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Risk of Infection Associated With Administration of Intravenous Iron: A Systematic Review and Meta-analysis.
Akshay A Shah1,2,3, Killian Donovan3, Claire Seeley4
1Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom.
JAMA Network Open
|November 12, 2021
Summary
Intravenous iron increases infection risk compared to oral iron or no iron, despite its effectiveness in treating anemia. Further research is needed to balance risks and benefits.
Area of Science:
- Hematology
- Clinical Pharmacology
- Infectious Diseases
Background:
- Intravenous iron is widely recommended for anemia treatment based on efficacy.
- The safety profile, particularly regarding infection risk, remains uncertain.
Purpose of the Study:
- To evaluate the association between intravenous iron and infection risk.
- Comparison made against oral iron or no iron supplementation.
Main Methods:
- Systematic review and meta-analysis of randomized clinical trials (RCTs) and nonrandomized studies.
- Searched Medline, Embase, Cochrane CENTRAL; included 154 RCTs with 32,920 participants.
- Assessed risk of bias and quality of evidence using PRISMA and GRADE guidelines.
Main Results:
- Intravenous iron showed a moderate certainty of increased infection risk (RR, 1.17; 95% CI, 1.04-1.31).
- Associated with increased hemoglobin levels and reduced red blood cell transfusion needs.
- No significant impact on mortality or hospital length of stay observed.
Conclusions:
- Intravenous iron administration is linked to a higher risk of infection.
- Further high-quality studies with standardized infection definitions are necessary.
- Understanding the risk-benefit balance of intravenous iron is crucial for clinical practice.
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