HYPOTHESIS: Transfusion of fresh frozen plasma (FFP) and platelets is independently associated with the development of multiple organ failure (MOF) in critically injured patients. DESIGN: Prospective cohort study. SETTING: Academic regional level I trauma center. PATIENTS: From 1992 to 2004, a total of 1440 critically injured patients were admitted to our surgical intensive care unit and survived at least 48 hours. Of these, 1415 had complete data on age, Injury Severity Score (ISS), and units of FFP, platelets, and packed red blood cells (PRBCs) transfused. Multiple organ failure was defined using the Denver MOF score. Multiple logistic regression analysis was used to adjust transfusion of FFP, platelets, and PRBCs for known MOF risk factors. MAIN OUTCOME MEASURE: Multiple organ failure. RESULTS: The mean (SD) ISS was 29.3 (11.3), and the mean (SD) patient age was 37.4 (16.6) years. Among 1440 patients, 346 (24.0%) developed MOF, and 118 (8.2%) died. Multiple logistic regression analysis detected a significant interaction between units of FFP and PRBCs transfused (P < .001). Regardless of the units of PRBCs transfused, FFP transfusion was independently associated with the development of MOF. However, the deleterious effect associated with FFP transfusion was more prominent among patients receiving fewer than 6 U of PRBCs. Platelet transfusion was unassociated with MOF after adjustment for age, ISS, and FFP and PRBC transfusion. CONCLUSIONS: Early transfusion of FFP is associated with an increased risk of postinjury MOF, even after adjusting for age, ISS, and PRBC transfusion. Caution is warranted in developing protocols for empirical FFP transfusion. Specifically, transfusion triggers for FFP should be reexamined, as well as the practice of delivering FFP in fixed ratios to the units of PRBCs transfused.
HYPOTHESIS: Transfusion of fresh frozen plasma (FFP) and platelets is independently associated with the development of multiple organ failure (MOF) in critically injured patients. DESIGN: Prospective cohort study. SETTING: Academic regional level I trauma center. PATIENTS: From 1992 to 2004, a total of 1440 critically injured patients were admitted to our surgical intensive care unit and survived at least 48 hours. Of these, 1415 had complete data on age, Injury Severity Score (ISS), and units of FFP, platelets, and packed red blood cells (PRBCs) transfused. Multiple organ failure was defined using the Denver MOF score. Multiple logistic regression analysis was used to adjust transfusion of FFP, platelets, and PRBCs for known MOF risk factors. MAIN OUTCOME MEASURE: Multiple organ failure. RESULTS: The mean (SD) ISS was 29.3 (11.3), and the mean (SD) patient age was 37.4 (16.6) years. Among 1440 patients, 346 (24.0%) developed MOF, and 118 (8.2%) died. Multiple logistic regression analysis detected a significant interaction between units of FFP and PRBCs transfused (P < .001). Regardless of the units of PRBCs transfused, FFP transfusion was independently associated with the development of MOF. However, the deleterious effect associated with FFP transfusion was more prominent among patients receiving fewer than 6 U of PRBCs. Platelet transfusion was unassociated with MOF after adjustment for age, ISS, and FFP and PRBC transfusion. CONCLUSIONS: Early transfusion of FFP is associated with an increased risk of postinjury MOF, even after adjusting for age, ISS, and PRBC transfusion. Caution is warranted in developing protocols for empirical FFP transfusion. Specifically, transfusion triggers for FFP should be reexamined, as well as the practice of delivering FFP in fixed ratios to the units of PRBCs transfused.
Authors: Nena Matijevic; Yao-Wei W Wang; Vadim Kostousov; Charles E Wade; K Vinod Vijayan; John B Holcomb Journal: Thromb Res Date: 2011-03-21 Impact factor: 3.944
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
Authors: John B Holcomb; Barbara C Tilley; Sarah Baraniuk; Erin E Fox; Charles E Wade; Jeanette M Podbielski; Deborah J del Junco; Karen J Brasel; Eileen M Bulger; Rachael A Callcut; Mitchell Jay Cohen; Bryan A Cotton; Timothy C Fabian; Kenji Inaba; Jeffrey D Kerby; Peter Muskat; Terence O'Keeffe; Sandro Rizoli; Bryce R H Robinson; Thomas M Scalea; Martin A Schreiber; Deborah M Stein; Jordan A Weinberg; Jeannie L Callum; John R Hess; Nena Matijevic; Christopher N Miller; Jean-Francois Pittet; David B Hoyt; Gail D Pearson; Brian Leroux; Gerald van Belle Journal: JAMA Date: 2015-02-03 Impact factor: 56.272
Authors: David F Schneider; Adrian Dobrowolsky; Irshad A Shakir; James M Sinacore; Michael J Mosier; Richard L Gamelli Journal: J Burn Care Res Date: 2012 Mar-Apr Impact factor: 1.845
Authors: Michael P Chapman; Ernest E Moore; Theresa L Chin; Arsen Ghasabyan; James Chandler; John Stringham; Eduardo Gonzalez; Hunter B Moore; Anirban Banerjee; Christopher C Silliman; Angela Sauaia Journal: Shock Date: 2015-08 Impact factor: 3.454