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Publications

Journal Article Systematic Review Meta-Analysis Epublish

PubMed: 40329392 DOI: 10.1186/s13054-025-05397-5

Liberal transfusion strategies reduce sepsis risk and improve neurological recovery in acute brain injury: an updated systematic review and meta-analysis.

Crit Care 29(1):181

Authors: Nhan Nguyen, Vinh Quang Tri Ho, David Downes, Bao Nghi Tran, Vy Ngoc Dan Nguyen, Emmanuel Mark M Velasco

Affiliations

  • Faculty of Medicine, University of Debrecen, 1 Egyetem ter, Debrecen, 4032, Hungary.
  • Faculty of Medicine, University of Debrecen, 1 Egyetem ter, Debrecen, 4032, Hungary.
  • Department of Rural Medicine, The University of New England, Armidale, Australia.
  • Faculty of Medicine, Dentistry and Health Sciences, Department of Nursing, The University of Melbourne, Melbourne, Australia.
  • Department of Anesthesiology and Pain Medicine, Toronto General Hospital, Toronto, Canada.

Abstract

PURPOSE

To advocate for a Liberal Transfusion Strategy (LTS) in neurocritical care patients with Acute Brain Injury (ABI) and provide updated evidence for optimizing transfusion thresholds in clinical guidelines.

BACKGROUND

Anemia frequently complicates ABI management, often necessitating red blood cell transfusions. However, the optimal hemoglobin (Hb) threshold for transfusion remains controversial. While earlier meta-analyses indicated no significant differences between LTS and restrictive transfusion strategies (RTS), emerging randomized controlled trials (RCTs) emphasize the need for reappraisal within neurocritical care.

METHODS

This meta-analysis included five RCTs involving 2399 patients (1,191 LTS; 1208 RTS) with ABI (subarachnoid hemorrhage, traumatic brain injury, or intracerebral hemorrhage). LTS was defined as transfusion at Hb ≤ 10-9 g/dL, and RTS as transfusion at Hb ≤ 7-8 g/dL. Outcomes assessed included sepsis or septic shock, ICU mortality, unfavorable functional outcomes at six months, venous thromboembolism (VTE), acute respiratory distress syndrome (ARDS), and in-hospital mortality.

RESULTS

RTS significantly increased the risk of sepsis or septic shock (relative risk [RR]: 1.42; 95% confidence interval [CI] 1.08-1.86; p = 0.01) and unfavorable functional outcomes at six months (RR 1.13; 95% CI 1.06-1.21; p = 0.0003). No significant differences were observed in ICU mortality (RR 1.00; 95% CI 0.84-1.20; p = 0.96), VTE (RR: 0.88; 95% CI 0.56-1.38; p = 0.58), ARDS (RR 1.05; 95% CI 0.69-1.61; p = 0.81), or in-hospital mortality (RR 0.98; 95% CI 0.76-1.26; p = 0.89). Heterogeneity was minimal (I < 25%).

CONCLUSION

LTS demonstrates the potential to enhance safety and functional recovery in ABI patients by mitigating sepsis risk and promoting favorable neurologic outcomes. Further high-powered RCTs are warranted to validate these findings and refine transfusion protocols.

MeSH

Brain Injuries, Mortality, Hemorrhage, Shock, Septic, Brain, Hospital Mortality, Recycling, Sepsis