储存后过滤器与储存前过滤器在血液成分白细胞减少方面对临床结局的影响：系统评价和荟萃分析。
Effect of post-storage filters vs. pre-storage filters for leukoreduction of blood components on clinical outcomes: a systematic review and meta-analysis.
机构信息
HCFMUSP: Universidade de São Paulo Hospital das Clínicas, Av. Dr. Ovídio Pires de Campos 225, Cerqueira César, São Paulo (SP), Brazil.
Universidade de São Paulo Escola de Enfermagem, São Paulo, Brazil.
出版信息
Syst Rev. 2024 Jul 25;13(1):196. doi: 10.1186/s13643-024-02615-z.
BACKGROUND
Leukoreduction has been used to limit the risk of adverse events. The most commonly used methodology is filtration (pre- or post-storage). However, whether pre-storage filtration is better than post-storage filtration needs to be clearly defined, particularly for countries that still use post-storage filtration. This study aimed to synthesize the best available evidence on the effectiveness of pre-storage filters compared with post-storage filters for transfusion reactions, for the occurrence of infections, for the length of hospital stay, and for the death of patients undergoing leukoreduced transfusion.
METHODS
We searched the MEDLINE (PubMed), CINAHL (EBSCO), PsycINFO (APA), Scopus (Elsevier), The Cochrane Library (J. Wiley), Web of Science Core Collection (Clarivate Analytics), Embase (Elsevier), and LILACS (VHL) databases and gray literature for eligible studies in August 2020 and updated the search in October 2023. The Joanna Briggs Institute critical assessment tools were applied to analyze the quality appraisal of the studies. GRADE was used to determine the certainty of the evidence.
RESULTS
The meta-analysis showed that pre-storage filtration was a protective factor for the occurrence of febrile non-hemolytic transfusion reaction in red blood cells (RR 0.49, 95% CI 0.41-0.59) and platelet concentrate transfusions (RR 0.16, 95% CI 0.12-0.22). The same did not occur for post-surgical infection after platelet concentrate transfusions (RR 0.82, 95% CI 0.65-1.04). Only one study analyzed the length of hospital stay and showed no significant difference between patients who received leukoreduced transfusions according to the type of filter used. According to the GRADE criteria, the certainty of the evidence for febrile non-hemolytic transfusion reactions was low for red blood cells and very low for platelet concentrate due to the high risk of bias. Infection was a low risk due to imprecision.
CONCLUSIONS
The results of this review showed that the certainty of recommending the best type of filter (pre- or post-storage) for the benefit of the outcomes analyzed is still fragile; therefore, more robust evidence is needed.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42020192202.
背景
白细胞减少已被用于降低不良反应的风险。最常用的方法是过滤（储存前或储存后）。然而，储存前过滤是否优于储存后过滤仍需明确，尤其是对于仍在使用储存后过滤的国家。本研究旨在综合比较储存前过滤与储存后过滤在输血反应、感染发生、住院时间和输注去白细胞血液的患者死亡方面有效性的最佳证据。
方法
我们于 2020 年 8 月在 MEDLINE（PubMed）、CINAHL（EBSCO）、PsycINFO（APA）、Scopus（Elsevier）、The Cochrane Library（J. Wiley）、Web of Science Core Collection（Clarivate Analytics）、Embase（Elsevier）和 LILACS（VHL）数据库以及灰色文献中搜索合格研究，并于 2023 年 10 月更新检索结果。采用 Joanna Briggs 研究所的关键评估工具对研究的质量评估进行分析。使用 GRADE 确定证据的确定性。
结果
荟萃分析显示，储存前过滤是红细胞（RR0.49，95%CI0.41-0.59）和血小板浓缩物输血（RR0.16，95%CI0.12-0.22）中发热性非溶血性输血反应发生的保护因素。然而，血小板浓缩物输血后手术部位感染的发生并没有这种情况（RR0.82，95%CI0.65-1.04）。仅有一项研究分析了住院时间，且表明根据所使用的过滤器类型，接受去白细胞输血的患者之间的住院时间无显著差异。根据 GRADE 标准，由于高偏倚风险，红细胞的发热性非溶血性输血反应和血小板浓缩物的证据确定性为低；由于不精确，感染为低风险。
结论
本综述的结果表明，推荐最佳类型的过滤器（储存前或储存后）以获得分析结果益处的确定性仍然很脆弱；因此，需要更有力的证据。
系统评价注册
PROSPERO CRD42020192202。
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