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JAMA. 2014 Apr 2;311(13):1317-26. doi: 10.1001/jama.2014.2726.

Health care-associated infection after red blood cell transfusion: a systematic review and meta-analysis.

Author information

1
University of Michigan, Division of General Medicine, Department of Internal Medicine, Ann Arbor.
2
Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York.
3
University of Michigan, Division of General Medicine, Department of Internal Medicine, Ann Arbor3VA Ann Arbor Medical Center/University of Michigan Patient Safety Enhancement Program, Ann Arbor4VA Ann Arbor Health Services Research and Development Center.
4
VA Ann Arbor Medical Center/University of Michigan Patient Safety Enhancement Program, Ann Arbor4VA Ann Arbor Health Services Research and Development Center of Excellence, Ann Arbor, Michigan.
5
University of Michigan, Division of General Medicine, Department of Internal Medicine, Ann Arbor3VA Ann Arbor Medical Center/University of Michigan Patient Safety Enhancement Program, Ann Arbor.
6
University of Michigan, Division of General Medicine, Department of Internal Medicine, Ann Arbor3VA Ann Arbor Medical Center/University of Michigan Patient Safety Enhancement Program, Ann Arbor5Institute for Healthcare Policy and Innovation, University of.

Erratum in

  • JAMA. 2014 Nov 19;312(19):2045.

Abstract

IMPORTANCE:

The association between red blood cell (RBC) transfusion strategies and health care-associated infection is not fully understood.

OBJECTIVE:

To evaluate whether RBC transfusion thresholds are associated with the risk of infection and whether risk is independent of leukocyte reduction.

DATA SOURCES:

MEDLINE, EMBASE, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, Cochrane Database of Sytematic Reviews, ClinicalTrials.gov, International Clinical Trials Registry, and the International Standard Randomized Controlled Trial Number register were searched through January 22, 2014.

STUDY SELECTION:

Randomized clinical trials with restrictive vs liberal RBC transfusion strategies.

DATA EXTRACTION AND SYNTHESIS:

Twenty-one randomized trials with 8735 patients met eligibility criteria, of which 18 trials (n = 7593 patients) contained sufficient information for meta-analyses. DerSimonian and Laird random-effects models were used to report pooled risk ratios. Absolute risks of infection were calculated using the profile likelihood random-effects method.

MAIN OUTCOMES AND MEASURES:

Incidence of health care-associated infection such as pneumonia, mediastinitis, wound infection, and sepsis.

RESULTS:

The pooled risk of all serious infections was 11.8% (95% CI, 7.0%-16.7%) in the restrictive group and 16.9% (95% CI, 8.9%-25.4%) in the liberal group. The risk ratio (RR) for the association between transfusion strategies and serious infection was 0.82 (95% CI, 0.72-0.95) with little heterogeneity (I2 = 0%; τ2 <.0001). The number needed to treat (NNT) with restrictive strategies to prevent serious infection was 38 (95% CI, 24-122). The risk of infection remained reduced with a restrictive strategy, even with leukocyte reduction (RR, 0.80 [95% CI, 0.67-0.95]). For trials with a restrictive hemoglobin threshold of <7.0 g/dL, the RR was 0.82 (95% CI, 0.70-0.97) with NNT of 20 (95% CI, 12-133). With stratification by patient type, the RR was 0.70 (95% CI, 0.54-0.91) in patients undergoing orthopedic surgery and 0.51 (95% CI, 0.28-0.95) in patients presenting with sepsis. There were no significant differences in the incidence of infection by RBC threshold for patients with cardiac disease, the critically ill, those with acute upper gastrointestinal bleeding, or for infants with low birth weight.

CONCLUSIONS AND RELEVANCE:

Among hospitalized patients, a restrictive RBC transfusion strategy was associated with a reduced risk of health care-associated infection compared with a liberal transfusion strategy. Implementing restrictive strategies may have the potential to lower the incidence of health care-associated infection.

PMID:
24691607
PMCID:
PMC4289152
DOI:
10.1001/jama.2014.2726
[Indexed for MEDLINE]
Free PMC Article

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