静脉铁补充在心脏手术后降低输血风险中的疗效：一项随机对照试验的更新荟萃分析。
Efficacy of intravenous iron supplementation in reducing transfusion risk following cardiac surgery: an updated meta-analysis of randomised controlled trials.
机构信息
Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan; Department of Hospital and Health Care Administration, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan.
Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan.
出版信息
Br J Anaesth. 2024 Dec;133(6):1137-1149. doi: 10.1016/j.bja.2024.08.030. Epub 2024 Sep 27.
BACKGROUND
Previous meta-analyses of intravenous iron supplementation for reducing red blood cell (RBC) transfusion risk after cardiac surgery were inconclusive because of limited data. This updated meta-analysis incorporates recent evidence.
METHODS
Major databases were searched on May 2, 2024 for randomised controlled trials comparing the incidence of RBC transfusion between adult patients receiving intravenous iron supplementation and those receiving controls (i.e. oral iron or placebo) after cardiac surgery. The secondary outcomes included the number of RBC units transfused, postoperative haemoglobin levels, iron status, complications, and length of hospital stay. Trial sequential analysis was conducted to examine the robustness of evidence.
RESULTS
Fourteen randomised controlled trials including 2043 subjects were identified. Intravenous iron supplementation was found to reduce the RBC transfusion risk compared with controls (relative risk 0.77, 95% confidence interval [CI] 0.65-0.91, P=0.002, n=1955, I=61%, certainty of evidence: moderate). The trial sequential analysis supported the robustness of the evidence. Furthermore, haemoglobin levels were higher in the intravenous iron supplementation group on postoperative days 4-10 (mean difference 0.17 g dl, 95% CI 0.06-0.29, n=1989) and >21 days (mean difference 0.66 g/dl, 95% CI 0.36-0.95, n=1008). Postoperative iron status also improved with Intravenous iron supplementation, particularly on postoperative days 4-10. There were no significant differences in other outcomes, including mortality.
CONCLUSIONS
Intravenous iron supplementation can reduce RBC transfusion risk and improve postoperative haemoglobin level and iron status after cardiac surgery, supporting the implementation of Intravenous iron supplementation in perioperative blood management strategies.
SYSTEMATIC REVIEW PROTOCOL
CRD42024542206 (PROSPERO).
背景
先前关于静脉铁剂补充以降低心脏手术后红细胞（RBC）输血风险的荟萃分析因数据有限而结论不一。本更新的荟萃分析纳入了最新证据。
方法
于 2024 年 5 月 2 日检索主要数据库，以查找比较接受静脉铁剂补充与接受对照（即口服铁剂或安慰剂）治疗的成年心脏手术后患者之间输血发生率的随机对照试验。次要结局包括输血量、术后血红蛋白水平、铁状态、并发症和住院时间。进行试验序贯分析以检查证据的稳健性。
结果
确定了 14 项随机对照试验，共纳入 2043 例患者。与对照组相比，静脉铁剂补充可降低输血风险（相对风险 0.77，95%置信区间 [CI] 0.65-0.91，P=0.002，n=1955，I=61%，证据确定性：中等）。试验序贯分析支持证据的稳健性。此外，静脉铁剂补充组在术后第 4-10 天（平均差异 0.17 g/dl，95%CI 0.06-0.29，n=1989）和>21 天（平均差异 0.66 g/dl，95%CI 0.36-0.95，n=1008）的血红蛋白水平更高。术后铁状态也随着静脉铁剂补充而改善，特别是在术后第 4-10 天。其他结局，包括死亡率，均无显著差异。
结论
静脉铁剂补充可降低心脏手术后的输血风险，提高术后血红蛋白水平和铁状态，支持将静脉铁剂补充纳入围手术期血液管理策略。
系统评价方案
CRD42024542206（PROSPERO）。
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