Dupuis Claire, Sonneville Romain, Adrie Christophe, Gros Antoine, Darmon Michael, Bouadma Lila, Timsit Jean-François
UMR 1137 - IAME Team 5 - DeSCID: Decision Sciences in Infectious Diseases, Control and Care Inserm/Univ Paris Diderot, Sorbonne Paris Cité, 75018, Paris, France.
Medical and Infectious Intensive Care Unit, AP-HP, Hôpital Bichat Claude Bernard, Paris Diderot University, 75018, Paris, France.
Ann Intensive Care. 2017 Dec;7(1):5. doi: 10.1186/s13613-016-0226-5. Epub 2017 Jan 4.
Red blood cell transfusion (RBCT) threshold in patients with sepsis remains a matter of controversy. A threshold of 7 g/dL for stabilized patients with sepsis is commonly proposed, although debated. The aim of the study was to compare the benefit and harm of restrictive versus liberal RBCT strategies in order to guide physicians on RBCT strategies in patients with severe sepsis or septic shock. Four outcomes were assessed: death, nosocomial infection (NI), acute lung injury (ALI) and acute kidney injury (AKI). Studies assessing RBCT strategies or RBCT impact on outcome and including intensive care unit (ICU) patients with sepsis were assessed. Two systematic reviews were achieved: first for the randomized controlled studies (RCTs) and second for the observational studies. MEDLINE, EMBASE, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Clinical Trials.gov were analyzed up to March 01, 2015. Der Simonian and Laird random-effects models were used to report pooled odds ratios (ORs). Subgroup analyses and meta-regressions were performed to explore studies heterogeneity. One RCT was finally included. The restrictive RBCT strategy was not associated with harm or benefit compared to liberal strategy. Twelve cohort studies were included, of which nine focused on mortality rate. RBCT was not associated with increased mortality rate (overall pooled OR was 1.10 [0.75, 1.60]; I = 57%, p = 0.03), but was associated with the occurrence of NI (2 studies: pooled OR 1.25 [1.04-1.50]; I = 0%, p = 0.97), the occurrence of ALI (1 study: OR 2.75 [1.22-6.37]; p = 0.016) and the occurrence of AKI (1 study: OR 5.22 [2.1-15.8]; p = 0.001). Because there was only one RCT, the final meta-analyses were only based on the cohort studies. As a result, the safety of a RBCT restrictive strategy was confirmed, although only one study specifically focused on ICU patients with sepsis. Then, RBCT was not associated with increased mortality rate, but was associated with increased in occurrence of NI, ALI and AKI. Nevertheless, the data on RBCT in patients with sepsis are sparse and the high heterogeneity between studies prevents from drawing any definitive conclusions.
脓毒症患者的红细胞输注（RBCT）阈值仍存在争议。对于病情稳定的脓毒症患者，通常建议的阈值为7g/dL，尽管存在争议。本研究的目的是比较限制性与宽松性RBCT策略的利弊，以便为重症脓毒症或脓毒性休克患者的RBCT策略指导医生。评估了四项结局：死亡、医院感染（NI）、急性肺损伤（ALI）和急性肾损伤（AKI）。评估了评估RBCT策略或RBCT对结局的影响并纳入脓毒症重症监护病房（ICU）患者的研究。进行了两项系统评价：第一项针对随机对照试验（RCT），第二项针对观察性研究。截至2015年3月1日，对MEDLINE、EMBASE、科学网核心合集、Cochrane对照试验中心注册库、Cochrane系统评价数据库和ClinicalTrials.gov进行了分析。采用Der Simonian和Laird随机效应模型报告合并比值比（OR）。进行亚组分析和meta回归以探讨研究的异质性。最终纳入一项RCT。与宽松策略相比，限制性RBCT策略未显示出有害或有益影响。纳入了12项队列研究，其中9项关注死亡率。RBCT与死亡率增加无关（总体合并OR为1.10[0.75,1.60]；I² = 57%，p = 0.03），但与NI的发生相关（2项研究：合并OR 1.25[1.04 - 1.50]；I² = 0%，p = 0.97）、ALI的发生相关（1项研究：OR 2.75[1.22 - 6.37]；p = 0.016）以及AKI的发生相关（1项研究：OR 5.22[2.1 - 15.8]；p = 0.001）。由于只有一项RCT，最终的meta分析仅基于队列研究。因此，尽管只有一项研究专门针对脓毒症ICU患者，但证实了RBCT限制性策略的安全性。然后，RBCT与死亡率增加无关，但与NI、ALI和AKI发生率增加相关。然而，脓毒症患者RBCT的数据稀少，研究之间的高度异质性使得无法得出任何明确结论。
