Geriatrics Section, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Department of Internal Medicine, University Center of Geriatric Medicine, University Medical Center Groningen, Groningen, The Netherlands.
J Am Geriatr Soc. 2017 Apr;65(4):728-737. doi: 10.1111/jgs.14564. Epub 2017 Feb 15.
Treating the precipitating factors of delirium is the mainstay of the prevention and treatment of delirium. We aim to investigate the role of anemia and blood transfusion within the multicomponent prevention and treatment strategy of delirium.
Systematic review.
We included cohort studies or Randomized Controlled Trials (RCTs) that considered blood transfusion as treatment for delirium or risk factor, and had delirium as outcome.
Hospitalized patients above 55 years old.
We searched MEDLINE from 1946 through November 2014. Quality assessment and data extraction were performed systematically.
We included 23 studies (n = 29,471). The majority of the studies (n = 22) had a limited quality and for one study quality was uncertain. Two studies evaluated the association between transfusion strategy and postoperative delirium and found no association. Twenty-one studies investigated blood transfusion as a risk factor for delirium. In four of the 21 studies it could be assumed that delirium occurred after transfusion. One of these studies stated that transfusion was a significant risk factor for subsequent delirium (odds ratio (OR) = 3.68, 95% confidence interval (CI) = 1.32-10.94). The other three studies found no association between transfusion and delirium. In the remaining 17 studies, it was not clear whether delirium occurred before or after transfusion, so no conclusion could be drawn on the role of transfusion in delirium development.
The majority of the included studies was not suited to answer the research question properly as the time course of the beginning of delirium as to transfusion was lacking. Our review shows that there is no good quality evidence available for blood transfusion to be a risk factor for delirium or to be a preventive or treatment option.
治疗谵妄的诱发因素是预防和治疗谵妄的主要方法。我们旨在研究贫血和输血在谵妄多组分预防和治疗策略中的作用。
系统评价。
我们纳入了考虑输血作为谵妄或危险因素的治疗方法且以谵妄为结局的队列研究或随机对照试验（RCT）。
年龄>55 岁的住院患者。
我们从 1946 年至 2014 年 11 月对 MEDLINE 进行了检索。系统地进行了质量评估和数据提取。
我们纳入了 23 项研究（n=29471）。大多数研究（n=22）的质量有限，有一项研究的质量不确定。两项研究评估了输血策略与术后谵妄之间的关联，未发现关联。21 项研究调查了输血作为谵妄的危险因素。在 21 项研究中的 4 项中可以假定在输血后发生了谵妄。其中一项研究指出，输血是随后发生谵妄的一个显著危险因素（比值比（OR）=3.68，95%置信区间（CI）=1.32-10.94）。其他三项研究未发现输血与谵妄之间的关联。在其余 17 项研究中，不清楚谵妄是在输血之前还是之后发生的，因此无法得出关于输血在谵妄发展中的作用的结论。
纳入的大多数研究都不适合正确回答研究问题，因为缺乏谵妄与输血开始之间的时间过程。我们的综述表明，没有高质量的证据表明输血是谵妄的危险因素，也没有证据表明输血是预防或治疗选择。
