高新鲜冷冻血浆与红细胞比值与钝性创伤生存结局的关系。
High Fresh Frozen Plasma to Red Blood Cell Ratio and Survival Outcomes in Blunt Trauma.
机构信息
Department of Management of Technology and Intellectual Property, School of Public Health, Kyoto University, Kyoto, Japan.
Department of Pharmacoepidemiology, School of Public Health, Kyoto University, Kyoto, Japan.
出版信息
JAMA Surg. 2024 Nov 1;159(11):1272-1280. doi: 10.1001/jamasurg.2024.3097.
IMPORTANCE
Current trauma-care protocols advocate early administration of fresh frozen plasma (FFP) in a ratio close to 1:1 with red blood cells (RBCs) to manage trauma-induced coagulopathy in patients with severe blunt trauma. However, the benefits of a higher FFP to RBC ratio have not yet been established.
OBJECTIVE
To investigate the effectiveness of a high FFP to RBC transfusion ratio in the treatment of severe blunt trauma and explore the nonlinear relationship between the ratio of blood products used and patient outcomes.
DESIGN, SETTING, AND PARTICIPANTS: This was a multicenter cohort study retrospectively analyzing data from the Japan Trauma Data Bank, including adult patients with severe blunt trauma without severe head injury (Injury Severity Score ≥16 and head Abbreviated Injury Scale <3) between 2019 and 2022.
EXPOSURES
Patients were categorized into 2 groups based on the ratio of FFP to RBC: the high-FFP group (ratio >1) and the low-FFP group (ratio ≤1).
MAIN OUTCOMES AND MEASURES
All-cause in-hospital mortality was the primary outcome. Additionally, the occurrence of transfusion-related adverse events was evaluated.
RESULTS
Among the 1954 patients (median [IQR] age, 61 [41-77] years; 1243 male [63.6%]) analyzed, 976 (49.9%) had a high FFP to RBC ratio. Results from logistic regression, weighted by inverse probability treatment weighting, demonstrated an association between the group with a high-FFP ratio and lower in-hospital mortality (odds ratio, 0.73; 95% CI, 0.56-0.93) compared with a low-FFP ratio. Nonlinear trends were noted, suggesting a potential ceiling effect on transfusion benefits.
CONCLUSIONS AND RELEVANCE
In this cohort study, a high FFP to RBC ratio was associated with favorable survival in patients with severe blunt trauma. These outcomes highlight the importance of revising the current transfusion protocols to incorporate a high FFP to RBC ratio, warranting further research on optimal patient treatment.
重要性
目前的创伤救治方案提倡在输注红细胞（RBC）时，将新鲜冷冻血浆（FFP）与 RBC 的比例接近 1:1，以治疗严重钝性创伤患者的创伤诱导性凝血病。然而，较高的 FFP 与 RBC 比值的益处尚未得到证实。
目的
研究高 FFP 与 RBC 输注比值在治疗严重钝性创伤中的效果，并探讨使用血液制品比例与患者结局之间的非线性关系。
设计、设置和参与者：这是一项多中心队列研究，回顾性分析了日本创伤数据库中的数据，包括 2019 年至 2022 年期间无严重头部损伤的严重钝性创伤成年患者（损伤严重程度评分≥16 分和头部简明损伤评分<3 分）。
暴露
根据 FFP 与 RBC 的比值将患者分为 2 组：高 FFP 组（比值>1）和低 FFP 组（比值≤1）。
主要结局和测量
全因住院死亡率为主要结局。此外，评估了输血相关不良事件的发生情况。
结果
在纳入的 1954 例患者中（中位数[IQR]年龄，61[41-77]岁；男性 1243 例[63.6%]），976 例（49.9%）的 FFP 与 RBC 比值较高。通过逆概率治疗加权的逻辑回归结果表明，与低 FFP 比值相比，高 FFP 比值组的住院死亡率较低（比值比，0.73；95%CI，0.56-0.93）。注意到存在非线性趋势，提示输血效益可能存在上限效应。
结论和相关性
在这项队列研究中，FFP 与 RBC 的高比值与严重钝性创伤患者的生存获益相关。这些结果强调了修订当前输血方案以纳入高 FFP 与 RBC 比值的重要性，需要进一步研究以确定最佳患者治疗方法。
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