Efficacy and safety of blood transfusion in obstetric patients: systematic review of the literature

Objectives: To evaluate the efficacy of blood transfusion compared to no intervention in obstetric patients. Material and methods: A systematic review was performed with Cochrane Database of Clinical Trials, PubMed, EMBASE and LILACS databases searched as of September, 2016. Two authors independently selected relevant clinical trials, assessed their methodological quality and extracted data, using the GRADE approach. Results: Five studies within a total of 6,297 met the inclusion criteria, with women generally aged 20–40 years. Three included studies allocated women to receive blood transfusion or no intervention. Two other studies allocated women with either restricted or full blood supplies. The major issue regarding risk of bias was the extent of concealment of randomization and blinding. There was no statistically significant difference between blood transfusion versus no transfusion or restricted blood supply on mortality (relative risk 0.82 [95% confidential interval 0.32 to 2.09], p = 0.68; two studies; I2 = not applicable). Conclusions: Very low-quality evidence suggests no significant difference between blood transfusion and no intervention in obstetric patients, underlining the need for more robust clinical trials evaluating this area

Study characteristics related to population, intervention or comparator groups, etiology of AKI, and eligibility criteria.

<p>Study characteristics related to population, intervention or comparator groups, etiology of AKI, and eligibility criteria.</p

Acute kidney injury in cats and dogs: A proportional meta-analysis of case series studies

<div><p>Introduction</p><p>Risk of mortality in the setting of acute kidney injury (AKI) in cats and dogs remains unclear.</p><p>Objectives</p><p>To evaluate the incidence of mortality in cats and dogs with AKI based on etiology (i.e. infectious versus non-infectious; receiving dialysis versus conservative treatment).</p><p>Materials and methods</p><p>Ovid Medline, EMBASE, and LILACS were searched up to July 2016. Articles were deemed eligible if they were case series studies evaluating the incidence of all-cause mortality in cats and dogs with AKI, regardless of etiology or the nature of treatment.</p><p>Results</p><p>Eighteen case series involving 1,201animalsproved eligible. The pooled proportions for overall mortality were: cats53.1% [95% CI 0.475, 0.586; I² = 11,9%, p = 0.3352]; dogs 45.0% [95% CI 0.33, 0.58; I² = 91.5%, P < 0.0001]. A non-significant increase in overall mortality risk was found among dialysed animals relative to those managed with conservative treatment, independent of animal type and the etiology of their AKI. The pooled proportions for overall mortality according to etiology, regardless of treatment type, were: AKI due infectious etiology for cats and dogs, 19.2% [95% CI 0.134, 0.258; I² = 37.7%, P = 0.0982]; AKI due non-infectious etiology for cats and dogs, 59.9% [95% CI 0.532, 0.663; I² = 51.0%, P = 0.0211].</p><p>Conclusion</p><p>Our findings suggest higher rates of overall mortality in cats and dogs with AKI due to non-infectious etiologies relative to infectious etiologies, and showed non-significant differences in terms of higher rates associated with dialysis compared to conservative management. Further investigations regarding optimal time to initiate dialysis and the development of clinical models to prognosticate the course of disease and guide optimal treatment initiation for less severe cases of AKI in cats and dogs is warranted.</p></div

Comparison of the plotted proportional meta-analysis, according to etiology in both cats and dogs, regardless treatment, for overall mortality.

<p>Effect differences were seen due to the non-overlap of the 95% confidence intervals showing a higher rates of mortality in the AKI due to non-infectious (cats and dogs; and only dogs) compared with AKI due to infectious (cats and dogs; and only dogs), as their CIs did not overlap. However, there was no statistically significance difference between rates of mortality by etiology in only cats, as their CIs overlapped.</p

Comparison of the plotted proportional meta-analysis for overall mortality, according to control group treatment and AKI etiology in both cats and dogs.

<p>Effect differences were seen due to the non-overlap of the 95% CIs showing higher rates of mortality in cats and dogs with AKI due to non-infectious compared to only dogs with AKI due to infectious.</p

Characteristics of small animals: Comparison among different AKI treatment and etiology.

<p>Characteristics of small animals: Comparison among different AKI treatment and etiology.</p

Comparison of the plotted proportional meta-analysis, according to dialysis treatment and etiology in both cats and dogs, for overall mortality.

<p>Effect differences were seen due to the non-overlap of the 95% confidence intervals showing a higher rates of mortality in the AKI due to non-infectious receiving dialysis (cats and dogs; dogs) compared with AKI due to infectious receiving dialysis (cats and dogs; dogs), as their CIs did not overlap. However, there was no statistically significance difference between rates of mortality in only cats that receiving dialysis, as their CIs overlapped.</p

Flowchart of the review.

<p>Flowchart of the review.</p

Study characteristics related to population, intervention or comparator groups, etiology of AKI, and eligibility criteria.

<p>Study characteristics related to population, intervention or comparator groups, etiology of AKI, and eligibility criteria.</p