Risks associated with red blood cell transfusion in the trauma population, a meta-analysis

Sunil V Patel; Biniam Kidane; Michelle Klingel; Neil Parry

doi:10.1016/j.injury.2014.05.015

Risks associated with red blood cell transfusion in the trauma population, a meta-analysis

Injury. 2014 Oct;45(10):1522-33. doi: 10.1016/j.injury.2014.05.015. Epub 2014 May 24.

Authors

Sunil V Patel¹, Biniam Kidane², Michelle Klingel³, Neil Parry⁴

Affiliations

¹ London Health Sciences Centre, London, Ontario, Canada. Electronic address: spatel2009@meds.uwo.ca.
² London Health Sciences Centre, London, Ontario, Canada. Electronic address: biniam.kidane@londonhospitals.ca.
³ London Health Sciences Centre, London, Ontario, Canada. Electronic address: michelle.klingel@lhsc.on.ca.
⁴ London Health Sciences Centre, London, Ontario, Canada. Electronic address: neil.parry@lhsc.on.ca.

PMID: 24975652
DOI: 10.1016/j.injury.2014.05.015

Abstract

Introduction: A previous meta-analysis has found an association between red blood cell (RBC) transfusions and mortality in critically ill patients, but no review has focused on the trauma population only.

Objectives: To determine the association between RBC transfusion and mortality in the trauma population, with secondary outcomes of multiorgan failure (MOF) and acute respiratory distress syndrome (ARDS) or acute lung injury (ALI).

Data sources: EMBASE (1947-2012) and MEDLINE (1946-2012).

Study eligibility criteria: Randomized controlled trials and observational studies were to be included if they assessed the association between RBC transfusion and either the primary (mortality) or secondary outcomes (MOF, ARDS/ALI).

Participants: Trauma patients.

Exposure: Red blood cell transfusion.

Methods: A literature search was completed and reviewed in duplicate to identify eligible studies. Studies were included in the pooled analyses if an attempt was made to determine the association between RBC and the outcomes, after adjusting for important confounders. A random effects model was used for and heterogeneity was quantified using the I(2) statistic. Study quality was assessed using the Newcastle-Ottawa Scale.

Results: 40 observational studies were included in the qualitative review. Including studies which adjusted for important confounders found the odds of mortality increased with each additional unit of RBC transfused (9 Studies, OR 1.07, 95%CI 1.04-1.10, I(2) 82.9%). The odds of MOF (3 studies, OR 1.08, 95%CI 1.02-1.14, I(2) 95.9%) and ARDS/ALI (2 studies, OR 1.06, 95%CI 1.03-1.10, I(2) 0%) also increased with each additional RBC unit transfused.

Conclusions: We have found an association between RBC transfusion and the primary and secondary outcomes, based on observational studies only. This represents the extent of the published literature. Further interventional studies are needed to clarify how limiting transfusion can affect mortality and other outcomes.

Keywords: Acute lung injury; Acute respiratory distress syndrome; Mortality; Multiorgan failure; Red blood cells; Transfusion; Trauma.

Publication types

Meta-Analysis
Review

MeSH terms

Acute Lung Injury / etiology*
Acute Lung Injury / mortality
Critical Illness / mortality
Critical Illness / therapy*
Erythrocyte Transfusion / adverse effects*
Erythrocyte Transfusion / mortality
Humans
Intensive Care Units / statistics & numerical data
Multiple Organ Failure / etiology*
Multiple Organ Failure / mortality
Observational Studies as Topic
Randomized Controlled Trials as Topic
Respiratory Distress Syndrome / etiology*
Respiratory Distress Syndrome / mortality
Risk Factors