Effect of blood products transfusion on the development of postinjury multiple organ failure.
OBJECTIVE
Transfusion of fresh frozen plasma (FFP) and platelets is independently associated with the development of multiple organ failure (MOF) in critically injured patients.


METHODS
Prospective cohort study.


METHODS
Academic regional level I trauma center.


METHODS
From 1992 to 2004, a total of 1440 critically injured patients were admitted to our surgical intensive care unit and survived at least 48 hours. Of these, 1415 had complete data on age, Injury Severity Score (ISS), and units of FFP, platelets, and packed red blood cells (PRBCs) transfused. Multiple organ failure was defined using the Denver MOF score. Multiple logistic regression analysis was used to adjust transfusion of FFP, platelets, and PRBCs for known MOF risk factors.


METHODS
Multiple organ failure.


RESULTS
The mean (SD) ISS was 29.3 (11.3), and the mean (SD) patient age was 37.4 (16.6) years. Among 1440 patients, 346 (24.0%) developed MOF, and 118 (8.2%) died. Multiple logistic regression analysis detected a significant interaction between units of FFP and PRBCs transfused (P < .001). Regardless of the units of PRBCs transfused, FFP transfusion was independently associated with the development of MOF. However, the deleterious effect associated with FFP transfusion was more prominent among patients receiving fewer than 6 U of PRBCs. Platelet transfusion was unassociated with MOF after adjustment for age, ISS, and FFP and PRBC transfusion.


CONCLUSIONS
Early transfusion of FFP is associated with an increased risk of postinjury MOF, even after adjusting for age, ISS, and PRBC transfusion. Caution is warranted in developing protocols for empirical FFP transfusion. Specifically, transfusion triggers for FFP should be reexamined, as well as the practice of delivering FFP in fixed ratios to the units of PRBCs transfused.
Johnson
Jeffrey L
JL
Department of Surgery, University of Colorado Denver, USA.
Moore
Ernest E
EE
Kashuk
Jeffry L
JL
Banerjee
Anirban
A
Cothren
C Clay
CC
Biffl
Walter L
WL
Sauaia
Angela
A
D000328:Adult; D016913:Blood Component Transfusion / Q000009:adverse effects*; D016638:Critical Illness / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D009102:Multiple Organ Failure / Q000453:epidemiology / Q000209:etiology*; D010949:Plasma; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D015599:Trauma Severity Indices; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000175:diagnosis / Q000628:therapy*