| Objective:Anemia is a common clinical phenomenon in the Intensive Care Units(ICUs)and is an independent risk factor for aggravating poor prognosis.Transfusion is the most direct and effective method for correcting anemia.There is currently no clear blood transfusion threshold for clinical treatment in patients with anemia in the ICU.The primary objective of this meta-analysis was to evaluate the impact of restrictive transfusion and liberal transfusion on the prognosis of patients with anemia in the ICU.Methods:According to the established search strategies,the four databases of PubMed,Web of Science,Embase and Cochrane Library were searched by computer to find and screen the studies of randomized controlled trails for restrictive transfusion and liberal transfusion in patients with anemia in ICU.The time for literatures search is to build the databases until July2018.The two researchers independently carried out the screening of the literatures.Screening studies in strict accordance with inclusion and exclusion criterias,which can be screened by the topics or abstracts of the literatures,and then further screened by reading the full texts.Then draw literatures screening flow chart.If there is any disagreement,the two will discuss the solution.If there is still a disagreement,find a third person to intervene.The qualities of the literatures that were ultimately included were assessed through a bias risk assessment tool provided by the Cochrane Library.The count datas use odds ratio(OR)or risk ratio/relative risk(RR),whether data can be statistically combined between data,heterogeneity test is required,and I~2 test can be adopted.If the I~2 value is not greater than(less than or equal to)50%,heterogeneity is acceptable.If the I~2is more than 50%,it is unacceptable.The sources of heterogeneity can be found by sensitivity analysis.Finally,the data analysis was performed by using the Review Manager 5.3.Results:A total of 8 articles were included,3894 patients with anemia in the ICU were given restrictive transfusion and liberal transfusion.Meta-analysis showed that the mortality of restrictive transfusion was not statistically significant compared with the liberal transfusion(OR=1.00,95%CI:0.74-1.35,P=0.98,I~2=59%),and the heterogeneity was large.The sensitivity analysis was used to find the sources of heterogeneity.Heterogeneity is mainly derived from the study of Almeida et al.The results of removing the study of Almeida et al were:OR=0.91,95%CI:0.69-1.19,P=0.50;I~2=46%<50%,heterogeneity is significantly smaller.The 30-day mortality was not statistically significant(OR=1.10,95%CI:0.64-1.91,P=0.73,I~2=64%).It was found that the heterogeneity was mainly from the study of Almeida et al.Removing the study,the results were:OR=0.81,95%CI:0.61-1.07,P=0.13;I~2=0%.The60-day mortality was not statistically significant(OR=1.08,95%CI:0.62-1.90,P=0.78).Heterogeneity was greater,and sensitivity analysis was performed to find the sources of heterogeneity.The infection rate was not statistically significant(OR=0.96,95%CI:0.73-1.27,P=0.79);and ventilator-assisted ventilation was not statistically significant(OR=1.14,95%CI:0.92-1.42,P=0.24).Renal replacement therapy was not statistically significant(OR=0.96,95%CI:0.65-1.43,P=0.86);and the incidence of adverse events was statistically significant(OR=0.35,95%CI:0.19-0.64,P=0.0008);the incidence of cardiovascular events was not statistically significant(OR=0.96,95%CI:0.68-1.34,P=0.81,I~2=59%),Heterogeneity is mainly derived from the study of Almeida et al.After eliminating the study,the results were:OR=0.85,95%CI:0.64-1.14,P=0.29;I~2=46%<50%.Conclusion:Compared with liberal blood transfusion,restrictive transfusion does not increase the mortality and infection rate of anemia patients in the ICU,and does not increase the risk of ventilator-assisted ventilation,renal replacement therapy,cardiovascular events. |
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