Fresh frozen plasma is independently associated with a higher risk of multiple organ failure and acute respiratory distress syndrome.
BACKGROUND
Blood transfusion is known to be an independent risk factor for mortality, multiple organ failure (MOF), acute respiratory distress syndrome (ARDS), and nosocomial infection after injury. Less is known about the independent risks associated with plasma-rich transfusion components including fresh frozen plasma (FFP), platelets (PLTS), and cryoprecipitate (CRYO) after injury. We hypothesized that plasma-rich transfusion components would be independently associated with a lower risk of mortality but result in a greater risk of morbid complications.


METHODS
Data were obtained from a multicenter prospective cohort study evaluating clinical outcomes in bluntly injured adults with hemorrhagic shock. All patients required blood transfusion for enrollment. Patients with isolated traumatic brain injury and those not surviving beyond 48 hours were excluded. Cox proportional hazard regression models were used to estimate the outcome risks (per unit) associated with plasma-rich transfusion requirements during the initial 24 hours after injury after controlling for important confounders.


RESULTS
For the entire study population (n = 1,175), 65%, 41%, and 28% of patients received FFP, PLTS and CRYO, respectively. There was no association with plasma-rich transfusion components and mortality or nosocomial infection. For every unit given, FFP was independently associated with a 2.1% and 2.5% increased risk of MOF and ARDS, respectively. CRYO was associated with a 4.4% decreased risk of MOF (per unit), and PLTS were not associated with any of the outcomes examined. When early deaths (within 48 hours) were included in the model, FFP was associated with a 2.9% decreased risk of mortality per unit transfused.


CONCLUSIONS
In patients who survive their initial injury, FFP was independently associated with a greater risk of developing MOF and ARDS, whereas CRYO was associated with a lower risk of MOF. Further investigation into the mechanisms by which these plasma-rich component transfusions are associated with these effects are required.
Watson
Gregory A
GA
Division of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
Sperry
Jason L
JL
Rosengart
Matthew R
MR
Minei
Joseph P
JP
Harbrecht
Brian G
BG
Moore
Ernest E
EE
Cuschieri
Joseph
J
Maier
Ronald V
RV
Billiar
Timothy R
TR
Peitzman
Andrew B
AB
D000328:Adult; D016913:Blood Component Transfusion / Q000009:adverse effects*; D005169:Factor VIII; D005260:Female; D005340:Fibrinogen; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology*; D010949:Plasma; D017713:Platelet Transfusion; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000209:etiology*; D012307:Risk Factors; D012771:Shock, Hemorrhagic / Q000150:complications / Q000628:therapy*; D014949:Wounds, Nonpenetrating / Q000150:complications; D055815:Young Adult
C026912:cryoprecipitate coagulum; D005169:Factor VIII; D005340:Fibrinogen