Natasha Dejigov Monteiro da Silva, Youko Nukui, Juliana Takahashi, Diná de Almeida Lopes Monteiro da Cruz, Lilia de Souza Nogueira
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This study aimed to synthesize the best available evidence on the effectiveness of pre-storage filters compared with post-storage filters for transfusion reactions, for the occurrence of infections, for the length of hospital stay, and for the death of patients undergoing leukoreduced transfusion.</p><p><strong>Methods: </strong>We searched the MEDLINE (PubMed), CINAHL (EBSCO), PsycINFO (APA), Scopus (Elsevier), The Cochrane Library (J. Wiley), Web of Science Core Collection (Clarivate Analytics), Embase (Elsevier), and LILACS (VHL) databases and gray literature for eligible studies in August 2020 and updated the search in October 2023. The Joanna Briggs Institute critical assessment tools were applied to analyze the quality appraisal of the studies. GRADE was used to determine the certainty of the evidence.</p><p><strong>Results: </strong>The meta-analysis showed that pre-storage filtration was a protective factor for the occurrence of febrile non-hemolytic transfusion reaction in red blood cells (RR 0.49, 95% CI 0.41-0.59) and platelet concentrate transfusions (RR 0.16, 95% CI 0.12-0.22). The same did not occur for post-surgical infection after platelet concentrate transfusions (RR 0.82, 95% CI 0.65-1.04). Only one study analyzed the length of hospital stay and showed no significant difference between patients who received leukoreduced transfusions according to the type of filter used. According to the GRADE criteria, the certainty of the evidence for febrile non-hemolytic transfusion reactions was low for red blood cells and very low for platelet concentrate due to the high risk of bias. 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引用次数: 0
摘要
背景：减少白细胞已被用于限制不良事件的风险。最常用的方法是过滤（储存前或储存后）。然而，储存前过滤是否优于储存后过滤需要明确界定，特别是对于仍在使用储存后过滤的国家。本研究旨在综合现有的最佳证据，说明与储存后过滤相比，储存前过滤对输血反应、感染发生、住院时间以及白细胞减少性输血患者死亡的有效性：我们于 2020 年 8 月在 MEDLINE（PubMed）、CINAHL（EBSCO）、PsycINFO（APA）、Scopus（Elsevier）、The Cochrane Library（J. Wiley）、Web of Science Core Collection（Clarivate Analytics）、Embase（Elsevier）和 LILACS（VHL）数据库及灰色文献中检索了符合条件的研究，并于 2023 年 10 月更新了检索结果。乔安娜-布里格斯研究所（Joanna Briggs Institute）的关键评估工具用于分析研究的质量评估。GRADE用于确定证据的确定性：荟萃分析表明，储存前过滤是红细胞（RR 0.49，95% CI 0.41-0.59）和血小板浓缩物（RR 0.16，95% CI 0.12-0.22）发生发热性非溶血性输血反应的保护因素。而输注血小板浓缩液后的术后感染（RR 0.82，95% CI 0.65-1.04）则没有发生同样的情况。只有一项研究对住院时间进行了分析，结果显示，根据所用过滤器的类型，接受白细胞减少输血的患者之间没有明显差异。根据 GRADE 标准，由于偏倚风险较高，红细胞和血小板浓缩物非溶血性发热输血反应的证据确定性较低。由于不精确，感染的证据确定性较低：本次综述的结果表明，推荐最佳过滤类型（储存前或储存后）以使分析结果获益的确定性仍然很脆弱；因此，需要更可靠的证据：系统综述注册：PREMCORD42020192202。
Effect of post-storage filters vs. pre-storage filters for leukoreduction of blood components on clinical outcomes: a systematic review and meta-analysis.
Background: Leukoreduction has been used to limit the risk of adverse events. The most commonly used methodology is filtration (pre- or post-storage). However, whether pre-storage filtration is better than post-storage filtration needs to be clearly defined, particularly for countries that still use post-storage filtration. This study aimed to synthesize the best available evidence on the effectiveness of pre-storage filters compared with post-storage filters for transfusion reactions, for the occurrence of infections, for the length of hospital stay, and for the death of patients undergoing leukoreduced transfusion.
Methods: We searched the MEDLINE (PubMed), CINAHL (EBSCO), PsycINFO (APA), Scopus (Elsevier), The Cochrane Library (J. Wiley), Web of Science Core Collection (Clarivate Analytics), Embase (Elsevier), and LILACS (VHL) databases and gray literature for eligible studies in August 2020 and updated the search in October 2023. The Joanna Briggs Institute critical assessment tools were applied to analyze the quality appraisal of the studies. GRADE was used to determine the certainty of the evidence.
Results: The meta-analysis showed that pre-storage filtration was a protective factor for the occurrence of febrile non-hemolytic transfusion reaction in red blood cells (RR 0.49, 95% CI 0.41-0.59) and platelet concentrate transfusions (RR 0.16, 95% CI 0.12-0.22). The same did not occur for post-surgical infection after platelet concentrate transfusions (RR 0.82, 95% CI 0.65-1.04). Only one study analyzed the length of hospital stay and showed no significant difference between patients who received leukoreduced transfusions according to the type of filter used. According to the GRADE criteria, the certainty of the evidence for febrile non-hemolytic transfusion reactions was low for red blood cells and very low for platelet concentrate due to the high risk of bias. Infection was a low risk due to imprecision.
Conclusions: The results of this review showed that the certainty of recommending the best type of filter (pre- or post-storage) for the benefit of the outcomes analyzed is still fragile; therefore, more robust evidence is needed.
期刊介绍：
Systematic Reviews encompasses all aspects of the design, conduct and reporting of systematic reviews. The journal publishes high quality systematic review products including systematic review protocols, systematic reviews related to a very broad definition of health, rapid reviews, updates of already completed systematic reviews, and methods research related to the science of systematic reviews, such as decision modelling. At this time Systematic Reviews does not accept reviews of in vitro studies. The journal also aims to ensure that the results of all well-conducted systematic reviews are published, regardless of their outcome.
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