In this issue of JAMA, Rohde and colleagues report results of a meta-analysis evaluating the association between a liberal transfusion strategy vs a restrictive strategy and risk of hospital-acquired infections.1 In the meta-analysis, which included 18 randomized trials that compared these strategies among 7593 patients, the absolute rates of hospital-associated infection were 16.9% in the liberal transfusion group and 11.8% in the restrictive transfusion group. The number needed to treat with a restrictive transfusion strategy to prevent serious infection was about 38 patients. Results were consistent when analyses were repeated in trials with concealed randomization and infrequent protocol violations. A prior meta-analysis of liberal vs restrictive transfusion strategies and infection outcomes reported a nonstatistically significant reduction in infections.2 The current meta-analyses by Rohde et al includes several newly published trials. Most trials define a restrictive transfusion strategy as the administration of red blood cells (RBCs) once hemoglobin falls below either 7 or 8 g/dL, and most trials define a liberal strategy as the administration of RBCs once hemoglobin level falls below 10 g/dL.
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