Watson Gregory A, Sperry Jason L, Rosengart Matthew R, Minei Joseph P, Harbrecht Brian G, Moore Ernest E, Cuschieri Joseph, Maier Ronald V, Billiar Timothy R, Peitzman Andrew B
Division of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
J Trauma. 2009 Aug;67(2):221-7; discussion 228-30. doi: 10.1097/TA.0b013e3181ad5957.
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.
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.
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.
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.
已知输血是损伤后死亡率、多器官功能衰竭（MOF）、急性呼吸窘迫综合征（ARDS）和医院感染的独立危险因素。关于损伤后富含血浆的输血成分，包括新鲜冰冻血浆（FFP）、血小板（PLTs）和冷沉淀（CRYO）的独立风险，人们了解较少。我们假设富含血浆的输血成分与较低的死亡风险独立相关，但会导致更高的并发症风险。
数据来自一项多中心前瞻性队列研究，评估钝性损伤并伴有失血性休克的成年患者的临床结局。所有患者均需输血才能入组。排除单纯性创伤性脑损伤患者和伤后48小时内未存活的患者。使用Cox比例风险回归模型，在控制重要混杂因素后，估计损伤后最初24小时内与富含血浆的输血需求相关的结局风险（每单位）。
在整个研究人群（n = 1175）中，分别有65%、41%和28%的患者接受了FFP、PLTs和CRYO。富含血浆的输血成分与死亡率或医院感染无关。每输注一个单位，FFP分别与MOF和ARDS风险增加2.1%和2.5%独立相关。CRYO与MOF风险降低4.4%（每单位）相关，而PLTs与所检查的任何结局均无关。当将早期死亡（48小时内）纳入模型时，每输注一个单位FFP与死亡率降低2.9%相关。
在初始损伤后存活的患者中，FFP与发生MOF和ARDS的风险增加独立相关，而CRYO与MOF风险降低相关。需要进一步研究这些富含血浆的成分输血与这些效应相关的机制。
