The effect of plasma transfusion on morbidity and mortality: A systematic review and meta-analysis

Mohammad H Murad, James R. Stubbs, Manish J. Gandhi, Amy T. Wang, Anu Paul, Patricia J. Erwin, Victor Manuel Montori, John D. Roback

Research output: Contribution to journalArticle

174 Citations (Scopus)

Abstract

BACKGROUND: Plasma transfusion is increasingly performed without clear consensus on indications. We systematically reviewed the literature to summarize the available evidence regarding the benefits and harms of plasma transfusion in common clinical settings. STUDY DESIGN AND METHODS: We searched electronic databases from inception through August 2009. Eligible studies enrolled adult patients transfused with plasma and compared to a control group. Paired reviewers independently assessed studies for eligibility and extracted quality and outcome data. RESULTS: Thirty-seven studies met eligibility criteria, most of which were observational. In patients undergoing massive transfusion, plasma infusion at high plasma : red blood cell ratios was associated with a significant reduction in the risk of death (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.24-0.60) and multiorgan failure (OR, 0.40; 95% CI, 0.26-0.60). However, the quality of this evidence was very low due to significant unexplained heterogeneity and several other biases. In a single retrospective study, plasma transfusion was associated with reduced mortality in anticoagulated patients with intracranial hemorrhage (OR, 0.29; 95% CI, 0.09-0.98). In patients undergoing surgery without massive transfusion, plasma infusion was associated with a trend toward increased mortality (OR, 1.22; 95% CI, 0.73-2.03). Plasma transfusion was associated with increased risk of developing acute lung injury (OR, 2.92; 95% CI, 1.99-4.29). CONCLUSIONS: Very-low-quality evidence suggests that plasma infusion in the setting of massive transfusion for trauma patients may be associated with a reduction in the risk of death and multiorgan failure. A survival benefit was not demonstrated in most other transfusion populations.

Original languageEnglish (US)
Pages (from-to)1370-1383
Number of pages14
JournalTransfusion
Volume50
Issue number6
DOIs
StatePublished - Jun 2010

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Meta-Analysis
Morbidity
Mortality
Odds Ratio
Confidence Intervals
Risk Reduction Behavior
Intracranial Hemorrhages
Acute Lung Injury
Consensus
Retrospective Studies
Erythrocytes
Databases
Control Groups
Survival
Wounds and Injuries
Population

ASJC Scopus subject areas

  • Hematology
  • Immunology
  • Immunology and Allergy

Cite this

Murad, M. H., Stubbs, J. R., Gandhi, M. J., Wang, A. T., Paul, A., Erwin, P. J., ... Roback, J. D. (2010). The effect of plasma transfusion on morbidity and mortality: A systematic review and meta-analysis. Transfusion, 50(6), 1370-1383. https://doi.org/10.1111/j.1537-2995.2010.02630.x

The effect of plasma transfusion on morbidity and mortality : A systematic review and meta-analysis. / Murad, Mohammad H; Stubbs, James R.; Gandhi, Manish J.; Wang, Amy T.; Paul, Anu; Erwin, Patricia J.; Montori, Victor Manuel; Roback, John D.

In: Transfusion, Vol. 50, No. 6, 06.2010, p. 1370-1383.

