Risk of Severe Sepsis After Blood Product Administration for Traumatic Hemorrhage: A Trauma Quality Improvement Program Study

Abstract

Introduction

Transfusion of whole blood (WB) for traumatic hemorrhage has generated renewed interest in civilian trauma based on military experience. The association between blood products and severe sepsis remains unknown. We sought to determine which blood products were associated with the development of severe sepsis.

Methods

We utilized the TQIP database from 2020 to 2021. We included patients ≥15 ys of age who received at least one blood product and survived at least 24 hs. Severe sepsis is a standardized core quality measure for all reporting centers and defined as sepsis with organ dysfunction. We used descriptive, inferential, and multivariable logistic regression methods to test for associations and adjust for confounders.

Results

There were 83,924 patients included, of whom 1471 met criteria for severe sepsis. Patients with severe sepsis tended to be older (47 versus 42, P < 0.001), male (79% versus 74%, P < 0.001), have a higher injury severity score (29 versus 19, P < 0.001), higher proportion of serious injuries to the thorax (65% versus 47%, P < 0.001), abdomen (54% versus 32%, P < 0.001), and extremities (45% versus 32%, P < 0.001). Severe sepsis patients received more packed red cells, WB, platelets, cryoprecipitate, and plasma. When adjusting for age, sex, mechanism of injury, and injury severity score, WB was positively associated with severe sepsis (unit odds ratio 1.04, 95% confidence interval 1.01-1.07).

Conclusions

Within this dataset, we found a 4% increased odds of sepsis with each unit of WB received among civilian trauma patients. The effects of blood product administration on immune system function remain unclear. High-quality, prospective explanatory studies are needed to better understand this relationship.