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Review
. 2024 Nov 28;14(1):177.
doi: 10.1186/s13613-024-01411-1.

Efficacy of restrictive versus liberal transfusion strategies in patients with traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials

Xiang Yuan #  1   2 , Sen Zhang #  3   2 , Jun Wan #  2   4 , Cheng Chen #  1   2 , Peng Wang  5 , Shijie Fan  3 , Yuyang Liu  3 , Jingxian Yang  3 , Jiayi Hou  3 , Qiaoyu You  3 , Xiao Li  3 , Kuilin Li  3 , Ziyan Xiang  3 , Yang Rao  3 , Yu Zhang  6   7
Affiliations
Review

Efficacy of restrictive versus liberal transfusion strategies in patients with traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials

Xiang Yuan et al. Ann Intensive Care. .

Abstract

Background: The effects of restrictive versus liberal transfusion strategies in critically ill patients with traumatic brain injury (TBI) and anemia, particularly in adult patients with moderate to severe TBI, remain inconclusive. Therefore, this systematic review and meta-analysis aim to evaluate the comparative impact of restrictive and liberal red blood cell transfusion strategies among critically ill adult patients with moderate to severe TBI.

Methods: We conducted a search of PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from their inception through October 20, 2024, to identify randomized controlled trials that compared restrictive (transfusions at a hemoglobin level of ≤ 7 g/dL) and liberal (transfusions at a hemoglobin level of ≤ 9-10 g/dL) transfusion strategies in adult patients with TBI. The primary outcome was mortality, with secondary outcomes including an unfavorable neurological outcome at six months, as determined by the Glasgow Outcome Scale (GOS < 4; or Glasgow Outcome Scale-Extended [GOSE] < 6), and the number of units of packed red blood cells (pRBCs) transfused.

Results: Five randomized controlled trials involving 1,528 patients were included in the analysis. The results showed that restrictive transfusion, compared to liberal transfusion, had no impact on mortality (RR 1.00, 95% CI 0.80 to 1.24, I2 = 0%) or unfavorable neurological outcome at 6 months (RR 1.06, 95% CI 0.94 to 1.20, I2 = 47%). Restrictive transfusion was associated with a reduction in the number of units of pRBCs transfused (MD -2.62, 95% CI -3.33 to -1.90, I2 = 63%).

Conclusion: In patients with TBI, a restrictive transfusion strategy did not reduce the risk of mortality or unfavorable neurological outcome compared with a liberal transfusion strategy.

Keywords: Meta-analysis; Transfusion; Traumatic brain injury.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Search strategy and final included and excluded studies
Fig. 2
Fig. 2
Forest plots comparing: mortality with restrictive and liberal transfusion thresholds in patients with traumatic brain injury. M–H: Mantel–Haenszel, CI: Confidence interval, df: Degrees of freedom
Fig. 3
Fig. 3
Forest plots comparing: (A) Unfavorable neurological outcome at six months (B) Units of packed red blood cells transfused. M–H: Mantel–Haenszel, CI: Confidence interval, df: Degrees of freedom
See this image and copyright information in PMC

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