From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery (M.D., K.H., L.C., M.Z., N.K., A.T., L.G., B.J.), College of Medicine, University of Arizona, Tucson, Arizona; and Division of Acute Care Surgery (J.S.), Johns Hopkins University, Baltimore, Maryland.
J Trauma Acute Care Surg. 2020 Aug;89(2):336-343. doi: 10.1097/TA.0000000000002764.
Cryoprecipitate was developed for the treatment of inherited and acquired coagulopathies. The role of cryoprecipitate in hemorrhaging trauma patients is still speculative. The aim of our study was to assess the role of cryoprecipitate as an adjunct to transfusion in trauma patients.
We performed a 2-year (2015-2016) analysis of the American College of Surgeons-Trauma Quality Improvement Program data set and included all adult trauma patients who received 4 or greater packed red blood cells (pRBCs)/4 hours. Patients were stratified based on receipt of cryoprecipitate within the first 24 hours (cryoprecipitate vs. no-cryoprecipitate). Outcomes were blood products transfused, in-hospital complications, and mortality. Regression analyses were performed.
A total of 19,643 (cryoprecipitate, 4,945; no-cryoprecipitate, 14,698) were included. Mean age was 40 ± 22 years, median Injury Severity Score was 27 [18-40], and Glasgow Coma Scale score was 9 [3-14]. The overall complication rate was 45%, mortality was 47%, and 29% of the patients died in the first 24 hours. Patients in the cryoprecipitate group received a lower volume of plasma (p < 0.01), and pRBCs (p < 0.01). Additionally, patients who received cryoprecipitate had lower rates of 24-hour mortality (p < 0.01) and in-hospital mortality (p < 0.01). However, there was no difference between the two groups regarding complications (p = 0.36) or volume of platelet transfused (p = 0.22). On multivariate logistic regression, the use of cryoprecipitate was associated with decreased (odds ratio [OR], 0.78 [0.63-0.84]; p = 0.02), in-hospital mortality (OR, 0.79 [0.77-0.87]; p = 0.01), but had no association with in-hospital complications (OR, 1.48 [0.71-1.99]; p = 0.31). On linear regression analysis, the use of cryoprecipitate was not associated with 24-hour pRBCs (β = -0.12 [-0.28 to 0.27], p = 0.47), 24-hour plasma (β = -0.06 [-0.21 to 0.43], p = 0.29), and 24-hour platelets (β = -0.24 [-0.09 to 0.33], p = 0.17) transfusion requirements.
The adjunctive use of cryoprecipitate in hemorrhaging trauma patients may reduce mortality without affecting in-hospital complications and transfusion requirements. Further studies are needed to better understand its potentially beneficial effects.
Therapeutic, level IV.
冷沉淀是为治疗遗传性和获得性凝血功能障碍而开发的。冷沉淀在出血性创伤患者中的作用仍存在推测。我们的研究目的是评估冷沉淀作为创伤患者输血辅助手段的作用。
我们对美国外科医师学会创伤质量改进计划数据集进行了为期 2 年（2015-2016 年）的分析，纳入了所有接受 4 个或更多单位浓缩红细胞（pRBCs）/4 小时的成年创伤患者。根据在 24 小时内是否接受冷沉淀（冷沉淀组与未接受冷沉淀组）进行分层。主要结局为血液制品的输注、院内并发症和死亡率。进行回归分析。
共纳入 19643 例患者（冷沉淀组 4945 例，未接受冷沉淀组 14698 例）。平均年龄为 40±22 岁，中位损伤严重程度评分 27[18-40]，格拉斯哥昏迷评分 9[3-14]。总体并发症发生率为 45%，死亡率为 47%，29%的患者在 24 小时内死亡。冷沉淀组输注的血浆量（p<0.01）和 pRBCs 量（p<0.01）较低。此外，接受冷沉淀的患者 24 小时死亡率（p<0.01）和院内死亡率（p<0.01）较低。然而，两组间并发症发生率（p=0.36）或血小板输注量（p=0.22）无差异。多变量逻辑回归分析显示，使用冷沉淀与降低（比值比[OR]，0.78[0.63-0.84]；p=0.02）、院内死亡率（OR，0.79[0.77-0.87]；p=0.01）相关，但与院内并发症无关联（OR，1.48[0.71-1.99]；p=0.31）。线性回归分析显示，使用冷沉淀与 24 小时内的 pRBCs（β=-0.12[-0.28 至 0.27]，p=0.47）、24 小时内的血浆（β=-0.06[-0.21 至 0.43]，p=0.29）和 24 小时内的血小板（β=-0.24[-0.09 至 0.33]，p=0.17）输注需求无关联。
在出血性创伤患者中，辅助使用冷沉淀可能降低死亡率，而不影响院内并发症和输血需求。需要进一步研究以更好地了解其潜在的有益作用。
治疗性，IV 级。
