Neuroanesthesia & neurocritical care
Liberal transfusion strategies reduce sepsis risk and improve neurological recovery in acute brain injury: an updated systematic review and meta-analysis
Authors' conclusion
LTS demonstrates the potential to enhance safety and functional recovery in ABI patients by mitigating sepsis risk and promoting favorable neurologic outcomes.
Study context
- Population
- Neurocritical care patients with acute brain injury (SAH, TBI or intracerebral hemorrhage)
- Participants
- 2,399 patients · 5 randomized controlled trials (RCTs)
- Comparison
- Liberal vs restrictive transfusion strategy
- Liberal Transfusion Strategy (LTS)n = 1,191
- Restrictive transfusion strategies (RTS)n = 1,208reference
Further pooled results
| Outcome | RR (95% CI) | P value | |
|---|---|---|---|
| Sepsis or septic shock | 1.42 (1.08–1.86) | P = 0.01 | |
| Unfavorable functional outcomes · six months | 1.13 (1.06–1.21) | P = 0.0003 | |
| 0.512Relative risk (log scale) |
- Sepsis or septic shock: I2 < 25%
- Unfavorable functional outcomes: I2 < 25%
ICU mortality
- No significant difference in ICU mortality
- RR 1.00; 95% CI 0.84-1.20; p = 0.96
In-hospital mortality
- No significant difference in in-hospital mortality
- RR 0.98; 95% CI 0.76-1.26; p = 0.89
Safety
Venous thromboembolism (VTE)
- No significant difference in VTE
- RR: 0.88; 95% CI 0.56-1.38; p = 0.58
Acute respiratory distress syndrome (ARDS)
- No significant difference in ARDS
- RR 1.05; 95% CI 0.69-1.61; p = 0.81
Original publication
Liberal transfusion strategies reduce sepsis risk and improve neurological recovery in acute brain injury: an updated systematic review and meta-analysis. Crit Care. Published 6 May 2025. doi:10.
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