title: Impact of the duration of platelet storage in critically ill trauma patients.
abstract: BACKGROUND
  There is increasing evidence that the duration of red blood cell (RBC) storage negatively impacts outcomes. Data regarding prolonged storage of other blood components, however, are lacking. The aim of this study was to evaluate how the duration of platelet storage affects trauma patient outcomes.
  
  
  METHODS
  Trauma patients admitted to a Level I trauma center requiring platelet transfusion (2006-2009) were retrospectively identified. Apheresis platelets (aPLT) containing ≥3 × 10(11) platelets/unit were used exclusively. Patients were analyzed in three groups: those who received only aPLT stored for ≤3 days, 4 days, and 5 days. The outcomes included mortality and complications (sepsis, acute respiratory distress syndrome, renal, and liver failure).
  
  
  RESULTS
  Three hundred eighty-one patients were available for analysis (128 received aPLT ≤3 days old; 109 = 4 days old; and 144 = 5 days old). There were no significant demographic differences between groups. Patients receiving aPLT aged = 4 days had significantly higher Injury Severity Score (p = 0.022) and were more likely to have a head Abbreviated Injury Scale ≥3 (p = 0.014). There were no differences in volumes transfused or age of RBC, plasma, cryoprecipitate, or factor VIIa. After adjusting for confounders, exposure to older aPLT did not impact mortality; however, with increasing age, complications were significantly higher. The rate of sepsis, in particular, was significantly increased (5.5% for aPLT ≤3 days vs. 9.2% for aPLT = 4 days vs. 16.7% for aPLT = 5 days, adjusted p = 0.033). For acute respiratory distress syndrome and renal and liver failure, similar trends were observed.
  
  
  CONCLUSIONS
  In critically ill trauma patients, there was a stepwise increase in complications, in particular sepsis, with exposure to progressively older platelets. Further evaluation of the underlying mechanism and methods for minimizing exposure to older platelets is warranted.
authors.affiliation: Division of Trauma and Surgical Critical Care, University of Southern California, Los Angeles, California 90033-4525, USA. kinaba@surgery.usc.edu
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Bernardino C
authors.initials: BC
authors.lastname: Branco
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
authors.forename: Lorne H
authors.initials: LH
authors.lastname: Blackbourne
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
authors.forename: Philip C
authors.initials: PC
authors.lastname: Spinella
authors.forename: Ira
authors.initials: I
authors.lastname: Shulman
authors.forename: Janice
authors.initials: J
authors.lastname: Nelson
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001771:Blood Banks; D001793:Blood Preservation / Q000009:adverse effects* / Q000379:methods; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion / Q000009:adverse effects* / Q000379:methods*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors; D014193:Trauma Centers; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D055815:Young Adult