Research output: Contribution to journalArticle

Murad, Mohammad H ; Stubbs, James R. ; Gandhi, Manish J. ; Wang, Amy T. ; Paul, Anu ; Erwin, Patricia J. ; Montori, Victor Manuel ; Roback, John D. / The effect of plasma transfusion on morbidity and mortality : A systematic review and meta-analysis. In: Transfusion. 2010 ; Vol. 50, No. 6. pp. 1370-1383.
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abstract = "BACKGROUND: Plasma transfusion is increasingly performed without clear consensus on indications. We systematically reviewed the literature to summarize the available evidence regarding the benefits and harms of plasma transfusion in common clinical settings. STUDY DESIGN AND METHODS: We searched electronic databases from inception through August 2009. Eligible studies enrolled adult patients transfused with plasma and compared to a control group. Paired reviewers independently assessed studies for eligibility and extracted quality and outcome data. RESULTS: Thirty-seven studies met eligibility criteria, most of which were observational. In patients undergoing massive transfusion, plasma infusion at high plasma : red blood cell ratios was associated with a significant reduction in the risk of death (odds ratio [OR], 0.38; 95{\%} confidence interval [CI], 0.24-0.60) and multiorgan failure (OR, 0.40; 95{\%} CI, 0.26-0.60). However, the quality of this evidence was very low due to significant unexplained heterogeneity and several other biases. In a single retrospective study, plasma transfusion was associated with reduced mortality in anticoagulated patients with intracranial hemorrhage (OR, 0.29; 95{\%} CI, 0.09-0.98). In patients undergoing surgery without massive transfusion, plasma infusion was associated with a trend toward increased mortality (OR, 1.22; 95{\%} CI, 0.73-2.03). Plasma transfusion was associated with increased risk of developing acute lung injury (OR, 2.92; 95{\%} CI, 1.99-4.29). CONCLUSIONS: Very-low-quality evidence suggests that plasma infusion in the setting of massive transfusion for trauma patients may be associated with a reduction in the risk of death and multiorgan failure. A survival benefit was not demonstrated in most other transfusion populations.",
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AU - Stubbs, James R.

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AU - Wang, Amy T.

AU - Paul, Anu

AU - Erwin, Patricia J.

AU - Montori, Victor Manuel

AU - Roback, John D.

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N2 - BACKGROUND: Plasma transfusion is increasingly performed without clear consensus on indications. We systematically reviewed the literature to summarize the available evidence regarding the benefits and harms of plasma transfusion in common clinical settings. STUDY DESIGN AND METHODS: We searched electronic databases from inception through August 2009. Eligible studies enrolled adult patients transfused with plasma and compared to a control group. Paired reviewers independently assessed studies for eligibility and extracted quality and outcome data. RESULTS: Thirty-seven studies met eligibility criteria, most of which were observational. In patients undergoing massive transfusion, plasma infusion at high plasma : red blood cell ratios was associated with a significant reduction in the risk of death (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.24-0.60) and multiorgan failure (OR, 0.40; 95% CI, 0.26-0.60). However, the quality of this evidence was very low due to significant unexplained heterogeneity and several other biases. In a single retrospective study, plasma transfusion was associated with reduced mortality in anticoagulated patients with intracranial hemorrhage (OR, 0.29; 95% CI, 0.09-0.98). In patients undergoing surgery without massive transfusion, plasma infusion was associated with a trend toward increased mortality (OR, 1.22; 95% CI, 0.73-2.03). Plasma transfusion was associated with increased risk of developing acute lung injury (OR, 2.92; 95% CI, 1.99-4.29). CONCLUSIONS: Very-low-quality evidence suggests that plasma infusion in the setting of massive transfusion for trauma patients may be associated with a reduction in the risk of death and multiorgan failure. A survival benefit was not demonstrated in most other transfusion populations.

AB - BACKGROUND: Plasma transfusion is increasingly performed without clear consensus on indications. We systematically reviewed the literature to summarize the available evidence regarding the benefits and harms of plasma transfusion in common clinical settings. STUDY DESIGN AND METHODS: We searched electronic databases from inception through August 2009. Eligible studies enrolled adult patients transfused with plasma and compared to a control group. Paired reviewers independently assessed studies for eligibility and extracted quality and outcome data. RESULTS: Thirty-seven studies met eligibility criteria, most of which were observational. In patients undergoing massive transfusion, plasma infusion at high plasma : red blood cell ratios was associated with a significant reduction in the risk of death (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.24-0.60) and multiorgan failure (OR, 0.40; 95% CI, 0.26-0.60). However, the quality of this evidence was very low due to significant unexplained heterogeneity and several other biases. In a single retrospective study, plasma transfusion was associated with reduced mortality in anticoagulated patients with intracranial hemorrhage (OR, 0.29; 95% CI, 0.09-0.98). In patients undergoing surgery without massive transfusion, plasma infusion was associated with a trend toward increased mortality (OR, 1.22; 95% CI, 0.73-2.03). Plasma transfusion was associated with increased risk of developing acute lung injury (OR, 2.92; 95% CI, 1.99-4.29). CONCLUSIONS: Very-low-quality evidence suggests that plasma infusion in the setting of massive transfusion for trauma patients may be associated with a reduction in the risk of death and multiorgan failure. A survival benefit was not demonstrated in most other transfusion populations.

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