Increased Platelet:RBC Ratios Are Associated With Improved Survival After Massive Transfusion
Increased Platelet:RBC Ratios Are Associated With Improved Survival After Massive Transfusion
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DOI：
10.1097/ta.0b013e318227edbb
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发表时间：
2011-08-01
影响因子：
--
通讯作者：
Wade, Charles E.
中科院分区：
文献类型：
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作者：
Holcomb, John B.;Zarzabal, Lee A.;Wade, Charles E.
背景资料：最近的几项军事和民用创伤研究表明，改善的结果与早期和增加使用基于血浆的复苏策略有关。然而，与血小板输注相关的结局特征不佳。我们假设血小板：红细胞（RBC）比率的增加将减少出血性死亡并提高大量输血（MT）后的生存率。方法：回顾了2005年至2006年12个月内从现场运送到22个一级创伤中心的患者的输血数据库。MT定义为在入院后24小时内接受≥ 10个RBC单位。为了减轻生存偏倚，25名在到达后60分钟内死亡的患者被排除在分析之外。认为6个随机供体血小板单位等于1个单采血小板单位。对低（> 1：20）、中（1：2）和高（1：1）血小板：红细胞比率相关的入院和结局数据进行了检查。这些群体的基础上的三分位数的血小板：红细胞units.Results的比例的中位数：23012例患者接受至少一个单位的血液和643接受MT。血小板比率组之间的入院生命体征、INR、体温、pH值、格拉斯哥昏迷评分、损伤严重程度评分和年龄相似。接受高血小板：红细胞比率的患者的平均入院血小板计数低于接受低比率的患者（192 vs. 216，p = 0.03）。接受MT的患者严重受伤，平均（+/-标准差）损伤严重程度评分为33 +/- 16，并在受伤后24小时内接受了22 +/- 15 RBC和11 +/- 14血小板。血小板比率增加与24小时和30天生存率的改善相关（两者均为p < 0.001）。作为死亡原因的躯干出血减少（低：67%，中：60%，高：47%，p = 0.04）。多器官衰竭死亡率增加（低：7%，中：16%，高：27%，p = 0.003），但总的30天生存率提高（低：52%，中：57%，高：70%）（中对高：p = 0.008;低对高：p = 0.007）。1与早期和晚期生存率的改善、出血性死亡率的降低以及多器官衰竭相关死亡率的增加相关。基于这项大型回顾性研究，在等待前瞻性随机输血数据的结果之前，增加和早期使用血小板可能是合理的。
Background: Several recent military and civilian trauma studies demonstrate that improved outcomes are associated with early and increased use of plasma-based resuscitation strategies. However, outcomes associated with platelet transfusions are poorly characterized. We hypothesized that increased platelet:red blood cells (RBC) ratios would decrease hemorrhagic death and improve survival after massive transfusion (MT).Methods: A transfusion database of patients transported from the scene to 22 Level I Trauma Centers over 12 months in 2005 to 2006 was reviewed. MT was defined as receiving >= 10 RBC units within 24 hours of admission. To mitigate survival bias, 25 patients who died within 60 minutes of arrival were excluded from analysis. Six random donor platelet units were considered equal to a single apheresis platelet unit. Admission and outcome data associated with the low (> 1:20), medium (1:2), and high (1:1) platelet:RBC ratios were examined. These groups were based on the median value of the tertiles for the ratio of platelets:RBC units.Results: Two thousand three hundred twelve patients received at least one unit of blood and 643 received an MT. Admission vital signs, INR, temperature, pH, Glasgow Coma Scale, Injury Severity Score, and age were similar between platelet ratio groups. The average admission platelet counts were lower in the patients who received the high platelet:RBC ratio versus the low ratio (192 vs. 216, p = 0.03). Patients who received MT were severely injured, with a mean (+/- standard deviation) Injury Severity Score of 33 +/- 16 and received 22 +/- 15 RBCs and 11 +/- 14 platelets within 24 hours of injury. Increased platelet ratios were associated with improved survival at 24 hours and 30 days (p < 0.001 for both). Truncal hemorrhage as a cause of death was decreased (low: 67%, medium: 60%, high: 47%, p = 0.04). Multiple organ failure mortality was increased (low: 7%, medium: 16%, high: 27%, p = 0.003), but overall 30-day survival was improved (low: 52%, medium: 57%, high: 70%) in the high ratio group (medium vs. high: p = 0.008; low vs. high: p = 0.007).Conclusion: Similar to recently published military data, transfusion of platelet:RBC ratios of 1:1 was associated with improved early and late survival, decreased hemorrhagic death and a concomitant increase in multiple organ failure-related mortality. Based on this large retrospective study, increased and early use of platelets may be justified, pending the results of prospective randomized transfusion data.