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Table 2 Red blood cell (RBC) transfusions and outcomes in cardiac patients: observational studies a

From: Anemia and red blood cell transfusion in critically ill cardiac patients

  Health problem Patients Riskc  
Outcome, first author, yearb   (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
  1. 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.
  2. aStudies on the relationship between the length of storage of RBC units and outcomes of transfused cardiac patients are excluded from this table.
  3. bYear of publication.
  4. cTransfused patients versus no RBC transfusion or restricted RBC transfusion strategy.
  5. 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 (I2 = 92%).
  6. ePre-transfusion hemoglobin concentration ≤ 80 g/L.
  7. fPre-transfusion hemoglobin concentration > 80 g/L.
  8. 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.
  9. hIschemic events: myocardial infarction, stroke, renal impairment, or failure.