Table 2.
Red blood cell (RBC) transfusions and outcomes in cardiac patients: observational studies a
| |
Health problem |
Patients |
Risk
c
|
|
|---|---|---|---|---|
| Outcome, first author, year b | (n) | (95% CI) | P- value | |
| Outcome: mortality in adults |
|
|
|
|
| Mortality, Alexander, 2008 [35] |
ACS |
44,242 |
OR: 3.2 (2.9 to 3.6) |
|
| |
ACS and Hct ≤ 24% |
|
aOR: 0.68 (0.45 to 1.02) |
|
| |
ACS and Hct = 24 to 27% |
|
aOR: 1.01 (0.79 to 1.30) |
|
| |
ACS and Hct = 27 to 30% |
|
aOR: 1.18 (0.92 to 1.50) |
|
| |
ACS and Hct > 30% |
|
aOR: 3.47 (2.30 to 5.23) |
|
| Mortality, Aronson, 2008 [36] |
AMI |
2,358 |
aHR: 0.13 (0.03 to 0.65)d,e |
0.013 |
| |
|
|
aHR: 2.2 (1.5 to 3.3)d,f |
< 0.0001 |
| Mortality, Jani, 2007 [37] |
AMI |
4,623 |
aOR: 2.02 (1.47 to 2.79) |
< 0.0001 |
| |
|
|
RR: 4.83 (3.81 to 6.12)d |
|
| Mortality, Jolicœur, 2009 [38] |
AMI |
5,188 |
RR: 6.38 (4.88 to 8.34) |
|
| |
|
5,532 |
aHR: 2.16 (1.20 to 3.88) |
< 0.0001 |
| |
|
5,188 |
RR: 6.38 (4.88 to 8.34)d |
|
| Mortality, Koch, 2006 [39] |
CABG |
5,814 |
OR: 1.77 (1.67 to 1.87) |
< 0.0001 |
| Mortality, Murphy, 2007 [40] |
Cardiac surgery (UK) |
8,518 |
HR: 6.69 (3.66 to 15.1) |
< 0.05 |
| Mortality, Nikolsky, 2009 [41] |
AMI |
2,060 |
HR: 4.71 (1.97 to 11.36) |
|
| |
|
|
RR: 2.92 (1.62 to 5.24)d |
|
| Mortality, Pattakos, 2012 [42] |
Cardiac surgery |
644 |
95% versus 89% |
0.007 |
| Mortality, Rao, 2004 [43] |
ACS |
24,112 |
aHR: 3.94 (3.26 to 4.75) |
< 0.05 |
| |
|
|
RR: 2.60 (2.22 to 3.03)d |
< 0.05 |
| Mortality, Shehata, 2012 [19] |
CABG |
2,102 |
OR: 0.44 (0.32 to 14.1) |
NS |
| Mortality, Shishehbor, 2009 [44] |
AMI |
3,575 |
aHR: 3.89 (2.66 to 5.68) |
< 0.001 |
| |
|
|
RR: 1.30 (0.90 to 1.88)d |
< 0.001 |
| Mortality, Singla, 2007 [45] |
AMI |
370 |
RR: 2.36 (1.49 to 3.76)d |
|
| Mortality, Wu, 2001, [46] |
AMI |
78,974 |
RR: 2.51 (2.42 to 2.61)d,g |
< 0.05 |
| Mortality, Yang, 2005 [47] |
AMI |
85,111 |
aOR: 1.67 (1.48 to 1.88) |
< 0.05 |
| |
|
|
RR: 3.03 (2.85 to 3.21)d |
< 0.05 |
| Outcomes: myocardial infarction or ischemic eventsh in adults |
|
|
|
|
| AMI, Jani, 2007 [37] |
AMI |
4,623 |
RR: 1.19 (0.82 to 1.74)d |
|
| AMI, Jolicœur, 2009 [38] |
AMI |
5,188 |
RR: 3.05 (1.85 to 5.04)d |
|
| IEh, Murphy, 2007 [40] |
Cardiac surgery (UK) |
8,518 |
aOR: 3.35 (2.68 to 4.35)c |
< 0.05 |
| AMI, Nikolsky, 2009 [41] |
AMI |
2,060 |
RR: 3.28 (1.44 to 7.49)d |
|
| AMI, Pattakos, 2012 [42] |
Cardiac surgery |
644 |
2.8% versus 0.31% |
< 0.01 |
| AMI + death, Rao, 2004 [43] |
ACS |
2,401 |
HR: 3.08 (2.84 to 3.35)d |
< 0.05 |
| AMI, Shishehbor, 2009 [44] |
ACS |
3,575 |
aHR : 3.44 |
< 0.001 |
| AMI + death, Singla, 2007 [45] |
AMI |
370 |
aOR: 2.57 (1.41 to 4.69) |
< 0.001 |
| |
|
|
RR: 2.10 (0.83 to 5.30)d |
|
| AMI, Yang, 2005 [47] |
AMI |
85,111 |
aOR: 0.95 (0.83 to 1.09)d |
< 0.05 |
|
Outcomes in children |
Health problem |
Children |
Risk
c
|
P
-value |
| LMV (days), 2011 [48] |
Cardiac surgery |
270 |
HR: 0.71 (0.54 to 0.92) |
0.009 |
| LMV (days), 2013 [49] |
Cardiac surgery |
335 |
HR: 2.6 (2.0 to 3.4) |
< 0.001 |
| PICU LOS (days), 2013 [49] |
Cardiac surgery |
335 |
LOS: 8 ± 0.9 versus 3.5 ± 2 |
< 0.001 |
| Hospital LOS, 2011 [24] |
Cardiac surgery |
802 |
aHR: 0.65 (0.49 to 0.87) |
< 0.001 |
| Wound infection, 2010 [50] | Cardiac surgery | 216 | aOR: 7.87 (1.63 to 37.92) | < 0.001 |
ACS: acute coronary syndrome; aHR: adjusted HR; AMI: acute myocardial infarction; aOR: adjusted OR; CABG: coronary artery bypass graft; card surg: cardiac surgery; CI: confidence interval; Hct: hematocrit; HR: hazard ratio; IE: ischemic events; LMV: length of MV; LOS: length of stay; MI: myocardial infarction; MV: mechanical ventilation; OR: odds ratio; PICU: pediatric intensive care unit; RBC: red blood cell; NS: not significant; RCT: randomized controlled trial; UK: United Kingdom.
aStudies on the relationship between the length of storage of RBC units and outcomes of transfused cardiac patients are excluded from this table.
bYear of publication.
cTransfused patients versus no RBC transfusion or restricted RBC transfusion strategy.
dChatterjee et al. [51] completed a systematic review that included the studies marked byd in this table, plus a small RCT conducted by Cooper et al. [52]. Overall, the risk ratio of death in transfused patients versus controls was 2.91 (95% confidence interval (CI): 2.46 to 3.44), but there was a very significant heterogeneity (I 2 = 92%).
ePre-transfusion hemoglobin concentration ≤ 80 g/L.
fPre-transfusion hemoglobin concentration > 80 g/L.
gThe study by Wu et al. [46] enrolled patients ≥ 65 years of age with AMI. RBC transfusion was associated with a reduction in 30-day mortality if hematocrit < 24% (aOR = 0.22; 95% CI: 0.11 to 0.45) or between 30% and 33% (aOR = 0.69; 95% CI: 0.53 to 0.89), but the risk of mortality was not increased in patients with a hematocrit > 33% who received RBC transfusion.
hIschemic events: myocardial infarction, stroke, renal impairment, or failure.