{"title":"静脉补铁对降低心脏手术后输血风险的功效：随机对照试验的最新荟萃分析。","authors":"Kuo-Chuan Hung , Li-Chen Chang , Chun-Ning Ho , Chih-Wei Hsu , Chia-Hung Yu , Jheng-Yan Wu , Chien-Ming Lin , I-Wen Chen","doi":"10.1016/j.bja.2024.08.030","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Previous meta-analyses of intravenous iron supplementation for reducing red blood cell (RBC) transfusion risk after cardiac surgery were inconclusive because of limited data. This updated meta-analysis incorporates recent evidence.</div></div><div><h3>Methods</h3><div>Major databases were searched on May 2, 2024 for randomised controlled trials comparing the incidence of RBC transfusion between adult patients receiving <em>intravenous iron supplementation</em> and those receiving controls (i.e. oral iron or placebo) after cardiac surgery. The secondary outcomes included the number of RBC units transfused, postoperative haemoglobin levels, iron status, complications, and length of hospital stay. Trial sequential analysis was conducted to examine the robustness of evidence.</div></div><div><h3>Results</h3><div>Fourteen randomised controlled trials including 2043 subjects were identified. Intravenous iron supplementation was found to reduce the RBC transfusion risk compared with controls (relative risk 0.77, 95% confidence interval [CI] 0.65–0.91, <em>P</em>=0.002, <em>n</em>=1955, <em>I</em><sup>2</sup>=61%, certainty of evidence: moderate). The trial sequential analysis supported the robustness of the evidence. Furthermore, haemoglobin levels were higher in the intravenous iron supplementation group on postoperative days 4–10 (mean difference 0.17 g dl<sup>−1</sup>, 95% CI 0.06–0.29, <em>n</em>=1989) and >21 days (mean difference 0.66 g/dl<sup>−1</sup>, 95% CI 0.36–0.95, <em>n</em>=1008). Postoperative iron status also improved with Intravenous iron supplementation, particularly on postoperative days 4–10. There were no significant differences in other outcomes, including mortality.</div></div><div><h3>Conclusions</h3><div>Intravenous iron supplementation can reduce RBC transfusion risk and improve postoperative haemoglobin level and iron status after cardiac surgery, supporting the implementation of Intravenous iron supplementation in perioperative blood management strategies.</div></div><div><h3>Systematic review protocol</h3><div>CRD42024542206 (PROSPERO).</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 6","pages":"Pages 1137-1149"},"PeriodicalIF":9.1000,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Efficacy of intravenous iron supplementation in reducing transfusion risk following cardiac surgery: an updated meta-analysis of randomised controlled trials\",\"authors\":\"Kuo-Chuan Hung , Li-Chen Chang , Chun-Ning Ho , Chih-Wei Hsu , Chia-Hung Yu , Jheng-Yan Wu , Chien-Ming Lin , I-Wen Chen\",\"doi\":\"10.1016/j.bja.2024.08.030\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Previous meta-analyses of intravenous iron supplementation for reducing red blood cell (RBC) transfusion risk after cardiac surgery were inconclusive because of limited data. This updated meta-analysis incorporates recent evidence.</div></div><div><h3>Methods</h3><div>Major databases were searched on May 2, 2024 for randomised controlled trials comparing the incidence of RBC transfusion between adult patients receiving <em>intravenous iron supplementation</em> and those receiving controls (i.e. oral iron or placebo) after cardiac surgery. The secondary outcomes included the number of RBC units transfused, postoperative haemoglobin levels, iron status, complications, and length of hospital stay. Trial sequential analysis was conducted to examine the robustness of evidence.</div></div><div><h3>Results</h3><div>Fourteen randomised controlled trials including 2043 subjects were identified. Intravenous iron supplementation was found to reduce the RBC transfusion risk compared with controls (relative risk 0.77, 95% confidence interval [CI] 0.65–0.91, <em>P</em>=0.002, <em>n</em>=1955, <em>I</em><sup>2</sup>=61%, certainty of evidence: moderate). The trial sequential analysis supported the robustness of the evidence. Furthermore, haemoglobin levels were higher in the intravenous iron supplementation group on postoperative days 4–10 (mean difference 0.17 g dl<sup>−1</sup>, 95% CI 0.06–0.29, <em>n</em>=1989) and >21 days (mean difference 0.66 g/dl<sup>−1</sup>, 95% CI 0.36–0.95, <em>n</em>=1008). Postoperative iron status also improved with Intravenous iron supplementation, particularly on postoperative days 4–10. There were no significant differences in other outcomes, including mortality.</div></div><div><h3>Conclusions</h3><div>Intravenous iron supplementation can reduce RBC transfusion risk and improve postoperative haemoglobin level and iron status after cardiac surgery, supporting the implementation of Intravenous iron supplementation in perioperative blood management strategies.</div></div><div><h3>Systematic review protocol</h3><div>CRD42024542206 (PROSPERO).</div></div>\",\"PeriodicalId\":9250,\"journal\":{\"name\":\"British journal of anaesthesia\",\"volume\":\"133 6\",\"pages\":\"Pages 1137-1149\"},\"PeriodicalIF\":9.1000,\"publicationDate\":\"2024-09-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"British journal of anaesthesia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0007091224005476\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"British journal of anaesthesia","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0007091224005476","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景由于数据有限，以前关于静脉补铁以降低心脏手术后红细胞（RBC）输血风险的荟萃分析尚无定论。方法于 2024 年 5 月 2 日在各大数据库中搜索随机对照试验，比较心脏手术后接受静脉铁质补充剂的成年患者与接受对照组（即口服铁质或安慰剂）患者之间的红细胞输血发生率。次要结果包括输注的红细胞单位数、术后血红蛋白水平、铁状态、并发症和住院时间。结果确定了 14 项随机对照试验，包括 2043 名受试者。结果发现，与对照组相比，静脉补铁可降低红细胞输注风险（相对风险 0.77，95% 置信区间 [CI] 0.65-0.91，P=0.002，n=1955，I2=61%，证据确定性：中等）。试验序列分析支持证据的稳健性。此外，静脉补铁组在术后第 4-10 天（平均差异为 0.17 g dl-1，95% CI 0.06-0.29，n=1989）和 >21 天（平均差异为 0.66 g/dl-1，95% CI 0.36-0.95，n=1008）的血红蛋白水平更高。通过静脉补充铁剂，术后铁质状况也有所改善，尤其是在术后第 4-10 天。结论静脉补铁可降低心脏手术后输注红细胞的风险，改善术后血红蛋白水平和铁状况，支持在围手术期血液管理策略中实施静脉补铁。
Efficacy of intravenous iron supplementation in reducing transfusion risk following cardiac surgery: an updated meta-analysis of randomised controlled trials
Background
Previous meta-analyses of intravenous iron supplementation for reducing red blood cell (RBC) transfusion risk after cardiac surgery were inconclusive because of limited data. This updated meta-analysis incorporates recent evidence.
Methods
Major databases were searched on May 2, 2024 for randomised controlled trials comparing the incidence of RBC transfusion between adult patients receiving intravenous iron supplementation and those receiving controls (i.e. oral iron or placebo) after cardiac surgery. The secondary outcomes included the number of RBC units transfused, postoperative haemoglobin levels, iron status, complications, and length of hospital stay. Trial sequential analysis was conducted to examine the robustness of evidence.
Results
Fourteen randomised controlled trials including 2043 subjects were identified. Intravenous iron supplementation was found to reduce the RBC transfusion risk compared with controls (relative risk 0.77, 95% confidence interval [CI] 0.65–0.91, P=0.002, n=1955, I2=61%, certainty of evidence: moderate). The trial sequential analysis supported the robustness of the evidence. Furthermore, haemoglobin levels were higher in the intravenous iron supplementation group on postoperative days 4–10 (mean difference 0.17 g dl−1, 95% CI 0.06–0.29, n=1989) and >21 days (mean difference 0.66 g/dl−1, 95% CI 0.36–0.95, n=1008). Postoperative iron status also improved with Intravenous iron supplementation, particularly on postoperative days 4–10. There were no significant differences in other outcomes, including mortality.
Conclusions
Intravenous iron supplementation can reduce RBC transfusion risk and improve postoperative haemoglobin level and iron status after cardiac surgery, supporting the implementation of Intravenous iron supplementation in perioperative blood management strategies.
期刊介绍：
The British Journal of Anaesthesia (BJA) is a prestigious publication that covers a wide range of topics in anaesthesia, critical care medicine, pain medicine, and perioperative medicine. It aims to disseminate high-impact original research, spanning fundamental, translational, and clinical sciences, as well as clinical practice, technology, education, and training. Additionally, the journal features review articles, notable case reports, correspondence, and special articles that appeal to a broader audience.
The BJA is proudly associated with The Royal College of Anaesthetists, The College of Anaesthesiologists of Ireland, and The Hong Kong College of Anaesthesiologists. This partnership provides members of these esteemed institutions with access to not only the BJA but also its sister publication, BJA Education. It is essential to note that both journals maintain their editorial independence.
Overall, the BJA offers a diverse and comprehensive platform for anaesthetists, critical care physicians, pain specialists, and perioperative medicine practitioners to contribute and stay updated with the latest advancements in their respective fields.
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