title: Impact of transfusion on patients with sepsis admitted in intensive care unit: a systematic review and meta-analysis.
abstract: Red blood cell transfusion (RBCT) threshold in patients with sepsis remains a matter of controversy. A threshold of 7 g/dL for stabilized patients with sepsis is commonly proposed, although debated. The aim of the study was to compare the benefit and harm of restrictive versus liberal RBCT strategies in order to guide physicians on RBCT strategies in patients with severe sepsis or septic shock. Four outcomes were assessed: death, nosocomial infection (NI), acute lung injury (ALI) and acute kidney injury (AKI). Studies assessing RBCT strategies or RBCT impact on outcome and including intensive care unit (ICU) patients with sepsis were assessed. Two systematic reviews were achieved: first for the randomized controlled studies (RCTs) and second for the observational studies. MEDLINE, EMBASE, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Clinical Trials.gov were analyzed up to March 01, 2015. Der Simonian and Laird random-effects models were used to report pooled odds ratios (ORs). Subgroup analyses and meta-regressions were performed to explore studies heterogeneity. One RCT was finally included. The restrictive RBCT strategy was not associated with harm or benefit compared to liberal strategy. Twelve cohort studies were included, of which nine focused on mortality rate. RBCT was not associated with increased mortality rate (overall pooled OR was 1.10 [0.75, 1.60]; I2= 57%, p = 0.03), but was associated with the occurrence of NI (2 studies: pooled OR 1.25 [1.04-1.50]; I2= 0%, p = 0.97), the occurrence of ALI (1 study: OR 2.75 [1.22-6.37]; p = 0.016) and the occurrence of AKI (1 study: OR 5.22 [2.1-15.8]; p = 0.001). Because there was only one RCT, the final meta-analyses were only based on the cohort studies. As a result, the safety of a RBCT restrictive strategy was confirmed, although only one study specifically focused on ICU patients with sepsis. Then, RBCT was not associated with increased mortality rate, but was associated with increased in occurrence of NI, ALI and AKI. Nevertheless, the data on RBCT in patients with sepsis are sparse and the high heterogeneity between studies prevents from drawing any definitive conclusions.
authors.affiliation: UMR 1137 - IAME Team 5 - DeSCID: Decision Sciences in Infectious Diseases, Control and Care Inserm/Univ Paris Diderot, Sorbonne Paris Cité, 75018, Paris, France.|Medical and Infectious Intensive Care Unit, AP-HP, Hôpital Bichat Claude Bernard, Paris Diderot University, 75018, Paris, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Dupuis
authors.affiliation: Medical and Infectious Intensive Care Unit, AP-HP, Hôpital Bichat Claude Bernard, Paris Diderot University, 75018, Paris, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Sonneville
authors.affiliation: Medical-Surgical ICU, Delafontaine Hospital, 2 rue du docteur Delafontaine, BP 279, 93 205, Saint-Denis, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Adrie
authors.affiliation: Medical-Surgical ICU, Versailles Hospital, 177 Rue de Versailles, 78150, Le Chesnay, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Gros
authors.affiliation: Medical ICU, Saint-Etienne University Hospital, Avenue Albert Raymond, 42270, Saint-Priest-en-Jarez, France.
authors.forename: Michael
authors.initials: M
authors.lastname: Darmon
authors.affiliation: UMR 1137 - IAME Team 5 - DeSCID: Decision Sciences in Infectious Diseases, Control and Care Inserm/Univ Paris Diderot, Sorbonne Paris Cité, 75018, Paris, France.|Medical and Infectious Intensive Care Unit, AP-HP, Hôpital Bichat Claude Bernard, Paris Diderot University, 75018, Paris, France.
authors.forename: Lila
authors.initials: L
authors.lastname: Bouadma
authors.affiliation: UMR 1137 - IAME Team 5 - DeSCID: Decision Sciences in Infectious Diseases, Control and Care Inserm/Univ Paris Diderot, Sorbonne Paris Cité, 75018, Paris, France. jean-francois.timsit@aphp.fr.|Medical and Infectious Intensive Care Unit, AP-HP, Hôpital Bichat Claude Bernard, Paris Diderot University, 75018, Paris, France. jean-francois.timsit@aphp.fr.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit