Review
Introduction
Anemia
Health problem | Patients | Studies | Risk | |
---|---|---|---|---|
Outcome | (n) | (n) | (95% CI) | |
Meta-analyses | ||||
Mortalitya[14] | ACS | 51,449 | 10 | aOR: 1.49 (1.24 to 1.79) |
Mortalityb[9] | ACS | 171,915 | 27 | aHR: 1.49 (1.23 to 1.81) |
Studies not included in the meta-analyses | ||||
Mortality [15] | New heart failure | 12,065 | 1 | aHR: 1.34 (1.24 to 1.46) |
Mortality [16] | PCI | 6,116 | 1 | aHR: 1.8 (1.3 to 2.3) |
Mortality [17] | PCI | 48,851 | 1 | aOR: 2.29 (1.79 to 2.92) |
Mortality [18] | Cardiac surgery | 13,843 | 1 | 12.5% versus 7.5%, P = 0.014 |
Mortality [19] | CABG | 2,102 | 1 | aOR: 0.99 (0.98 to 1.0) |
Mortality [20] | ACS | 7,922 | 1 | aOR: 1.71 (1.34 to 2.17) |
Meta-analyses on other outcomes | ||||
Heart failurea[14] | ACS | 152,849 | 5 | OR: 1.96 (1.47 to 2.62) |
Cardiogenic shocka[14] | ACS | 129,136 | 4 | OR: 1.95 (1.04 to 2.64) |
Reinfarctionb[9] | ACS | 22,115 | 6 | RR: 1.25 (1.02 to 1.53) |
Transfusion
Risks and benefits of RBC transfusions
Non-cardiac patients
Adult cardiac patients
Health problem | Patients | Riskc | ||
---|---|---|---|---|
Outcome, first author, yearb | (n) | (95% CI) | P- value | |
Outcome: mortality in adults | ||||
Mortality, Alexander, 2008 [35] | ACS | 44,242 | OR: 3.2 (2.9 to 3.6) | |
ACS and Hct ≤ 24% | aOR: 0.68 (0.45 to 1.02) | |||
ACS and Hct = 24 to 27% | aOR: 1.01 (0.79 to 1.30) | |||
ACS and Hct = 27 to 30% | aOR: 1.18 (0.92 to 1.50) | |||
ACS and Hct > 30% | aOR: 3.47 (2.30 to 5.23) | |||
Mortality, Aronson, 2008 [36] | AMI | 2,358 | aHR: 0.13 (0.03 to 0.65)d,e | 0.013 |
aHR: 2.2 (1.5 to 3.3)d,f | < 0.0001 | |||
Mortality, Jani, 2007 [37] | AMI | 4,623 | aOR: 2.02 (1.47 to 2.79) | < 0.0001 |
RR: 4.83 (3.81 to 6.12)d | ||||
Mortality, Jolicœur, 2009 [38] | AMI | 5,188 | RR: 6.38 (4.88 to 8.34) | |
5,532 | aHR: 2.16 (1.20 to 3.88) | < 0.0001 | ||
5,188 | RR: 6.38 (4.88 to 8.34)d | |||
Mortality, Koch, 2006 [39] | CABG | 5,814 | OR: 1.77 (1.67 to 1.87) | < 0.0001 |
Mortality, Murphy, 2007 [40] | Cardiac surgery (UK) | 8,518 | HR: 6.69 (3.66 to 15.1) | < 0.05 |
Mortality, Nikolsky, 2009 [41] | AMI | 2,060 | HR: 4.71 (1.97 to 11.36) | |
RR: 2.92 (1.62 to 5.24)d | ||||
Mortality, Pattakos, 2012 [42] | Cardiac surgery | 644 | 95% versus 89% | 0.007 |
Mortality, Rao, 2004 [43] | ACS | 24,112 | aHR: 3.94 (3.26 to 4.75) | < 0.05 |
RR: 2.60 (2.22 to 3.03)d | < 0.05 | |||
Mortality, Shehata, 2012 [19] | CABG | 2,102 | OR: 0.44 (0.32 to 14.1) | NS |
Mortality, Shishehbor, 2009 [44] | AMI | 3,575 | aHR: 3.89 (2.66 to 5.68) | < 0.001 |
