Van Remoortel Hans, De Buck Emmy, Dieltjens Tessa, Pauwels Nele S, Compernolle Veerle, Vandekerckhove Philippe
Belgian Red Cross-Flanders, Mechelen, Belgium.
Faculty of Medicine, University of Ghent, Ghent, Belgium.
Transfusion. 2016 Feb;56(2):472-80. doi: 10.1111/trf.13385. Epub 2015 Nov 6.
Recent literature suggests that more restrictive red blood cell (RBC) transfusion practices are equivalent or better than more liberal transfusion practices. The methodologic quality of guidelines recommending more restrictive transfusion thresholds and their underlying scientific evidence is unclear. Therefore, we aimed to evaluate the quality of the development process of RBC transfusion guidelines and to investigate the underlying evidence of guidelines recommending a more restrictive hemoglobin (Hb) threshold.
Via systematic literature screening of relevant databases (NGC, GIN, Medline, and Embase), RBC transfusion guidelines recommending a more restrictive Hb level (<6, <7, or <8 g/dL) were included. Four assessors independently evaluated the methodologic quality by scoring the rigor of development domain (AGREE II checklist). The level of evidence served as a reference for the quality of the underlying evidence.
The methodologic quality of 13 RBC transfusion guidelines was variable (18%-72%) but highest for those developed by Advancing Transfusion and Cellular Therapies Worldwide (72%), the Task Force of Advanced Bleeding Care in Trauma (70%), and the Dutch Institute for Healthcare Improvement (61%). A Hb level of less than 7 g/dL (intensive care unit patients) or less than 8 g/dL (postoperative patients) were the only thresholds based on high-quality evidence. Only four of 32 recommendations had a high-quality evidence base.
Methodologic quality should be guaranteed in future RBC transfusion guideline development to ensure that the best available evidence is captured when recommending restrictive transfusion strategies. More high-quality trials are needed to provide a stronger scientific basis for RBC transfusion guidelines that recommend more restrictive transfusion thresholds.
近期文献表明，更严格的红细胞（RBC）输血策略等同于或优于更宽松的输血策略。推荐更严格输血阈值的指南的方法学质量及其基础科学证据尚不清楚。因此，我们旨在评估红细胞输血指南制定过程的质量，并调查推荐更严格血红蛋白（Hb）阈值的指南的基础证据。
通过对相关数据库（NGC、GIN、Medline和Embase）进行系统文献筛选，纳入推荐更严格Hb水平（<6、<7或<8 g/dL）的红细胞输血指南。四名评估者通过对制定领域的严谨性（AGREE II清单）进行评分，独立评估方法学质量。证据水平作为基础证据质量的参考。
13项红细胞输血指南的方法学质量各不相同（18%-72%），但由全球推进输血与细胞治疗组织（72%）、创伤高级出血护理工作组（70%）和荷兰医疗保健改善研究所（61%）制定的指南质量最高。Hb水平低于7 g/dL（重症监护病房患者）或低于8 g/dL（术后患者）是基于高质量证据的唯一阈值。32项推荐中只有4项有高质量的证据基础。
未来红细胞输血指南的制定应保证方法学质量，以确保在推荐限制性输血策略时能够获取最佳现有证据。需要更多高质量试验，为推荐更严格输血阈值的红细胞输血指南提供更有力的科学依据。
