Haltmeier Tobias, Benjamin Elizabeth, Gruen John Peter, Shulman Ira A, Lam Lydia, Inaba Kenji, Demetriades Demetrios
Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Los Angeles County and University of Southern California Medical Center, Los Angeles, CA, USA.
Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Los Angeles County and University of Southern California Medical Center, Los Angeles, CA, USA.
Injury. 2018 Jan;49(1):62-66. doi: 10.1016/j.injury.2017.07.035. Epub 2017 Aug 5.
Higher transfusion ratios of plasma to packed red blood cells (PRBC) and platelets (PLT) to PRBC have been shown to be associated with decreased mortality in major trauma patients. However, little is known about the effect of transfusion ratios on mortality in patients with isolated severe traumatic brain injury (TBI). The aim of this study was to investigate the effect of transfusion ratios on mortality in patients with isolated severe blunt TBI. We hypothesized that higher transfusion ratios of plasma to PRBC and PLT to PRBC are associated with a lower mortality rate in these patients.
Retrospective observational study. Patients with isolated severe blunt TBI (AIS head≥3, AIS extracranial <3) admitted to an urban level I trauma centre were included. Clinical data were extracted from the institution's trauma registry, blood transfusion data from the blood bank database. The effect of higher transfusion ratios on in-hospital mortality was analysed using univariate and multivariable regression analysis.
A total of 385 patients were included. Median age was 32 years (IQR 2-50), 71.4% were male, and 76.6% had an ISS≥16. Plasma:PRBC transfusion ratios≥1 were identified as an independent predictor for decreased in-hospital mortality (adjusted OR 0.43 [CI 0.22-0.81]). PLT:PRBC transfusion ratios≥1 were not significantly associated with mortality (adjusted OR 0.39 [CI 0.08-1.92]).
This study revealed plasma to PRBC transfusion ratios≥1 as an independent predictor for decreased in-hospital mortality in patients with isolated severe blunt TBI.
较高的血浆与红细胞悬液（PRBC）的输注比例以及血小板（PLT）与PRBC的输注比例已被证明与严重创伤患者死亡率降低相关。然而，关于输注比例对单纯性严重创伤性脑损伤（TBI）患者死亡率的影响知之甚少。本研究的目的是调查输注比例对单纯性严重钝性TBI患者死亡率的影响。我们假设较高的血浆与PRBC以及PLT与PRBC的输注比例与这些患者较低的死亡率相关。
回顾性观察研究。纳入入住城市一级创伤中心的单纯性严重钝性TBI患者（简明损伤定级（AIS）头部≥3，AIS颅外＜3）。临床数据从该机构的创伤登记处提取，输血数据从血库数据库提取。使用单变量和多变量回归分析来分析较高输注比例对住院死亡率的影响。
共纳入385例患者。中位年龄为32岁（四分位间距2 - 50），71.4%为男性，76.6%的损伤严重程度评分（ISS）≥16。血浆：PRBC输注比例≥1被确定为住院死亡率降低的独立预测因素（校正比值比0.43 [可信区间0.22 - 0.81]）。PLT：PRBC输注比例≥1与死亡率无显著相关性（校正比值比0.39 [可信区间0.08 - 1.92]）。
本研究表明，血浆与PRBC输注比例≥1是单纯性严重钝性TBI患者住院死亡率降低的独立预测因素。
