Montgomery Eric Y, Barrie Umaru, Kenfack Yves J, Edukugho Derrek, Caruso James P, Rail Benjamin, Hicks William H, Oduguwa Emmanuella, Pernik Mark N, Tao Jonathan, Mofor Paula, Adeyemo Emmanuel, Ahmadieh Tarek Y El, Tamimi Mazin Al, Bagley Carlos A, Bedros Nicole, Aoun Salah G
Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Department of Neurological Surgery, Boonshoft School of Medicine, Wright State University, Dayton, Ohio, USA.
Neurotrauma Rep. 2022 Dec 22;3(1):554-568. doi: 10.1089/neur.2022.0056. eCollection 2022.
Our study aims to provide a synthesis of the best available evidence on the hemoglobin (hgb) red blood cell (RBC) transfusion thresholds in adult traumatic brain injury (TBI) patients, as well as describing the risk factors and outcomes associated with RBC transfusion in this population. A systematic review and meta-analysis was conducted using PubMed, Google Scholar, and Web of Science electronic databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to assess articles discussing RBC transfusion thresholds and describe complications secondary to transfusion in adult TBI patients in the perioperative period. Fifteen articles met search criteria and were reviewed for analysis. Compared to non-transfused, TBI patients who received transfusion tended to be primarily male patients with worse Injury Severity Score (ISS) and Glasgow Coma Scale. Further, the meta-analysis corroborated that transfused TBI patients are older ( = 0.04), have worse ISS scores ( = 0.001), receive more units of RBCs ( = 0.02), and have both higher mortality ( < 0.001) and complication rates ( < 0.0001). There were no differences identified in rates of hypertension, diabetes mellitus, and Abbreviated Injury Scale scores. Additionally, whereas many studies support restrictive (hgb <7 g/dL) transfusion thresholds over liberal (hgb <10 g/dL), our meta-analysis revealed no significant difference in mortality between those thresholds ( = 0.79). Current Class B/C level III evidence predominantly recommends against a liberal transfusion threshold of 10 g/dL for TBI patients (Class B/C level III), but our meta-analysis found no difference in survival between groups. There is evidence suggesting that an intermediate threshold between 7 and 9 g/dL, reflecting the physiological oxygen needs of cerebral tissue, may be worth exploring.
我们的研究旨在综合现有关于成年创伤性脑损伤（TBI）患者血红蛋白（hgb）和红细胞（RBC）输血阈值的最佳证据，并描述该人群中与RBC输血相关的危险因素和结局。根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，使用PubMed、谷歌学术和科学网电子数据库进行了一项系统评价和荟萃分析，以评估讨论RBC输血阈值的文章，并描述成年TBI患者围手术期输血继发的并发症。15篇文章符合检索标准并进行了分析。与未输血的患者相比，接受输血的TBI患者主要为男性，损伤严重程度评分（ISS）和格拉斯哥昏迷量表评分更差。此外，荟萃分析证实，接受输血的TBI患者年龄更大（=0.04），ISS评分更差（=0.001），接受的RBC单位更多（=0.02），死亡率（<0.001）和并发症发生率（<0.0001）更高。高血压、糖尿病和简明损伤量表评分的发生率没有差异。此外，虽然许多研究支持限制性（hgb<7 g/dL）输血阈值而非宽松性（hgb<10 g/dL）输血阈值，但我们的荟萃分析显示，这些阈值之间的死亡率没有显著差异（=0.79）。目前B/C级III类证据主要建议反对对TBI患者采用10 g/dL的宽松输血阈值（B/C级III类），但我们的荟萃分析发现两组之间的生存率没有差异。有证据表明，反映脑组织生理氧需求的7至9 g/dL之间的中间阈值可能值得探索。
