BACKGROUND: Blood transfusion is known to be an independent risk factor for mortality, multiple organ failure (MOF), acute respiratory distress syndrome (ARDS), and nosocomial infection after injury. Less is known about the independent risks associated with plasma-rich transfusion components including fresh frozen plasma (FFP), platelets (PLTS), and cryoprecipitate (CRYO) after injury. We hypothesized that plasma-rich transfusion components would be independently associated with a lower risk of mortality but result in a greater risk of morbid complications. METHODS: Data were obtained from a multicenter prospective cohort study evaluating clinical outcomes in bluntly injured adults with hemorrhagic shock. All patients required blood transfusion for enrollment. Patients with isolated traumatic brain injury and those not surviving beyond 48 hours were excluded. Cox proportional hazard regression models were used to estimate the outcome risks (per unit) associated with plasma-rich transfusion requirements during the initial 24 hours after injury after controlling for important confounders. RESULTS: For the entire study population (n = 1,175), 65%, 41%, and 28% of patients received FFP, PLTS and CRYO, respectively. There was no association with plasma-rich transfusion components and mortality or nosocomial infection. For every unit given, FFP was independently associated with a 2.1% and 2.5% increased risk of MOF and ARDS, respectively. CRYO was associated with a 4.4% decreased risk of MOF (per unit), and PLTS were not associated with any of the outcomes examined. When early deaths (within 48 hours) were included in the model, FFP was associated with a 2.9% decreased risk of mortality per unit transfused. CONCLUSIONS: In patients who survive their initial injury, FFP was independently associated with a greater risk of developing MOF and ARDS, whereas CRYO was associated with a lower risk of MOF. Further investigation into the mechanisms by which these plasma-rich component transfusions are associated with these effects are required.
BACKGROUND: Blood transfusion is known to be an independent risk factor for mortality, multiple organ failure (MOF), acute respiratory distress syndrome (ARDS), and nosocomial infection after injury. Less is known about the independent risks associated with plasma-rich transfusion components including fresh frozen plasma (FFP), platelets (PLTS), and cryoprecipitate (CRYO) after injury. We hypothesized that plasma-rich transfusion components would be independently associated with a lower risk of mortality but result in a greater risk of morbid complications. METHODS: Data were obtained from a multicenter prospective cohort study evaluating clinical outcomes in bluntly injured adults with hemorrhagic shock. All patients required blood transfusion for enrollment. Patients with isolated traumatic brain injury and those not surviving beyond 48 hours were excluded. Cox proportional hazard regression models were used to estimate the outcome risks (per unit) associated with plasma-rich transfusion requirements during the initial 24 hours after injury after controlling for important confounders. RESULTS: For the entire study population (n = 1,175), 65%, 41%, and 28% of patients received FFP, PLTS and CRYO, respectively. There was no association with plasma-rich transfusion components and mortality or nosocomial infection. For every unit given, FFP was independently associated with a 2.1% and 2.5% increased risk of MOF and ARDS, respectively. CRYO was associated with a 4.4% decreased risk of MOF (per unit), and PLTS were not associated with any of the outcomes examined. When early deaths (within 48 hours) were included in the model, FFP was associated with a 2.9% decreased risk of mortality per unit transfused. CONCLUSIONS: In patients who survive their initial injury, FFP was independently associated with a greater risk of developing MOF and ARDS, whereas CRYO was associated with a lower risk of MOF. Further investigation into the mechanisms by which these plasma-rich component transfusions are associated with these effects are required.
Authors: Phillip A Letourneau; Madonna McManus; Kendell Sowards; Weiwei Wang; Yao-wei Wang; Nena Matijevic; Shibani Pati; Charles E Wade; John B Holcomb Journal: J Trauma Date: 2011-11
Authors: Mareike Kristina Keller; Axel Pruss; Michael Sander; Claudia Spies; Helge Schoenfeld; Michael Schuster; Kristian Meinck; Klaus-Dieter Wernecke; Christian Von Heymann Journal: Blood Transfus Date: 2012-03-28 Impact factor: 3.443
Authors: E Bui; K Inaba; A Ebadat; E Karamanos; S Byerly; O Okoye; I Shulman; P Rhee; D Demetriades Journal: Eur J Trauma Emerg Surg Date: 2015-09-11 Impact factor: 3.693
Authors: Amy T Makley; Michael D Goodman; Ritha M Belizaire; Lou Ann W Friend; Jay A Johannigman; Warren C Dorlac; Alex B Lentsch; Timothy A Pritts Journal: J Surg Res Date: 2011-12-15 Impact factor: 2.192
Authors: Che Ngufor; Matthew A Warner; Dennis H Murphree; Hongfang Liu; Rickey Carter; Curtis B Storlie; Daryl J Kor Journal: AMIA Annu Symp Proc Date: 2018-04-16
Authors: George Kasotakis; Nichole Starr; Erek Nelson; Bedabrata Sarkar; Peter Ashley Burke; Daniel George Remick; Ronald Gary Tompkins Journal: Eur J Trauma Emerg Surg Date: 2018-04-07 Impact factor: 3.693