title: An FFP:PRBC transfusion ratio >/=1:1.5 is associated with a lower risk of mortality after massive transfusion.
abstract: OBJECTIVE
  The detrimental effects of coagulopathy, hypothermia, and acidosis are well described as markers for mortality after traumatic hemorrhage. Recent military experience suggests that a high fresh frozen plasma (FFP):packed red blood cell (PRBC) transfusion ratio improves outcome; however, the appropriate ratio these transfusion products should be given remains to be established in a civilian trauma population.
  
  
  METHODS
  Data were obtained from a multicenter prospective cohort study evaluating clinical outcomes in blunt injured adults with hemorrhagic shock. Those patients who required >/=8 units PRBCs within the first 12 hours postinjury were analyzed (n = 415).
  
  
  RESULTS
  Patients who received transfusion products in >/=1:1.50 FFP:PRBC ratio (high F:P ratio, n = 102) versus <1:1.50 FFP:PRBC ratio (low F:P, n = 313) required significantly less blood transfusion at 24 hours (16 +/- 9 units vs. 22 +/- 17 units, p = 0.001). Crude mortality differences between the groups did not reach statistical significance (high F:P 28% vs. low F:P 35%, p = 0.202); however, there was a significant difference in early (24 hour) mortality (high F:P 3.9% vs. low F:P 12.8%, p = 0.012). Cox proportional hazard regression revealed that receiving a high F:P ratio was independently associated with 52% lower risk of mortality after adjusting for important confounders (HR 0.48, p = 0.002, 95% CI 0.3-0.8). A high F:P ratio was not associated with a higher risk of organ failure or nosocomial infection, however, was associated with almost a twofold higher risk of acute respiratory distress syndrome, after controlling for important confounders.
  
  
  CONCLUSIONS
  In patients requiring >/=8 units of blood after serious blunt injury, an FFP:PRBC transfusion ratio >/=1:1.5 was associated with a significant lower risk of mortality but a higher risk of acute respiratory distress syndrome. The mortality risk reduction was most relevant to mortality within the first 48 hours from the time of injury. These results suggest that the mortality risk associated with an FFP:PRBC ratio <1:1.5 may occur early, possibly secondary to ongoing coagulopathy and hemorrhage. This analysis provides further justification for the prospective trial investigation into the optimal FFP:PRBC ratio required in massive transfusion practice.
authors.affiliation: Division of General Surgery and Trauma, Departments of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. sperryjl@upmc.edu
authors.forename: Jason L
authors.initials: JL
authors.lastname: Sperry
authors.forename: Juan B
authors.initials: JB
authors.lastname: Ochoa
authors.forename: Scott R
authors.initials: SR
authors.lastname: Gunn
authors.forename: Louis H
authors.initials: LH
authors.lastname: Alarcon
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Minei
authors.forename: Joseph
authors.initials: J
authors.lastname: Cuschieri
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Rosengart
authors.forename: Ronald V
authors.initials: RV
authors.lastname: Maier
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Billiar
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Peitzman
authors.forename: Ernest E
authors.initials: EE
authors.lastname: Moore
mesh_terms: D000328:Adult; D016913:Blood Component Transfusion / Q000379:methods / Q000401:mortality*; D017707:Erythrocyte Transfusion / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010949:Plasma; D011446:Prospective Studies; D012771:Shock, Hemorrhagic / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000628:therapy*