Abstract
BackgroundThe 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.MethodsIn 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.ResultsIn 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.ConclusionThe 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.
Highlights
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
A previous study using data from a Japanese administrative database, which included a large number of older adults, reported that a higher plasma-to-RBC ratio was associated with increased incidence of adverse events after Massive transfusion (MT) in a ratio-dependent manner [15]
Patients’ characteristics In total, 970,315 trauma patients were identified in the Trauma Quality Improvement Program (TQIP) database between 2013 and 2016, of which 17,154 received ≥ 5 units of RBC within 4 h or ≥ 10 units of RBC within 24 h of hospital arrival
Summary
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. Studies have demonstrated that an increased transfusion ratio of plasma-to-red blood cells (RBCs) may prevent the development of trauma-induced. A recent randomized controlled trial failed to show a clinically important difference in overall mortality between patients who received transfusion with a 1:1 blood product ratio of plasma and RBCs and those who received transfusion with a 1:2 ratio [9]. A previous study using data from a Japanese administrative database, which included a large number of older adults, reported that a higher plasma-to-RBC ratio was associated with increased incidence of adverse events after MT in a ratio-dependent manner [15]. Several investigators have documented increased mortality with increased age among trauma patients who received massive transfusions, the interaction between age and the effect of transfusion ratio has not been evaluated [16, 17]
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