title: Gender-based differences in mortality in response to high product ratio massive transfusion.
abstract: BACKGROUND
  Recent data suggest that patients undergoing massive transfusion have lower mortality rates when ratios of plasma and platelets to red blood cells (RBCs) of ≥ 1:2 are used. This has not been examined independently in women and men. A gender dichotomy in outcome after severe injury is known to exist. This study examined gender-related differences in mortality after high product ratio massive transfusion.
  
  
  METHODS
  A retrospective study was conducted using a database containing massively transfused trauma patients from 23 Level I trauma centers. Baseline demographic, physiologic, and biochemical data were obtained. Univariate and logistic regression analyses were performed. Adjusted mortality in patients receiving high (≥ 1:2) or low (<1:2) ratios of plasma or platelets to RBCs was compared in women and men independently.
  
  
  RESULTS
  Seven hundred four patients were analyzed. In males, mortality was lower for patients receiving a high plasma:RBC ratio at 24 hours (20.6% vs. 33.0% for low ratio, p = 0.005) and at 30 days (34.9% vs. 42.8%, p = 0.032). Males receiving a high platelet:RBC ratio also had lower 24-hour mortality (17.6% vs. 31.5%, p = 0.004) and 30-day mortality (32.1% vs. 42.2%, p = 0.045). Females receiving high ratios of plasma or platelets to RBCs had no improvement in 24-hour mortality (p = 0.119 and 0.329, respectively) or 30-day mortality (p = 0.199 and 0.911, respectively). Use of high product ratio transfusions did not affect 24-hour RBC requirements in males or females.
  
  
  CONCLUSIONS
  Use of high plasma:RBC or platelet:RBC ratios in massive transfusion may benefit men more than women. This may be due to gender-related differences in coagulability. Further study is needed to determine whether separate protocols for women and men should be established.
authors.affiliation: Department of Surgery, Oregon Health and Science University, Portland, Oregon 97239, USA. rowells@ohsu.edu.
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mesh_terms: D000328:Adult; D001803:Blood Transfusion; D004906:Erythrocyte Count; D005260:Female; D006470:Hemorrhage / Q000097:blood / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D012189:Retrospective Studies; D012737:Sex Factors; D015996:Survival Rate; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000097:blood / Q000401:mortality* / Q000628:therapy*; D055815:Young Adult