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Outcomes of patients receiving a massive transfusion for major trauma. BJS 2018; 105: 1426-1434.

Published: 12th July 2018

Authors: A. Endo, A. Shiraishi, K. Fushimi, K. Murata, Y. Otomo


The benefits of high transfusion ratios (plasma to red blood cells and platelets to red blood cells) on survival in injured patients who receive massive transfusions remain uncertain. This study aimed to assess the association between transfusion ratios and adverse events and survival in patients undergoing massive transfusion for major trauma.


A retrospective observational study was conducted on patients who had major trauma using a Japanese national administrative database. The associations between transfusion ratios and outcomes (in‐hospital mortality and incidence of adverse events) were analysed using a non‐linear logistic generalized additive model (GAM). In a logistic generalized estimating equation model, adjusted for patient and hospital‐level confounders, transfusion ratios were included as continuous or categorical variables (low, transfusion ratio 0·75 or less; intermediate, over 0·75 to 1·25; high, over 1·25).


Some 1777 patients were included in the analysis, of whom 602 died in hospital. GAM plots of the transfusion ratios for in‐hospital mortality demonstrated a downward convex unimodal curve. In‐hospital mortality was similar with increasing transfusion ratios for plasma (adjusted odds ratio (OR) 1·13, 95 per cent c.i. 0·82 to 1·55; P = 0·446) and platelets (adjusted OR 0·84, 0·66 to 1·08; P = 0·171). Both plasma to red blood cell ratio (adjusted OR 1·77, 1·32 to 2·37; P < 0·001) and platelet to red blood cell ratio (adjusted OR 1·71, 1·35 to 2·15; P < 0·001) were significantly associated with a higher incidence of adverse events. No significant differences in in‐hospital mortality were observed between the three transfusion categories (low, medium and high).


In this study, transfusion strategies with high plasma to red blood cell and platelet to red blood cell ratios did not have survival benefits, but were associated with an increase in adverse events.

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