High Fresh Frozen Plasma to Red Blood Cell Ratio and Survival Outcomes in Blunt Trauma.

IF 15.7 1区医学 Q1 SURGERY JAMA surgery Pub Date : 2024-11-01 DOI:10.1001/jamasurg.2024.3097

Gaku Fujiwara, Yohei Okada, Wataru Ishii, Tadashi Echigo, Naoto Shiomi, Shigeru Ohtsuru

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Abstract

Importance: Current trauma-care protocols advocate early administration of fresh frozen plasma (FFP) in a ratio close to 1:1 with red blood cells (RBCs) to manage trauma-induced coagulopathy in patients with severe blunt trauma. However, the benefits of a higher FFP to RBC ratio have not yet been established.

Objective: To investigate the effectiveness of a high FFP to RBC transfusion ratio in the treatment of severe blunt trauma and explore the nonlinear relationship between the ratio of blood products used and patient outcomes.

Design, setting, and participants: This was a multicenter cohort study retrospectively analyzing data from the Japan Trauma Data Bank, including adult patients with severe blunt trauma without severe head injury (Injury Severity Score ≥16 and head Abbreviated Injury Scale <3) between 2019 and 2022.

Exposures: Patients were categorized into 2 groups based on the ratio of FFP to RBC: the high-FFP group (ratio >1) and the low-FFP group (ratio ≤1).

Main outcomes and measures: All-cause in-hospital mortality was the primary outcome. Additionally, the occurrence of transfusion-related adverse events was evaluated.

Results: Among the 1954 patients (median [IQR] age, 61 [41-77] years; 1243 male [63.6%]) analyzed, 976 (49.9%) had a high FFP to RBC ratio. Results from logistic regression, weighted by inverse probability treatment weighting, demonstrated an association between the group with a high-FFP ratio and lower in-hospital mortality (odds ratio, 0.73; 95% CI, 0.56-0.93) compared with a low-FFP ratio. Nonlinear trends were noted, suggesting a potential ceiling effect on transfusion benefits.

Conclusions and relevance: In this cohort study, a high FFP to RBC ratio was associated with favorable survival in patients with severe blunt trauma. These outcomes highlight the importance of revising the current transfusion protocols to incorporate a high FFP to RBC ratio, warranting further research on optimal patient treatment.

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新鲜冷冻血浆与红细胞的高比率与钝性创伤患者的生存结果

重要性：目前的创伤护理方案主张尽早使用新鲜冰冻血浆（FFP），与红细胞（RBC）的比例接近 1:1，以控制严重钝性创伤患者因创伤引起的凝血功能障碍。然而，提高 FFP 与红细胞比例的益处尚未得到证实：研究高FFP与RBC输血比例在治疗严重钝性创伤中的有效性，并探索血液制品使用比例与患者预后之间的非线性关系：这是一项多中心队列研究，对日本创伤数据库的数据进行回顾性分析，研究对象包括严重钝性创伤但无严重头部损伤（损伤严重程度评分≥16分，头部简略损伤量表暴露）的成年患者：根据FFP与RBC的比例将患者分为两组：高FFP组（比例>1）和低FFP组（比例≤1）：主要结果和测量指标：主要结果是全因住院死亡率。此外，还评估了输血相关不良事件的发生率：在分析的1954名患者（中位数[IQR]年龄，61[41-77]岁；1243名男性[63.6%]）中，976名患者（49.9%）的FFP与RBC比率较高。通过反概率治疗加权的逻辑回归结果显示，与低 FFP 比率相比，高 FFP 比率组与较低的院内死亡率之间存在关联（几率比 0.73；95% CI，0.56-0.93）。非线性趋势表明输血效益可能存在上限效应：在这项队列研究中，FFP与RBC的高比率与严重钝性创伤患者的良好存活率相关。这些结果凸显了修订现行输血方案以纳入高 FFP 与 RBC 比值的重要性，因此有必要对患者的最佳治疗方法进行进一步研究。

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来源期刊

JAMA surgery SURGERY-

CiteScore

20.80

自引率

3.60%

发文量

400

期刊介绍： JAMA Surgery, an international peer-reviewed journal established in 1920, is the official publication of the Association of VA Surgeons, the Pacific Coast Surgical Association, and the Surgical Outcomes Club.It is a proud member of the JAMA Network, a consortium of peer-reviewed general medical and specialty publications.

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