Centre for Statistics in Medicine, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Faculty of Medicine, University of Toronto, Canada.
Nuffield Division of Clinical Laboratory Sciences, University of Oxford, Oxford, UK; NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK.
Lancet Gastroenterol Hepatol. 2017 May;2(5):354-360. doi: 10.1016/S2468-1253(17)30054-7. Epub 2017 Mar 23.
Acute upper gastrointestinal bleeding is a leading indication for red blood cell (RBC) transfusion worldwide, although optimal thresholds for transfusion are debated.
We searched MEDLINE, Embase, CENTRAL, CINAHL, and the Transfusion Evidence Library from inception to Oct 20, 2016, for randomised controlled trials comparing restrictive and liberal RBC transfusion strategies for acute upper gastrointestinal bleeding. Main outcomes were mortality, rebleeding, ischaemic events, and mean RBC transfusion. We computed pooled estimates for each outcome by random effects meta-analysis, and individual participant data for a cluster randomised trial were re-analysed to facilitate meta-analysis. We compared treatment effects between patient subgroups, including patients with liver cirrhosis, patients with non-variceal upper gastrointestinal bleeding, and patients with ischaemic heart disease at baseline.
We included four published and one unpublished randomised controlled trial, totalling 1965 participants. The number of RBC units transfused was lower in the restrictive transfusion group than in the liberal transfusion group (mean difference -1·73 units, 95% CI -2·36 to -1·11, p<0·0001). Restrictive transfusion was associated with lower risk of all-cause mortality (relative risk [RR] 0·65, 95% CI 0·44-0·97, p=0·03) and rebleeding overall (0·58, 0·40-0·84, p=0·004). We detected no difference in risk of ischaemic events. There were no statistically significant differences in the subgroups.
These results support more widespread implementation of restrictive transfusion policies for adults with acute upper gastrointestinal bleeding.
None.
急性上消化道出血是全世界范围内导致红细胞（RBC）输注的主要原因，尽管对于输血的最佳阈值存在争议。
我们检索了 MEDLINE、Embase、CENTRAL、CINAHL 和 Transfusion Evidence Library 从建库到 2016 年 10 月 20 日的随机对照试验，比较了急性上消化道出血的限制性和宽松性 RBC 输血策略。主要结局为死亡率、再出血、缺血事件和平均 RBC 输注量。我们通过随机效应荟萃分析计算了每个结局的汇总估计值，并对一项聚类随机试验的个体参与者数据进行了重新分析，以促进荟萃分析。我们比较了亚组患者之间的治疗效果，包括肝硬化患者、非静脉曲张性上消化道出血患者和基线时有缺血性心脏病的患者。
我们纳入了四项已发表和一项未发表的随机对照试验，共计 1965 名参与者。限制性输血组输注的 RBC 单位数低于宽松输血组（平均差异-1.73 单位，95%CI-2.36 至-1.11，p<0.0001）。限制性输血与全因死亡率降低相关（相对风险[RR]0.65，95%CI0.44-0.97，p=0.03）和总体再出血风险降低（0.58，0.40-0.84，p=0.004）。我们未发现缺血事件风险的差异。在亚组中也没有统计学上的显著差异。
这些结果支持更广泛地实施限制输血策略，用于治疗急性上消化道出血的成年人。
无。
