Efficacy and Safety of Intravenous Iron in Critically Ill Patients: A Systematic Review and Meta-Analysis
CCCF ePoster library. Hickey M. 11/13/19; 283390; EP98
Dr. Michael Hickey
Dr. Michael Hickey
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Topic: Systematic Review, Meta-Analysis, or Meta-Synthesis

Hickey, Michael1,2; Pease, Christopher3; Hickey, Carly4; Sikora, Lindsey5; Yadav, Krishan1; McIntyre, Lauralyn2; Perry, Jeffrey1
Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; 2Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; 3Division of Respirology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; 4Queensway-Carleton Hospital, Ottawa, Ontario, Canada;
 4Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada

INTRUDUCTION: Anemia is a common and challenging problem in critical care medicine (1, 2), often requiring red blood cell (RBC) transfusion in the absence of active bleeding in many critically ill patients (3, 4). Previous studies have reported that 16-85% of critically ill patients receive a RBC transfusion during the course of their ICU stay (5, 6). Over the past two decades, the benefit of RBC transfusion in critically ill patients has been questioned, and studies have suggested restricting the transfusion of blood products may benefit critically ill patients  (1, 5, 7-9). Strategies exist to prevent and treat anemia in the ICU (7), but its management remains challenging. A recent meta-analysis that examined the use of both oral and intravenous (IV) iron formulations in critically ill adults demonstrated that supplementation was not associated with a reduced RBC transfusion requirement (10). However, a more recently published randomized trial of IV iron in critically ill patients demonstrated that patients' hemoglobin upon discharge from hospital was significantly higher in the IV iron group versus placebo (11).
 OBJECTIVES: To evaluate: (i) the efficacy of IV iron in critically ill patients based on the requirement for red blood cell transfusion; and (ii) the incidence of infection in patients receiving IV iron.
 METHODS: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (12). Studies which report the administration of IV iron in patients admitted to a critical care unit were eligible, regardless of the outcomes measured. A comprehensive electronic search was conducted using Medline (Ovid), EMBASE(Ovid), PubMed, EBM Reviews (including Cochrane Central databases, Ovid), and CINAHL(EBSCOHost) from inception until April 17, 2019. Three independent reviewers screened study titles and abstracts, followed by full text review for eligible studies. Included studies were assessed using the Cochrane Risk of Bias Tool (13).
 RESULTS: After deduplication, title and abstract screening and full text review of 301 articles, five studies remained and were included in the analysis. All five studies were randomized, interventional trials. Two of the studies reported on cardiac surgical patients (14, 15), one reported on trauma patients (16) and two encompassed a broader variety of critically ill patients (11, 17). None of the trials had a low risk of bias across all domains. In this meta-analysis, there was no evidence that IV iron reduces the proportion of patients receiving a RBC transfusion (OR 0.76, 95% CI 0.51 – 1.11, I2=0%). In addition, there was no evidence that the administration of IV iron was associated with in-hospital infection (OR 0.88, 95% CI 0.53 – 1.45, I2=54%).
 CONCLUSION: Our results indicate that while IV iron is not associated with an increased incidence of infection, it does not reduce transfusion requirements in critically ill patients. Therefore, the findings of this meta-analysis do not support routine use of IV iron in critically ill patients.

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