The survival impact of plasma to red blood cell ratio in massively transfused non-trauma patients.

Abstract

High ratios of Plasma to Packed Red Blood Cells (FFP:PRBC) improve survival in massively transfused trauma patients. We hypothesized that non-trauma patients also benefit from this transfusion strategy. Non-trauma patients requiring massive transfusion from November 2003 to September 2011 were reviewed. Logistic regression was performed to identify independent predictors of mortality. The population was stratified using two FFP:PRBC ratio cut-offs (1:2 and 1:3) and adjusted mortality derived. Over 8years, 29% (260/908) of massively transfused surgical patients were non-trauma patients. Mortality decreased with increasing FFP:PRBC ratios (45% for ratio ≤1:8, 33% for ratio >1:8 and ≤1:3, 27% for ratio >1:3 and ≤1:2 and 25% for ratio >1:2). Increasing FFP:PRBC ratio independently predicted survival (AOR [95% CI]: 1.91 [1.35-2.71]; p<0.001). Patients achieving a ratio >1:3 had improved survival (AOR [95% CI]: 3.24 [1.24-8.47]; p=0.016). In non-trauma patients undergoing massive transfusion, increasing FFP:PRBC ratio was associated with improved survival. A ratio >1:3 significantly improved survival probability.