Department of Intensive Care Unit, Ningbo No. 2 Hospital, Ningbo, Zhejiang, China.
Department of Anesthesiology, Ningbo No. 2 Hospital, Ningbo, Zhejiang, China.
Shock. 2023 Oct 1;60(4):545-552. doi: 10.1097/SHK.0000000000002209.
Background: Plasma is commonly used in patients with coagulopathy; however, its role in patients with sepsis-induced coagulopathy (SIC) is unclear. This study aimed to evaluate the effect of plasma transfusion on the prognosis of patients with SIC. Methods: Data were collected from the Medical Information Mart for Intensive Care IV database. Multivariable logistic regression analysis was used to determine the association between plasma transfusion and the incidence of in-hospital mortality, pulmonary embolism, and lower extremity deep vein thrombosis in critically ill patients with SIC. Propensity score matching (PSM) and propensity score-based inverse probability of treatment weighting (IPTW) models were used to ensure the robustness of our findings. Furthermore, the nonparametric relationship between in-hospital mortality and plasma transfusion volume was analyzed using restricted cubic spline. Subgroups analyses were performed for age, sex, Charlson score, Sequential Organ Failure Assessment score, SIC score, and with hemorrhage. Results: A total of 8,747 patients with SIC were enrolled: of them, 1874 were in the plasma infusion group, and 6,873 were in the no plasma infusion group. Compared with the no plasma infusion group, the plasma infusion group had higher in-hospital mortality (odds ratio [OR], 1.4411; 95% confidence interval [CI], 1.2280-1.6897, P < 0.05), and the results were robust after PSM (OR, 1.3227; 95% CI, 1.1152-1.5697; P < 0.05) and IPTW (OR, 1.1541; 95% CI, 1.0738-1.2404; P < 0.05). Similar results were also observed in different subgroups. However, because of conflicting results after PSM and IPTW, we were unable to definitively link plasma transfusion with pulmonary embolism and deep vein thrombosis. Compared with the no early plasma transfusion group (≥12 h), the in-hospital mortality rate was lower in the early plasma transfusion group (<12 h) (OR, 0.5426; 95% CI, 0.4398-0.6844; P < 0.05). The restricted cubic spline analysis indicated that increased plasma transfusion was associated with increased in-hospital mortality in patients with SIC. Conclusion: Plasma transfusion increases in-hospital mortality in patients with SIC, and the mortality rate increases with the amount of plasma transfusion. Patients with SIC who received early plasma infusion had lower in-hospital mortality than those who received no early plasma transfusion.
在凝血功能障碍患者中常使用血浆；然而，其在脓毒症诱导的凝血功能障碍（SIC）患者中的作用尚不清楚。本研究旨在评估血浆输注对 SIC 患者预后的影响。
数据来自重症监护医学信息数据库。采用多变量逻辑回归分析确定血浆输注与 SIC 危重症患者住院期间死亡率、肺栓塞和下肢深静脉血栓形成发生率之间的关联。采用倾向评分匹配（PSM）和基于倾向评分的逆概率治疗加权（IPTW）模型来确保我们发现的稳健性。此外，使用限制性立方样条分析住院期间死亡率与血浆输注量之间的非参数关系。进行了年龄、性别、Charlson 评分、序贯器官衰竭评估评分、SIC 评分和出血亚组分析。
共纳入 8747 例 SIC 患者：其中 1874 例接受血浆输注，6873 例未接受血浆输注。与未接受血浆输注组相比，接受血浆输注组的住院期间死亡率更高（比值比 [OR]，1.4411；95%置信区间 [CI]，1.2280-1.6897，P<0.05），PSM 后结果仍具有稳健性（OR，1.3227；95%CI，1.1152-1.5697；P<0.05）和 IPTW（OR，1.1541；95%CI，1.0738-1.2404；P<0.05）。在不同的亚组中也观察到了相似的结果。然而，由于 PSM 和 IPTW 后的结果存在冲突，我们无法确定将血浆输注与肺栓塞和深静脉血栓形成联系起来。与无早期血浆输注组（≥12 h）相比，早期血浆输注组（<12 h）的住院期间死亡率较低（OR，0.5426；95%CI，0.4398-0.6844；P<0.05）。限制性立方样条分析表明，SIC 患者血浆输注量增加与住院期间死亡率增加相关。
血浆输注会增加 SIC 患者的住院期间死亡率，且死亡率随血浆输注量的增加而增加。接受早期血浆输注的 SIC 患者的住院期间死亡率低于未接受早期血浆输注的患者。
