Kojima Mitsuaki, Endo Akira, Shiraishi Atsushi, Shoko Tomohisa, Otomo Yasuhiro, Coimbra Raul
Emergency and Critical Care Medicine, Tokyo Women's Medical University Adachi Medical Center, 4-33-1 Kohoku, Adachi-ku, Tokyo, Japan.
Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan.
J Intensive Care. 2022 Jan 11;10(1):2. doi: 10.1186/s40560-022-00595-7.
The benefits of a high plasma-to-red blood cell (RBC) ratio on the survival of injured patients who receive massive transfusions remain unclear, especially in older patients. We aimed to investigate the interaction of age with the plasma-to-RBC ratio and clinical outcomes of trauma patients.
In this retrospective study conducted from 2013 to 2016, trauma patients who received massive transfusions were included. Using a generalized additive model (GAM),we assessed how the plasma-to-RBC ratio and age affected the in-hospital mortality rates. The association of the plasma-to-RBC ratio [low (< 0.5), medium (0.5-1.0), and high (≥ 1.0)] with in-hospital mortality and the incidence of adverse events were assessed for the overall cohort and for patients stratified into non-geriatric (16-64 years) and geriatric (≥ 65 years) groups using logistic regression analyses.
In total, 13,894 patients were included. The GAM plot of the plasma-to-RBC ratio for in-hospital mortality demonstrated a downward convex unimodal curve for the entire cohort. The low-transfusion ratio group was associated with increased odds of in-hospital mortality in the non-geriatric cohort [odds ratio 1.38, 95% confidence interval (CI) 1.22-1.56]; no association was observed in the geriatric group (odds ratio 0.84, 95% CI 0.62-1.12). An increase in the transfusion ratio was associated with a higher incidence of adverse events in the non-geriatric and geriatric groups.
The association of the non-geriatric age category and plasma-to-RBC ratio for in-hospital mortality was clearly demonstrated. However, the relationship between the plasma-to-RBC ratio with mortality among geriatric patients remains inconclusive.
高血浆与红细胞（RBC）比例对接受大量输血的受伤患者生存的益处仍不明确，尤其是在老年患者中。我们旨在研究年龄与血浆与红细胞比例之间的相互作用以及创伤患者的临床结局。
在这项于2013年至2016年进行的回顾性研究中，纳入了接受大量输血的创伤患者。使用广义相加模型（GAM），我们评估了血浆与红细胞比例和年龄如何影响住院死亡率。使用逻辑回归分析评估了整个队列以及分为非老年（16 - 64岁）和老年（≥65岁）组的患者中，血浆与红细胞比例[低（<0.5）、中（0.5 - 1.0）和高（≥1.0）]与住院死亡率及不良事件发生率之间的关联。
总共纳入了13894例患者。住院死亡率的血浆与红细胞比例的GAM图显示，整个队列呈现向下凸的单峰曲线。低输血比例组与非老年队列中住院死亡率增加的几率相关[比值比1.38，95%置信区间（CI）1.22 - 1.56]；老年组未观察到关联（比值比0.84，95%CI 0.62 - 1.12）。输血比例的增加与非老年组和老年组中不良事件的较高发生率相关。
明确证明了非老年年龄类别与血浆与红细胞比例对住院死亡率的关联。然而，老年患者中血浆与红细胞比例与死亡率之间的关系仍无定论。
