Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2025 Apr 1;30(1):220.
doi: 10.1186/s40001-025-02498-3.

Red blood cell transfusion strategy in traumatic brain injury patients: a systematic review and meta-analysis

Jing Wang  1 , Xiang-Hui Li  2 , Jiang-Quan Yu  3 , Rui-Qiang Zheng  4
Affiliations
Meta-Analysis

Red blood cell transfusion strategy in traumatic brain injury patients: a systematic review and meta-analysis

Jing Wang et al. Eur J Med Res. .

Abstract

Background: The optimal red blood cell transfusion (RBCT) strategy for traumatic brain injury (TBI) patients remains a topic of debate. This systematic review and meta-analysis aimed to compare the outcomes of a liberal transfusion strategy versus a restrictive strategy in critically ill patients with TBI.

Methods: PubMed, Web of Science, Embase, and Cochrane Library were searched from inception to November 17, 2024. We included randomized controlled trials (RCTs) of critically ill adult patients with TBI, reporting data on RBCT strategies. The outcomes included intensive care unit (ICU) mortality, long-term mortality, unfavorable functional outcomes, and the incidence of adverse events, such as transfused acute respiratory distress syndrome (TARDS) and venous thromboembolism. We also performed subgroup analyses comparing the association between disease severity and long-term mortality. This review was submitted to PROSPERO (Registration number: CRD42024558797).

Results: In the results, our analysis revealed that compared to a restrictive transfusion strategy, a liberal strategy did not significantly reduce the risk of ICU mortality (RR: 0.74; 95% CI 0.28-1.91; P = 0.53) and long-term mortality (RR: 1.02; 95% CI 0.83-1.25; P = 0.87), but it was able to reduce the risk of unfavorable functional outcomes (RR: 0.90; 95% CI 0.82-0.98; P = 0.01), although there may be a false positive error. In addition, the liberal transfusion strategy was associated with a higher incidence of Transfused Acute Respiratory Distress Syndrome (TARDS) (RR: 1.78; 95% CI 1.06-2.98; P = 0.03).

Conclusions: In critically ill patients with TBI, a liberal RBCT strategy appears to improve functional outcomes but carries the risk of false positive errors. In addition, this strategy does not seem to improve survival and may increase the risk of TARDS. Despite this, there remains insufficient evidence to recommend either strategy in this population.

Keywords: Meta-analysis; Mortality; Red blood cell transfusion; Transfused acute respiratory distress syndrome; Traumatic brain injury.

PubMed Disclaimer

Conflict of interest statement

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

Figures

Fig. 1
Fig. 1
Study flow diagram detailing the literature search
Fig. 2
Fig. 2
Effects of different transfusion strategies on mortality. M–H, Mantel–Haenszel method; CI, confidence interval. a Effects of different transfusion strategies on ICU mortality. b Effects of different transfusion strategies on long-term mortality
Fig. 3
Fig. 3
Risk ratio of unfavorable functional outcomes in the LTS group versus the RTS group. M–H, Mantel–Haenszel method; CI, confidence interval
Fig. 4
Fig. 4
Effects of different transfusion strategies on secondary outcome. M–H, Mantel–Haenszel method; CI, confidence interval. a Risk ratio of ARDS in the LTS group versus the RTS group. b Risk ratio of venous thromboembolic in the LTS group versus the RTS group
Fig. 5
Fig. 5
Forest plot of the relationship between disease severity and long-term mortality
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Maas AIR, Menon DK, Adelson PD, Andelic N, Bell MJ, Belli A, et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol. 2017;16:987–1048. - PubMed
    1. Yu Y, Zhang K, Zhang L, Zong H, Meng L, Han R. Cerebral near-infrared spectroscopy (NIRS) for perioperative monitoring of brain oxygenation in children and adults. Cochrane Database Syst Rev. 2018. 10.1002/14651858.CD010947.pub2. - PMC - PubMed
    1. Gouvêa Bogossian E, Rass V, Lindner A, Iaquaniello C, Miroz JP, Cavalcante Dos Santos E, et al. Factors associated with brain tissue oxygenation changes after RBC transfusion in acute brain injury patients. Crit Care Med. 2022;50:e539-47. - PubMed
    1. Badenes R, Oddo M, Suarez JI, Antonelli M, Lipman J, Citerio G, et al. Hemoglobin concentrations and RBC transfusion thresholds in patients with acute brain injury: an international survey. Crit Care. 2017;21:159. - PMC - PubMed
    1. Lelubre C, Bouzat P, Crippa IA, Taccone FS. Anemia management after acute brain injury. Crit Care. 2016;20:152. - PMC - PubMed

MeSH terms

LinkOut - more resources