Early Fresh Frozen Plasma Transfusion: Is It Associated With Improved Outcomes of Patients With Sepsis?

Xiaoyi Qin,Xiaodan Zhu,Wei Zhang,Xiang Hu,Wei Zhou

doi:10.3389/fmed.2021.754859

Abstract

Background: So far, no study has investigated the effects of plasma transfusion in the patients with sepsis, especially in the terms of prognosis. Therefore, we aimed to explore the association of early fresh frozen plasma (FFP) transfusion with the outcomes of patients with sepsis.Methods: We performed a cohort study using data extracted from the Medical Information Mart for Intensive Care III database (v1.4). External validation was obtained from the First Affiliated Hospital of Wenzhou Medical University, China. We adopted the Sepsis-3 criteria to extract the patients with sepsis and septic shock. The occurrence of transfusion during the first 3-days of intensive care unit (ICU) stay was regarded as early FFP transfusion. The primary outcome was 28-day mortality. We assessed the association of early FFP transfusion with the patient outcomes using a Cox regression analysis. Furthermore, we performed the sensitivity analysis, subset analysis, and external validation to verify the true strength of the results.Results: After adjusting for the covariates in the three models, respectively, the significantly higher risk of death in the FFP transfusion group at 28-days [e.g., Model 2: hazard ratio (HR) = 1.361, P = 0.018, 95% CI = 1.054–1.756] and 90-days (e.g., Model 2: HR = 1.368, P = 0.005, 95% CI = 1.099–1.704) remained distinct. Contrarily, the mortality increased significantly with the increase of FFP transfusion volume. The outcomes of the patients with sepsis with hypocoagulable state after early FFP transfusion were not significantly improved. Similar results can also be found in the subset analysis of the septic shock cohort. The results of external validation exhibited good consistency.Conclusions: Our study provides a new understanding of the rationale and effectiveness of FFP transfusion for the patients with sepsis. After recognizing the evidence of risk-benefit and cost-benefit, it is important to reduce the inappropriate use of FFP and avoid unnecessary adverse transfusion reactions.

Highlights

Sepsis, a syndrome of pathophysiological abnormalities and severe organ dysfunction induced by infection, leads to high incidence and mortality rates worldwide [1,2,3,4]
We performed a retrospective cohort study using data extracted from the Medical Information Mart for Intensive Care III (MIMIC III) database (v1.4) which integrated deidentified and Abbreviations: APACHE II, Acute Physiology and Chronic Health Evaluation II; BIDMC, Beth Israel Deaconess Medical Center; CIs, confidence intervals; FFP, fresh frozen plasma; GCS, Glasgow coma scale; HRs, hazard ratios; ICU, intensive care unit; INR, international normalized ratio; inter-quartile ranges (IQRs), interquartile ranges; K–M, Kaplan–Meier; LOS, length of stay; MIMIC III, Medical Information Mart for Intensive Care III; ORs, odds ratios; PTT, partial thromboplastin time; SAPS II, Simplified Acute Physiology Score II; SOFA, Sequential Organ Failure Assessment; and TRALI, transfusion-related acute lung injury
Through the data analyses of dual centers and dual populations, the present study uncovered for the first time that for the patients with sepsis with coagulopathy, early FFP transfusion cannot improve the outcomes and was unfavorable

Summary

Introduction

A syndrome of pathophysiological abnormalities and severe organ dysfunction induced by infection, leads to high incidence and mortality rates worldwide [1,2,3,4]. Plasma transfusion instead of other blood products is associated with the decreased mortality in trauma patients [10, 11]. Dara SI et al considered that the risk-benefit ratio of fresh frozen plasma (FFP) transfusion in the patients with critical illness with coagulopathy may not be favorable [12]. This contradiction may attribute to the adverse effects accompanied by plasma transfusion in aspects of infections, immunomodulation, allergic reactions, circulatory overload, and citrate toxicity [13]. We aimed to explore the association of early fresh frozen plasma (FFP) transfusion with the outcomes of patients with sepsis

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Discussion

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