Transfusion practices significantly predict early inhospital mortality among adult trauma patients, suggests a report published in the Archives of Surgery.
The likelihood of death in the first 6 hours of admission, where hemorrhage was the predominant cause, was significantly and negatively associated with increased transfusion ratios of plasma to red blood cells (RBCs; adjusted hazard ratio [HR]=0.31) and platelet to RBCs (HR=0.55).
Patients whose ratios were below 1:2 were three to four times more likely to die within 6 hours than patients whose ratios were 1:1 or higher, report John Holcomb (University of Texas Health Sciences Center, Houston, USA) and co-authors.
By 24 hours after admission, however, when nonhemorrhagic causes were the major reasons for death, the ratio of plasma and platelet transfusions to RBC transfusions no longer significantly predicted mortality.
"This study supports a potential net survival benefit of early and higher plasma and platelet ratios to be assessed in a randomized trial," Holcomb et al say.
"Our findings offer guidance and evidence for designing a rigorous, multicenter, randomized transfusion trial," they continue, recommending research into transfusion ratios in level I trauma centers using well defined endpoints and time varying covariates.
The team adds that the research should focus on procedures that "promote integrated, consistent transfusion practices across individual clinicians, blood banks, research teams, and trauma centers."
The study compared 1245 patients who received at least one RBC unit within 6 hours of admission and 905 patients who received three or more units of RBC, plasma, or platelets. All patients survived for at least 30 minutes after admission to a level I trauma center, and the overall mortality rates were 21% and 25%, respectively.
The median time to hemorrhagic death was 2.6 hours, with 94% occurring within 24 hours and 60% within 3 hours of admission.
Of concern, the ratio of plasma or platelet to RBC transfusions was not constant among individual patients over the first 24 hours. This was because the majority (67%) of patients had not received plasma and 99% had not received platelets within 30 minutes of admission. At 3 hours, just 10% of patients who survived had not received plasma and 28% had not been given platelets.
The likelihood of receiving plasma and platelets increased with each hour for the first 6 hours, exceeding a 1 to 2 ratio for plasma in 29%, 47%, 69%, 78%, and 84% at 30 minutes, 1, 2, 3, and 6 hours after admission. For platelets, the proportion of patients exceeding a 1 to 2 ratio was 1%, 14%, 40%, 60%, and 80%, respectively.
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