfusion threshold in aSAH patients, and c) describing complications associated with RBC transfusion in aSAH patients. We plan a descriptive reporting of all included citations including study characteristics, methodological quality, and reported outcomes. Clinical and statistical heterogeneity observed between studies will be described. If appropriate, meta-analyses of suitable studies and interpretation of their results will be performed. Effect measures will be converted to obtain relative risks and odds ratios (RR and ORs) with 95% confidence intervals and pooled according to study design (randomized trials and observational studies respectively) using a random effects model.
DISCUSSION
This review will summarize the existing observational and trial evidence regarding RBC transfusion in aSAH patients. The analytical plan has made considerations for different study designs, both observational and interventional in nature, and will summarize the best available evidence to inform the end user and policy and guideline producers and to highlight areas in need of further study.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42014014806.
背景
动脉瘤性蛛网膜下腔出血（aSAH）是一种严重的疾病，在年轻患者群体中会导致严重的发病和死亡。aSAH后贫血很常见，并且可能因临床医生作为标准治疗的一部分而采取的治疗措施而加重。在该患者群体中红细胞（RBC）输血的作用和最佳阈值仍然未知。
方法/设计：我们将使用MEDLINE、EMBASE和循证医学评论（包括Cochrane中心数据库）对文献进行系统评价，采用全面的检索策略，以查找关于aSAH患者RBC输血的观察性和干预性研究。我们的主要目标是评估RBC输血与aSAH患者死亡率之间的关联。次要目标包括：a）确定RBC输血与不良神经功能结局之间的关联；b）确定aSAH患者的最佳RBC输血阈值；c）描述aSAH患者RBC输血相关的并发症。我们计划对所有纳入的文献进行描述性报告，包括研究特征、方法学质量和报告的结局。将描述研究之间观察到的临床和统计异质性。如果合适，将对适当的研究进行荟萃分析并解释其结果。将转换效应量以获得相对风险和比值比（RR和OR）及其95%置信区间，并根据研究设计（分别为随机试验和观察性研究）使用随机效应模型进行汇总。
讨论
本综述将总结关于aSAH患者RBC输血的现有观察性和试验性证据。分析计划考虑了不同性质的研究设计，包括观察性和干预性，并将总结最佳可得证据，以为最终用户、政策和指南制定者提供信息，并突出需要进一步研究的领域。
系统评价注册
PROSPERO CRD42014014806
Zotero 插件