{"id":26988,"date":"2024-10-14T04:41:00","date_gmt":"2024-10-13T20:41:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=26988"},"modified":"2024-10-14T05:52:12","modified_gmt":"2024-10-13T21:52:12","slug":"jama%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e6%80%a5%e6%80%a7%e8%84%91%e6%8d%9f%e4%bc%a4%e6%82%a3%e8%80%85%e7%9a%84%e9%99%90%e5%88%b6%e6%80%a7%e4%b8%8e%e8%87%aa%e7%94%b1%e8%a1%8c%e8%be%93","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=26988","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]\uff1a\u6025\u6027\u8111\u635f\u4f24\u60a3\u8005\u7684\u9650\u5236\u6027\u4e0e\u81ea\u7531\u6027\u8f93\u8840\u7b56\u7565"},"content":{"rendered":"\n

Original Investigation\uff5cCaring for the Critically Ill Patient<\/p>\n\n\n\n

October 9, 2024<\/p>\n\n\n\n

Restrictive vs Liberal Transfusion Strategy in Patients With Acute Brain Injury: The TRAIN Randomized Clinical Trial<\/h1>\n\n\n\n

Fabio Silvio Taccone, Carla Rynkowski Bittencourt, Kirsten M\u00f8ller, et al<\/h3>\n\n\n\n

JAMA. <\/em>Published online October 9, 2024. doi:10.1001\/jama.2024.20424<\/h3>\n\n\n\n

<\/a>Key Points<\/p>\n\n\n\n

Question<\/strong>  How does use of a liberal or restrictive strategy of blood transfusion influence neurological outcome among patients with acute brain injury?<\/p>\n\n\n\n

Findings<\/strong>  In this randomized clinical trial that included 850 patients with acute brain injury and a hemoglobin level below 9 g\/dL, those who were treated with a liberal transfusion strategy triggered by hemoglobin below 9 g\/dL had a lower probability of unfavorable neurological outcome at 180 days than those treated with a restrictive strategy triggered by hemoglobin below 7 g\/dL (62.6% vs 72.6%, respectively; adjusted relative risk, 0.86).<\/p>\n\n\n\n

Meaning<\/strong>  A liberal transfusion strategy compared with a restrictive strategy resulted in a lower rate of unfavorable neurological outcome among patients with acute brain injury.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Blood transfusions are commonly administered to patients with acute brain injury. The optimal hemoglobin transfusion threshold is uncertain in this patient population.<\/p>\n\n\n\n

Objective<\/strong>  To assess the impact on neurological outcome of 2 different hemoglobin thresholds to guide red blood cell transfusions in patients with acute brain injury.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  Multicenter, phase 3, parallel-group, investigator-initiated, pragmatic, open-label randomized clinical trial conducted in 72 intensive care units across 22 countries. Eligible patients had traumatic brain injury, aneurysmal subarachnoid hemorrhage, or intracerebral hemorrhage; hemoglobin values below 9 g\/dL within the first 10 days after injury; and an expected intensive care unit stay of at least 72 hours. Enrollment occurred between September 1, 2017, and December 31, 2022. The last day of follow-up was June 30, 2023.<\/p>\n\n\n\n

Interventions<\/strong>  Eight hundred fifty patients were randomly assigned to undergo a liberal (transfusion triggered by hemoglobin <9 g\/dL; n\u2009=\u2009408) or a restrictive (transfusion triggered by hemoglobin <7 g\/dL; n\u2009=\u2009442) transfusion strategy over a 28-day period.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  The primary outcome was occurrence of an unfavorable neurological outcome, defined as a Glasgow Outcome Scale Extended score between 1 and 5, at 180 days following randomization. There were 14 prespecified serious adverse events, including occurrence of cerebral ischemia after randomization.<\/p>\n\n\n\n

Results<\/strong>  Among 820 patients who completed the trial (mean age, 51 years; 376 [45.9%] women), 806 had available data on the primary outcome, 393 in the liberal strategy group and 413 in the restrictive strategy group. The liberal strategy group received a median of 2 (IQR, 1-3) units of blood, and the restrictive strategy group received a median of 0 (IQR, 0-1) units of blood, with an absolute mean difference of 1.0 unit (95% CI, 0.87-1.12 units). At 180 days after randomization, 246 patients (62.6%) in the liberal strategy group had an unfavorable neurological outcome compared with 300 patients (72.6%) in the restrictive strategy group (absolute difference, \u221210.0% [95% CI, \u221216.5% to \u22123.6%]; adjusted relative risk, 0.86 [95% CI, 0.79-0.94]; P<\/em>\u2009=\u2009.002). The effect of the transfusion thresholds on neurological outcome at 180 days was consistent across prespecified subgroups. In the liberal strategy group, 35 (8.8%) of 397 patients had at least 1 cerebral ischemic event compared with 57 (13.5%) of 423 in the restrictive strategy group (relative risk, 0.65 [95% CI, 0.44-0.97]).<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  Patients with acute brain injury and anemia randomized to a liberal transfusion strategy were less likely to have an unfavorable neurological outcome than those randomized to a restrictive strategy.<\/p>\n\n\n\n

Trial Registration<\/strong>  ClinicalTrials.gov Identifier: NCT02968654<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation\uff5cCaring for the Critically Ill Pa […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/26988"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=26988"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/26988\/revisions"}],"predecessor-version":[{"id":27017,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/26988\/revisions\/27017"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=26988"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=26988"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=26988"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}