Qin Xiaoyi, Zhang Wei, Zhu Xiaodan, Hu Xiang, Zhou Wei
Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Department of Thoracic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Front Med (Lausanne). 2021 Nov 16;8:754859. doi: 10.3389/fmed.2021.754859. eCollection 2021.
So far, no study has investigated the effects of plasma transfusion in the patients with sepsis, especially in the terms of prognosis. Therefore, we aimed to explore the association of early fresh frozen plasma (FFP) transfusion with the outcomes of patients with sepsis. We performed a cohort study using data extracted from the Medical Information Mart for Intensive Care III database (v1.4). External validation was obtained from the First Affiliated Hospital of Wenzhou Medical University, China. We adopted the Sepsis-3 criteria to extract the patients with sepsis and septic shock. The occurrence of transfusion during the first 3-days of intensive care unit (ICU) stay was regarded as early FFP transfusion. The primary outcome was 28-day mortality. We assessed the association of early FFP transfusion with the patient outcomes using a Cox regression analysis. Furthermore, we performed the sensitivity analysis, subset analysis, and external validation to verify the true strength of the results. After adjusting for the covariates in the three models, respectively, the significantly higher risk of death in the FFP transfusion group at 28-days [e.g., Model 2: hazard ratio () = 1.361, = 0.018, 95% = 1.054-1.756] and 90-days (e.g., Model 2: = 1.368, = 0.005, 95% = 1.099-1.704) remained distinct. Contrarily, the mortality increased significantly with the increase of FFP transfusion volume. The outcomes of the patients with sepsis with hypocoagulable state after early FFP transfusion were not significantly improved. Similar results can also be found in the subset analysis of the septic shock cohort. The results of external validation exhibited good consistency. Our study provides a new understanding of the rationale and effectiveness of FFP transfusion for the patients with sepsis. After recognizing the evidence of risk-benefit and cost-benefit, it is important to reduce the inappropriate use of FFP and avoid unnecessary adverse transfusion reactions.
到目前为止，尚无研究调查血浆输注对脓毒症患者的影响，尤其是在预后方面。因此，我们旨在探讨早期输注新鲜冰冻血浆（FFP）与脓毒症患者预后之间的关联。我们进行了一项队列研究，使用从重症监护医学信息数据库III（v1.4）中提取的数据。外部验证来自中国温州医科大学附属第一医院。我们采用脓毒症-3标准来提取脓毒症和脓毒性休克患者。在重症监护病房（ICU）住院的前3天内发生的输血被视为早期FFP输注。主要结局是28天死亡率。我们使用Cox回归分析评估早期FFP输注与患者预后之间的关联。此外，我们进行了敏感性分析、亚组分析和外部验证，以验证结果的真实强度。在分别对三个模型中的协变量进行调整后，FFP输注组在28天[例如，模型2：风险比（HR）=1.361，P = 0.018，95%置信区间（CI）=1.054 - 1.756]和90天（例如，模型2：HR = 1.368，P = 0.005，95%CI = 1.099 - 1.704）时死亡风险显著更高。相反，死亡率随着FFP输注量的增加而显著升高。早期FFP输注后处于低凝状态的脓毒症患者的预后没有得到显著改善。在脓毒性休克队列的亚组分析中也发现了类似结果。外部验证结果显示出良好的一致性。我们的研究为脓毒症患者FFP输注的原理和有效性提供了新的认识。在认识到风险效益和成本效益的证据后，减少FFP的不当使用并避免不必要的输血不良反应非常重要。
