Red Blood Cell Transfusion in Neurocritical Patients: An Updated Systematic Review and Meta-Analysis of Mortality and...

Anemia is highly prevalent in neurocritical patients; within the first few days of intensive care, nearly 95% of patients become anemic. The best transfusion approach-liberal or restrictive -remains controversial because red blood cell (RBC) transfusions are commonly used. The purpose of this meta-analysis was to evaluate the effects of liberal and restrictive transfusion strategies on neurological outcomes and mortality in patients who require neurocritical care. A systematic search was carried out on PubMed, the Cochrane Library, and ClinicalTrials.gov in accordance with the PRISMA 2020 guidelines to find randomized controlled trials (RCTs) comparing restrictive and liberal RBC transfusion techniques in neurocritical patients. Mortality at various time intervals and unfavorable neurological outcomes were the primary outcomes. The Cochrane RoB-2 tool was used to evaluate the risk of bias, and a random effects model in R was used to conduct the meta-analyses. We assessed a total of 2585 patients. ICU mortality (RR: 0.74; 95% CI: 0.28; 1.91), in-hospital mortality (RR: 1.02; 95% CI: 0.79; 1.31), and long-term mortality did not significantly differ between the restrictive and liberal transfusion groups. Unfavorable neurological outcomes, however, showed marginal yet statistically significant risk reductions with the liberal strategy (RR: 0.92; 95% CI: 0.84; 1.00; p = 0.04). In neurocritical patients, restrictive and liberal transfusion approaches have similar mortality outcomes. However, a marginal but statistically significant reduction in unfavorable neurological outcomes with the liberal strategy warrants further investigation. To improve transfusion practices in neurocritical care, more extensive studies utilizing standardized neurological evaluations are needed.

The online version contains supplementary material available at 10.1007/s12288-025-02159-9.