METAANALYSIS OF CLINICAL-STUDIES OF THE EFFICACY OF GRANULOCYTE TRANSFUSIONS IN THE TREATMENT OF BACTERIAL SEPSIS

Background: Meta-analysis was used to explain disagreements across con trolled clinical studies of the efficacy of granulocyte transfusions ( GTX) in the treatment of bacterial sepsis. Methods: Studies published in English in 1970-1994 were retrieved. Seven studies of adults and fi ve of neonates were eligible for analysis. Summary relative odds (RR) of survival in treated patients versus controls were computed for pati ent subsets defined on the basis of microbiologic proof of infection, recovery of bone marrow function, method of procurement of granulocyte s for transfusion, dose of granulocytes transfused, assessment of leuk ocyte compatibility, and survival rate of controls. The random-effects method was used for all analyses. Results: Differences between the re viewed studies in the dose of granulocytes transfused and the survival rate of controls were primarily responsible for the disagreements acr oss the reports. Adults (RR = 4.2) and neonates (RR = 18.0) receiving adequate doses of granulocytes and adults transfused in centers with a low survival rate of controls (RR = 8.9) experienced a significant (P < .05) benefit from GTX. Conclusion: GTX of adequate dose may be indi cated in the 1990s for the treatment of sepsis in neonates, and perhap s also adults admitted to centers with an unusually high mortality rat e of untransfused controls. More research is needed to reassess the pr oper role of GTX, in the light of modern transfusion medicine technolo gy and the presently available options for the treatment of sepsis. (C ) 1996 Wiley-Liss, Inc.