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. 2022 Dec 30:2022:2124019.
doi: 10.1155/2022/2124019. eCollection 2022.

A Network Meta-Analysis of Two Doses of Recombinant Human Thrombopoietin for Treating Sepsis-Related Thrombocytopenia

Dandan Chen  1 , Yu Hou  1 , Chaochao Wei  2 , Xingjun Cai  2
Affiliations

A Network Meta-Analysis of Two Doses of Recombinant Human Thrombopoietin for Treating Sepsis-Related Thrombocytopenia

Dandan Chen et al. Int J Clin Pract. .

Abstract

Previous studies suggest that sepsis remains a common critical illness with a global incidence of 31.5 million. The aim of this study was to evaluate the comparative therapeutic value of recombinant human thrombopoietin (rhTPO) in treating sepsis patients with thrombocytopenia. We conducted a comprehensive electronic search of PubMed, EMBASE, the Cochrane Library, and CNKI from its inception through December 31, 2021. Thirteen randomized controlled trials (RCTs) involving 963 patients were included. Network meta-analyses showed that rhTPO 300 U/kg/day and rhTPO 15000 U/day significantly increased the platelet (PLT) levels on the 7th day and decreased the requirement of transfusion of red blood cells (RBCs), plasma, and PLT compared with IVIG and NAT. SUCRA showed that rhTPO 300 U/kg/day ranked first in terms of 28-day mortality (85.5%) and transfusion, including RBC (88.7%), plasma (89.6%), and PLT (95.2%), while rhTPO 15000 U/day ranked first for the length of the intensive care unit (ICU) stay (95.9%) and PLT level at day 7 (91.6%). rhTPO 300 U/kg/day may be the optimal dose to reduce 28-day mortality and transfusion requirements. However, rhTPO 15000 U/day may be the optimal dose for shortening the ICU stay and increasing the PLT level on the 7th day. However, additional studies to further validate our findings are needed.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram of study selection.
Figure 2
Figure 2
Evidence network of 28-day mortality. NAT, no additional treatment; IVIG, intravenous immunoglobulin; rhTPO 300, 300 U/kg/d recombinant human thrombopoietin; rhTPO 15000, 15000 U/d recombinant human thrombopoietin.
Figure 3
Figure 3
Network meta-analysis of the relative efficacy (a) and the rank probabilities (b) among different treatment strategies in terms of 28-day mortality. NAT, no additional treatment; IVIG, intravenous immunoglobulin; rhTPO 300, 300 U/kg/d recombinant human thrombopoietin; rhTPO 15000, 15000 U/d recombinant human thrombopoietin.
Figure 4
Figure 4
Evidence network of the length of ICU stay. NAT, no additional treatment; IVIG, intravenous immunoglobulin; rhTPO 300, 300 U/kg/d recombinant human thrombopoietin; rhTPO 15000, 15000 U/d recombinant human thrombopoietin.
Figure 5
Figure 5
Network meta-analysis of the relative efficacy (a) and the rank probabilities (b) among different treatment strategies in terms of the length of ICU stay. NAT, no additional treatment; IVIG, intravenous immunoglobulin; rhTPO 300, 300 U/kg/d recombinant human thrombopoietin; rhTPO 15000, 15000 U/d recombinant human thrombopoietin.
Figure 6
Figure 6
Network meta-analysis of the relative efficacy and the rank probabilities among different treatment strategies in terms of the level of platelet on the 7th day (a), transfusion of RBC (b), transfusion of plasma (c), and transfusion of platelets (d). NAT, no additional treatment; IVIG, intravenous immunoglobulin; rhTPO 300, 300 U/kg/d recombinant human thrombopoietin; rhTPO 15000, 15000 U/d recombinant human thrombopoietin.
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