Fresh Frozen Plasma-to-Packed Red Blood Cell Ratio and Mortality in Traumatic Hemorrhage: Nationwide Analysis of 4,427 Patients
| Autor: | Haytham M.A. Kaafarani, Majed El Hechi, Napaporn Kongkaewpaisan, Peter J. Fagenholz, George C. Velmahos, April E. Mendoza, David R. King, Nikolaos Kokoroskos, Noelle Saillant, Charlie J. Nederpelt |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Hemorrhage Plasma Young Adult 03 medical and health sciences Injury Severity Score 0302 clinical medicine Internal medicine medicine Humans Survival rate Retrospective Studies business.industry Retrospective cohort study Emergency department Middle Aged United States Survival Rate Treatment Outcome Blunt trauma 030220 oncology & carcinogenesis Cohort Wounds and Injuries Female 030211 gastroenterology & hepatology Surgery Fresh frozen plasma Erythrocyte Transfusion Packed red blood cells business |
| Zdroj: | Journal of the American College of Surgeons. 230:893-901 |
| ISSN: | 1072-7515 |
| Popis: | Background Despite the presence of highly reliable data, studies on packed red blood cells (pRBC):fresh frozen plasma (FFP) ratio suffer from limited sample size and the presence of survivor bias. We sought to study the association between FFP:pRBC and early mortality in the hemorrhaging trauma patient. Study Design This was a retrospective nationwide cohort that included all TQIP participating hospitals (2013 to 2016). We included all trauma patients who were transfused ≥10 pRBCs and ≥1 FFP within 24 hours. We excluded transferred patients and those who died in the emergency department or had missing/inaccurate transfusion data. Patients were assigned to 7 FFP:pRBC cohorts (range 1:1 to 1:6, and 1:6+) only if the ratio was similar at 4 and 24 hours and, to avoid survival bias, were excluded otherwise. Multivariable analyses correcting for all available confounders (age, demographics, comorbidities, vital signs, Injury Severity Score [ISS] and mechanism, procedures performed) were derived to study the independent relationship between FFP:pRBC and 24-hour mortality. Results Of 1,002,595 patients, 4,427 patients were included. Mean age was 41 years, 79% were males, 61% had blunt trauma, and median ISS was 29. Most patients were transfused in a 1:1, 1:2, or 1:3 ratio (31%, 41%, and 11%, respectively); mortality ranged between 28% for 1:1 and 62% for 1:4. In multivariable analyses, the odds of mortality independently and incrementally increased to 1.23 (95% CI 1.02 to 1.48) for a 1:2 ratio, 2.11 (95% CI 1.42 to 3.13) for 1:4, and as high as 4.11 (95% CI 2.31 to 7.31) for 1:5 (all p Conclusions A 1:1 FFP:pRBC ratio is associated with the lowest mortality in the hemorrhaging trauma patient, and mortality increases with decreasing ratios. |
| Databáze: | OpenAIRE |
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