Trauma and Acute Critical Care Medical Centre, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan.
Emergency and Trauma Centre, Kameda Medical Centre, Kamogawa, Japan.
Br J Surg. 2018 Oct;105(11):1426-1434. doi: 10.1002/bjs.10905. Epub 2018 Jul 12.
The benefits of high transfusion ratios (plasma to red blood cells and platelets to red blood cells) on survival in injured patients who receive massive transfusions remain uncertain. This study aimed to assess the association between transfusion ratios and adverse events and survival in patients undergoing massive transfusion for major trauma.
A retrospective observational study was conducted on patients who had major trauma using a Japanese national administrative database. The associations between transfusion ratios and outcomes (in-hospital mortality and incidence of adverse events) were analysed using a non-linear logistic generalized additive model (GAM). In a logistic generalized estimating equation model, adjusted for patient and hospital-level confounders, transfusion ratios were included as continuous or categorical variables (low, transfusion ratio 0·75 or less; intermediate, over 0·75 to 1·25; high, over 1·25).
Some 1777 patients were included in the analysis, of whom 602 died in hospital. GAM plots of the transfusion ratios for in-hospital mortality demonstrated a downward convex unimodal curve. In-hospital mortality was similar with increasing transfusion ratios for plasma (adjusted odds ratio (OR) 1·13, 95 per cent c.i. 0·82 to 1·55; P = 0·446) and platelets (adjusted OR 0·84, 0·66 to 1·08; P = 0·171). Both plasma to red blood cell ratio (adjusted OR 1·77, 1·32 to 2·37; P < 0·001) and platelet to red blood cell ratio (adjusted OR 1·71, 1·35 to 2·15; P < 0·001) were significantly associated with a higher incidence of adverse events. No significant differences in in-hospital mortality were observed between the three transfusion categories (low, medium and high).
In this study, transfusion strategies with high plasma to red blood cell and platelet to red blood cell ratios did not have survival benefits, but were associated with an increase in adverse events.
大量输血的创伤患者中，高输血比例（血浆与红细胞比、血小板与红细胞比）对生存的益处仍不确定。本研究旨在评估大量输血治疗的严重创伤患者输血比例与不良事件和生存的相关性。
本研究使用日本国家行政数据库对严重创伤患者进行了回顾性观察性研究。使用非线性逻辑广义加性模型（GAM）分析输血比例与结局（院内死亡率和不良事件发生率）的相关性。在逻辑广义估计方程模型中，根据患者和医院水平的混杂因素进行调整，输血比例被作为连续或分类变量（低，输血比例为 0.75 或更低；中，0.75 至 1.25；高，1.25 以上）纳入。
在纳入分析的 1777 例患者中，有 602 例患者院内死亡。输血比例与院内死亡率的 GAM 图显示出向下凸的单峰曲线。随着血浆（校正比值比（OR）1.13，95%置信区间（CI）0.82 至 1.55；P=0.446）和血小板（校正 OR 0.84，0.66 至 1.08；P=0.171）输血比例的增加，院内死亡率相似。血浆与红细胞比（校正 OR 1.77，1.32 至 2.37；P<0.001）和血小板与红细胞比（校正 OR 1.71，1.35 至 2.15；P<0.001）均与不良事件发生率的增加显著相关。在低、中、高三个输血类别之间，院内死亡率无显著差异。
在本研究中，高血浆与红细胞比和血小板与红细胞比的输血策略并未带来生存获益，但与不良事件的增加相关。
