Gallagher Shea, Dilday Joshua, Ugarte Chaiss, Park Stephen, Siletz Anaar, Matsushima Kazuhide, Schellenberg Morgan, Inaba Kenji, Hazelton Joshua P, Oh John, Gurney Jennifer, Martin Matthew J
From the Division of Trauma and Acute Care Surgery, Department of Surgery (S.G., J.D., C.U., S.P., A.S., K.M., M.S., K.I., M.J.M.), Los Angeles General Medical Center, Los Angeles, California; Division of Trauma and Acute Care Surgery, Department of Surgery (J.D.), Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Trauma & Critical Care Surgery, Department of Surgery (J.P.H.), WellSpan York, York; Division of Trauma and Acute Care Surgery, Department of Surgery (J.O.), Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania; and Department of Surgery (J.G.), Joint Trauma System, San Antonio, Texas.
J Trauma Acute Care Surg. 2025 Feb 1;98(2):263-270. doi: 10.1097/TA.0000000000004431. Epub 2024 Sep 3.
Resuscitation with cold-stored whole blood (WB) has outcome benefits, but benefits varied by patient sex is unknown. There are also concerns about alloimmunization risk for premenopausal females given WB, leading to some protocols excluding this cohort. We sought to analyze WB utilization, outcomes, and disparities by patient sex.
This is a secondary analysis of a prospective multicenter study of WB resuscitation. Patients were stratified by sex and compared by transfusion strategy of WB or component therapy (CT). Generalized estimated equation models using inverse probability of treatment weighting were utilized.
There were 1,617 patients (83% male; 17% female) included. Females were less likely to receive WB versus males (55% vs. 76%; p < 0.001), with wide variability between individual centers (0%-33% female vs. 66%-100% male, p < 0.01). Male WB had more blunt trauma (45% vs. 31%) and higher shock index (1.0 vs. 0.8) compared with the male CT cohort (all p < 0.05) but similar Injury Severity Score. The female WB cohort was older (53 vs. 36) and primarily blunt trauma (77% vs. 62%) compared with the female CT cohort (all p < 0.05) but had similar shock index and Injury Severity Score. Male WB had lower early and overall mortality (27% vs. 42%), but a higher rate of acute kidney injury (16% vs. 6%) vs. the male CT cohort (all p < 0.01). Female cohorts had no difference in mortality, but the WB cohort had higher bleeding complications. Whole blood use was independently associated with decreased mortality (OR, 0.6; p < 0.01) for males but not for females (OR, 0.9; p = 0.78).
Whole blood was independently associated with a decreased mortality for males with no difference identified for females. Whole blood was significantly less utilized in females and showed wide variability between centers. Further study of the impact of patient sex on outcomes with WB and WB utilization is needed.
Prognostic and Epidemiological; Level IV.
使用冷保存全血（WB）进行复苏对预后有益，但益处是否因患者性别而异尚不清楚。对于绝经前女性输注WB还存在同种免疫风险的担忧，这导致一些方案将该队列排除在外。我们试图分析WB的使用情况、预后以及患者性别差异。
这是一项对WB复苏的前瞻性多中心研究的二次分析。患者按性别分层，并根据WB或成分输血疗法（CT）的输血策略进行比较。使用治疗加权逆概率的广义估计方程模型。
共纳入1617例患者（83%为男性；17%为女性）。与男性相比，女性接受WB的可能性较小（55%对76%；p<0.001），各中心之间差异很大（女性为0%-33%，男性为66%-100%，p<0.01）。与男性CT队列相比，男性WB组钝性创伤更多（45%对31%），休克指数更高（1.0对0.8）（均p<0.05），但损伤严重程度评分相似。与女性CT队列相比，女性WB队列年龄更大（53岁对36岁），主要为钝性创伤（77%对62%）（均p<0.05），但休克指数和损伤严重程度评分相似。男性WB组早期和总体死亡率较低（27%对42%），但与男性CT队列相比，急性肾损伤发生率较高（16%对6%）（均p<0.01）。女性队列的死亡率无差异，但WB队列出血并发症较多。全血使用与男性死亡率降低独立相关（OR，0.6；p<0.01），但与女性无关（OR，0.9；p=0.78）。
全血与男性死亡率降低独立相关，女性无差异。女性使用全血的比例明显较低，且各中心之间差异很大。需要进一步研究患者性别对WB预后和WB使用的影响。
预后和流行病学；四级。
