Advertisement
ADVANCED SEARCH

This Article Figures Only Full Text Full Text (PDF) Résumé Online Appendices All Versions of this Article: cmaj.071055v1 cmaj.071055v2 177/7/725    most recent Submit a response View responses Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Zarychanski, R. Articles by Fergusson, D. A. Search for Related Content PubMed PubMed Citation Articles by Zarychanski, R., MD Articles by Fergusson, D. A., MHA PhD Related Collections Français Related Articles

Erythropoietin-receptor agonists in critically ill patients: a meta-analysis of randomized controlled trials

From the Department of Epidemiology and Community Medicine (Zarychanski, McInytre, Fergusson), University of Ottawa; the Ottawa Health Research Institute (Zarychanski, McIntyre, Fergusson), The Ottawa Hospital, Ottawa, Ont.; and the Centre Hospitalier Affilié Universitaire de Québec Research Center, the Department of Anesthesia and the Division of Critical Care Medicine (Turgeon), Laval University, Québec City, Que.

Correspondence to: Dr. Ryan Zarychanski, Ottawa Health Research Institute, 501 Smyth Rd., Ottawa ON K1H 8L6; ryan{at}zarychanski.com

Introduction: Anemia and the need for red blood cell transfusions are common among patients admitted to intensive care units. Erythropoietin has been used to decrease the need for transfusions; however, its ability to improve clinical outcomes is unknown. We evaluated the effect of erythropoietin-receptor agonists on clinically important outcomes, including mortality, length of stay in hospital or intensive care unit, ventilator use, transfusion requirements and major adverse events.

Methods: To identify relevant studies, we searched electronic databases covering 1950 to 2007 (MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and the Scopus database). We also searched conference proceedings and grey literature sources. We selected all randomized controlled trials involving critically ill patients that compared an erythropoietin-receptor agonist with a placebo or no intervention. No language restrictions were considered. Data were extracted using a standardized extraction template. We used a fixed effects model to calculate all summary measures of treatment effects.

Results: Of 673 identified records, 9 studies that investigated erythropoietin alpha met the eligibility criteria and were included in our analysis. Erythropoietin, compared with placebo or no intervention, had no statistically significant effect on overall mortality (odds ratio [OR] 0.86, 95% confidence interval [CI] 0.71–1.05, I² = 0%). The treatment and control groups did not differ in the length of stay in hospital or intensive care unit, or in the duration of mechanical ventilation, in the 3 studies that reported these outcomes. Erythropoietin, compared with placebo, significantly reduced the odds of a patient receiving at least 1 transfusion (OR 0.73, 95% CI 0.64–0.84, I² = 54.7%). The mean number of units of blood transfused per patient was decreased by 0.41 units in the erythropoietin group (95% CI 0.10–0.74, I² = 79.2%). Most of the included studies were performed before the widespread adoption of a restrictive transfusion strategy. Only 1 study provided detailed reports of adverse events, and none of the studies systematically evaluated all patients for venous thromboembolism.

Interpretation: At this time, we do not recommend the routine use of erythropoietin-receptor agonists in critically ill patients. The reduction in red blood cell transfusions per patient was very small, and there is insufficient evidence to determine whether this intervention results in clinically important benefits with acceptable risks.

This article has been cited by other articles:

				R. Zarychanski MD and D. S. Houston MD PhD Anemia of chronic disease: A harmful disorder or an adaptive, beneficial response? Can. Med. Assoc. J., August 12, 2008; 179(4): 333 - 337. [Full Text] [PDF]

				K. M. Shermock, E. Horn, and T. L. Rice Erythropoietic agents for anemia of critical illness Am. J. Health Syst. Pharm., March 15, 2008; 65(6): 540 - 546. [Abstract] [Full Text] [PDF]

				A. T. Tinmouth MD MSc, L. A. McIntyre MD MSc, and R. A. Fowler MDCM MS Blood conservation strategies to reduce the need for red blood cell transfusion in critically ill patients Can. Med. Assoc. J., January 1, 2008; 178(1): 49 - 57. [Abstract] [Full Text] [PDF]

				C. S. McLachlan PhD MPH Corticosteroids and erythropoeitin-receptor agonists Can. Med. Assoc. J., January 1, 2008; 178(1): 66 - 66. [Full Text] [PDF]

				P. C. Hebert MD MHSc and M. Stanbrook MD PhD Indication creep: physician beware Can. Med. Assoc. J., September 25, 2007; 177(7): 697 - 697. [Full Text] [PDF]

				H. L. Corwin MD Erythropoietin use in critically ill patients: forest and trees Can. Med. Assoc. J., September 25, 2007; 177(7): 747 - 749. [Full Text] [PDF]

				P. C. Hebert MD MHSc and M. Stanbrook MD PhD L'expansion des indications : medecins, attention Can. Med. Assoc. J., September 25, 2007; 177(7): 699 - 699. [Full Text] [PDF]

eLetters:

HOME	CURRENT ISSUE	PAST ISSUES	COLLECTIONS	HELP	SEARCH
Copyright 1995-2007, Canadian Medical Association. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p) All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.