Department of Emergency Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA.
Department of Biostatistics and Informatics, Colorado School of Public Health, Anschutz Medical Campus, Aurora, Colorado, USA.
Transfusion. 2024 May;64 Suppl 2:S155-S166. doi: 10.1111/trf.17792. Epub 2024 Mar 19.
Blood products form the cornerstone of contemporary hemorrhage control but are limited resources. Freeze-dried plasma (FDP), which contains coagulation factors, is a promising adjunct in hemostatic resuscitation. We explore the association between FDP alone or in combination with other blood products on 24-h mortality.
This is a secondary data analysis from a cross-sectional prospective observational multicenter study of adult trauma patients in the Western Cape of South Africa. We compare mortality among trauma patients at risk of hemorrhage in three treatment groups: Blood Products only, FDP + Blood Products, and FDP only. We apply inverse probability of treatment weighting and fit a multivariable Cox proportional hazards model to assess the hazard of 24-h mortality.
Four hundred and forty-eight patients were included, and 55 (12.2%) died within 24 h of hospital arrival. Compared to the Blood Products only group, we found no difference in 24-h mortality for the FDP + Blood Product group (p = .40) and a lower hazard of death for the FDP only group (hazard = 0.38; 95% CI, 0.15-1.00; p = .05). However, sensitivity analyses showed no difference in 24-h mortality across treatments in subgroups with moderate and severe shock, early blood product administration, and accounting for immortal time bias.
We found insufficient evidence to conclude there is a difference in relative 24-h mortality among trauma patients at risk for hemorrhage who received FDP alone, blood products alone, or blood products with FDP. There may be an adjunctive role for FDP in hemorrhagic shock resuscitation in settings with significantly restricted access to blood products.
血液制品是当代控制出血的基石，但它们是有限的资源。冻干血浆（FDP）含有凝血因子，是止血复苏的一种有前途的辅助手段。我们研究了单独使用 FDP 或与其他血液制品联合使用对 24 小时死亡率的影响。
这是一项来自南非西开普省成人创伤患者的横断面前瞻性观察性多中心研究的二次数据分析。我们比较了三种治疗组（仅血液制品、FDP+血液制品和仅 FDP）中出血风险的创伤患者的死亡率：血液制品、FDP+血液制品、FDP 仅。我们应用逆概率治疗加权和多变量 Cox 比例风险模型来评估 24 小时死亡率的风险。
共纳入 448 例患者，55 例（12.2%）在入院后 24 小时内死亡。与仅血液制品组相比，我们发现 FDP+血液制品组在 24 小时死亡率方面没有差异（p=0.40），而仅 FDP 组的死亡风险较低（风险比=0.38；95%置信区间，0.15-1.00；p=0.05）。然而，敏感性分析表明，在中度和重度休克、早期血液制品使用以及考虑不朽时间偏倚的亚组中，治疗方法之间的 24 小时死亡率没有差异。
我们没有足够的证据得出结论，在接受单独使用 FDP、单独使用血液制品或血液制品加 FDP 的出血风险创伤患者中，相对 24 小时死亡率存在差异。在血液制品获取受限的情况下，FDP 在出血性休克复苏中可能具有辅助作用。
