Effects of shorter versus longer storage time of transfused red blood cells in adult ICU patients: a systematic review with meta-analysis and Trial Sequential Analysis

TY - JOUR

T1 - Effects of shorter versus longer storage time of transfused red blood cells in adult ICU patients

T2 - a systematic review with meta-analysis and Trial Sequential Analysis

AU - Rygård, Sofie L.

AU - Jonsson, Andreas B.

AU - Madsen, Martin B.

AU - Perner, Anders

AU - Holst, Lars B.

AU - Johansson, Pär I.

AU - Wetterslev, Jørn

PY - 2018

Y1 - 2018

N2 - Purpose: Patients in the intensive care unit (ICU) are often transfused with red blood cells (RBC). During storage, the RBCs and storage medium undergo changes, which may have clinical consequences. Several trials now have assessed these consequences, and we reviewed the present evidence on the effects of shorter versus longer storage time of transfused RBCs on outcomes in ICU patients. Methods: We conducted a systematic review with meta-analyses and trial sequential analyses (TSA) of randomised clinical trials including adult ICU patients transfused with fresher versus older or standard issue blood. Results: We included seven trials with a total of 18,283 randomised ICU patients; two trials of 7504 patients were judged to have low risk of bias. We observed no effects of fresher versus older blood on death (relative risk 1.04, 95% confidence interval (CI) 0.97–1.11; 7349 patients; TSA-adjusted CI 0.93–1.15), adverse events (1.26, 0.76–2.09; 7332 patients; TSA-adjusted CI 0.16–9.87) or post-transfusion infections (1.07, 0.96–1.20; 7332 patients; TSA-adjusted CI 0.90–1.27). The results were unchanged by including trials with high risk of bias. TSA confirmed the results and the required information size was reached for mortality for a relative risk change of 20%. Conclusions: We may be able to reject a clinically meaningful effect of RBC storage time on mortality in transfused adult ICU patients as our trial sequential analyses reject a 10% relative risk change in death when comparing fresher versus older blood for transfusion.

AB - Purpose: Patients in the intensive care unit (ICU) are often transfused with red blood cells (RBC). During storage, the RBCs and storage medium undergo changes, which may have clinical consequences. Several trials now have assessed these consequences, and we reviewed the present evidence on the effects of shorter versus longer storage time of transfused RBCs on outcomes in ICU patients. Methods: We conducted a systematic review with meta-analyses and trial sequential analyses (TSA) of randomised clinical trials including adult ICU patients transfused with fresher versus older or standard issue blood. Results: We included seven trials with a total of 18,283 randomised ICU patients; two trials of 7504 patients were judged to have low risk of bias. We observed no effects of fresher versus older blood on death (relative risk 1.04, 95% confidence interval (CI) 0.97–1.11; 7349 patients; TSA-adjusted CI 0.93–1.15), adverse events (1.26, 0.76–2.09; 7332 patients; TSA-adjusted CI 0.16–9.87) or post-transfusion infections (1.07, 0.96–1.20; 7332 patients; TSA-adjusted CI 0.90–1.27). The results were unchanged by including trials with high risk of bias. TSA confirmed the results and the required information size was reached for mortality for a relative risk change of 20%. Conclusions: We may be able to reject a clinically meaningful effect of RBC storage time on mortality in transfused adult ICU patients as our trial sequential analyses reject a 10% relative risk change in death when comparing fresher versus older blood for transfusion.

KW - Blood preservation

KW - Blood transfusion

KW - Erythrocyte transfusion

KW - Intensive care unit and critical care

KW - Storage

U2 - 10.1007/s00134-018-5069-0

DO - 10.1007/s00134-018-5069-0

M3 - Review

C2 - 29372291

AN - SCOPUS:85040951768

SN - 0342-4642

VL - 44

SP - 204

EP - 217

JO - Intensive Care Medicine

JF - Intensive Care Medicine

IS - 2

ER -