RR: 1.30 (0.90 to 1.88)d | < 0.001 | |||
Mortality, Singla, 2007 [45] | AMI | 370 | RR: 2.36 (1.49 to 3.76)d | |
Mortality, Wu, 2001, [46] | AMI | 78,974 | RR: 2.51 (2.42 to 2.61)d,g | < 0.05 |
Mortality, Yang, 2005 [47] | AMI | 85,111 | aOR: 1.67 (1.48 to 1.88) | < 0.05 |
RR: 3.03 (2.85 to 3.21)d | < 0.05 | |||
Outcomes: myocardial infarction or ischemic eventsh in adults | ||||
AMI, Jani, 2007 [37] | AMI | 4,623 | RR: 1.19 (0.82 to 1.74)d | |
AMI, Jolicœur, 2009 [38] | AMI | 5,188 | RR: 3.05 (1.85 to 5.04)d | |
IEh, Murphy, 2007 [40] | Cardiac surgery (UK) | 8,518 | aOR: 3.35 (2.68 to 4.35)c | < 0.05 |
AMI, Nikolsky, 2009 [41] | AMI | 2,060 | RR: 3.28 (1.44 to 7.49)d | |
AMI, Pattakos, 2012 [42] | Cardiac surgery | 644 | 2.8% versus 0.31% | < 0.01 |
AMI + death, Rao, 2004 [43] | ACS | 2,401 | HR: 3.08 (2.84 to 3.35)d | < 0.05 |
AMI, Shishehbor, 2009 [44] | ACS | 3,575 | aHR : 3.44 | < 0.001 |
AMI + death, Singla, 2007 [45] | AMI | 370 | aOR: 2.57 (1.41 to 4.69) | < 0.001 |
RR: 2.10 (0.83 to 5.30)d | ||||
AMI, Yang, 2005 [47] | AMI | 85,111 | aOR: 0.95 (0.83 to 1.09)d | < 0.05 |
Outcomes in children
|
Health problem
|
Children
|
Risk
c
|
P
-value
|
LMV (days), 2011 [48] | Cardiac surgery | 270 | HR: 0.71 (0.54 to 0.92) | 0.009 |
LMV (days), 2013 [49] | Cardiac surgery | 335 | HR: 2.6 (2.0 to 3.4) | < 0.001 |
PICU LOS (days), 2013 [49] | Cardiac surgery | 335 | LOS: 8 ± 0.9 versus 3.5 ± 2 | < 0.001 |
Hospital LOS, 2011 [24] | Cardiac surgery | 802 | aHR: 0.65 (0.49 to 0.87) | < 0.001 |
Wound infection, 2010 [50] | Cardiac surgery | 216 | aOR: 7.87 (1.63 to 37.92) | < 0.001 |
Pediatric cardiac patients
Risks/benefits of RBC transfusions: summary
Transfusion related adverse events
Restrictive or liberal RBC transfusion strategy
Health problem | Patients | Mortalityb | ||
---|---|---|---|---|
First author, yeara | (n) | (95% CI) | P-value | |
Adults | ||||
Bracey, 1999 [73] | CABG | 428 | RR: 0.52 (0.13 to 2.04) | NS |
Carson, 2011 [74] | Hip surgeryc | 2,016 | ARR: 0.9 (−1.5 to +3.4) | NS |
Cooper, 2001 [52] | Myocardial infarction | 46 | 8% versus 5% | 1.0 |
Hajjar, 2012 [23] | Cardiac surgery | 502 | 6% versus 5% | 0.93 |
Hébert, 2001 [75] | ICU cardiac patients | 357 | 22.5% versus 22.7% | 1.00 |
Johnson, 1992 [76] | CABG | 38 | No differenced | NS |
Shehata, 2012 [19] | Cardiac surgery | 50 | 16% versus 4% | NS |
Pediatric cardiac surgery | ||||
Cholette, 2011 [77] | Cyanotic | 60 | 1 death | NS |
de Gast-Bakker, 2013 [78] | Non-cyanotic | 107 | No death | NS |
Willems, 2010 [79] | Non-cyanotic | 125 | 12.7% versus 6.5% | 0.36 |