Wang Jing, Li Xiang-Hui, Yu Jiang-Quan, Zheng Rui-Qiang
Medical College, Yangzhou University, Department of Intensive Care Unit, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No. 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China.
Department of Intensive Care Unit, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No. 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China.
Eur J Med Res. 2025 Apr 1;30(1):220. doi: 10.1186/s40001-025-02498-3.
The optimal red blood cell transfusion (RBCT) strategy for traumatic brain injury (TBI) patients remains a topic of debate. This systematic review and meta-analysis aimed to compare the outcomes of a liberal transfusion strategy versus a restrictive strategy in critically ill patients with TBI.
PubMed, Web of Science, Embase, and Cochrane Library were searched from inception to November 17, 2024. We included randomized controlled trials (RCTs) of critically ill adult patients with TBI, reporting data on RBCT strategies. The outcomes included intensive care unit (ICU) mortality, long-term mortality, unfavorable functional outcomes, and the incidence of adverse events, such as transfused acute respiratory distress syndrome (TARDS) and venous thromboembolism. We also performed subgroup analyses comparing the association between disease severity and long-term mortality. This review was submitted to PROSPERO (Registration number: CRD42024558797).
In the results, our analysis revealed that compared to a restrictive transfusion strategy, a liberal strategy did not significantly reduce the risk of ICU mortality (RR: 0.74; 95% CI 0.28-1.91; P = 0.53) and long-term mortality (RR: 1.02; 95% CI 0.83-1.25; P = 0.87), but it was able to reduce the risk of unfavorable functional outcomes (RR: 0.90; 95% CI 0.82-0.98; P = 0.01), although there may be a false positive error. In addition, the liberal transfusion strategy was associated with a higher incidence of Transfused Acute Respiratory Distress Syndrome (TARDS) (RR: 1.78; 95% CI 1.06-2.98; P = 0.03).
In critically ill patients with TBI, a liberal RBCT strategy appears to improve functional outcomes but carries the risk of false positive errors. In addition, this strategy does not seem to improve survival and may increase the risk of TARDS. Despite this, there remains insufficient evidence to recommend either strategy in this population.
创伤性脑损伤（TBI）患者的最佳红细胞输注（RBCT）策略仍是一个有争议的话题。本系统评价和荟萃分析旨在比较重症TBI患者采用宽松输血策略与限制性策略的结局。
检索了从创刊至2024年11月17日的PubMed、Web of Science、Embase和Cochrane图书馆。我们纳入了重症成年TBI患者的随机对照试验（RCT），报告了关于RBCT策略的数据。结局包括重症监护病房（ICU）死亡率、长期死亡率、不良功能结局以及不良事件的发生率，如输血相关急性呼吸窘迫综合征（TARDS）和静脉血栓栓塞。我们还进行了亚组分析，比较疾病严重程度与长期死亡率之间的关联。本综述已提交至PROSPERO（注册号：CRD42024558797）。
在结果中，我们的分析显示，与限制性输血策略相比，宽松策略并未显著降低ICU死亡率（RR：0.74；95%CI 0.28 - 1.91；P = 0.53）和长期死亡率（RR：1.02；95%CI 0.83 - 1.25；P = 0.87），但能够降低不良功能结局的风险（RR：0.90；95%CI 0.82 - 0.98；P = 0.01），尽管可能存在假阳性误差。此外，宽松输血策略与输血相关急性呼吸窘迫综合征（TARDS）的发生率较高相关（RR：1.78；95%CI 1.06 - 2.98；P = 0.03）。
在重症TBI患者中，宽松的RBCT策略似乎能改善功能结局，但存在假阳性误差的风险。此外，该策略似乎并未改善生存率，且可能增加TARDS的风险。尽管如此，仍缺乏足够证据在该人群中推荐任何一种策略。
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