1. Older Blood Is Associated With Increased Mortality and Adverse Events in Massively Transfused Trauma Patients: Secondary Analysis of the PROPPR Trial
- Author
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Allison R. Jones, Rakesh P. Patel, Marisa B. Marques, John P. Donnelly, Russell L. Griffin, Jean-Francois Pittet, Jeffrey D. Kerby, Shannon W. Stephens, Stacia M. DeSantis, John R. Hess, Henry E. Wang, John B. Holcomb, Charles E. Wade, Deborah J. del Junco, Erin E. Fox, Nena Matijevic, Jeanette Podbielski, Angela M. Beeler, Barbara C. Tilley, Sarah Baraniuk, Hongjian Zhu, Joshua Nixon, Roann Seay, Savitri N. Appana, Hui Yang, Michael O. Gonzalez, Lisa Baer, Yao-Wei W. Wang, Brittany S. Hula, Elena Espino, An Nguyen, Nicholas Pawelczyk, Kisha D. Arora-Nutall, Rishika Sharma, Jessica C. Cardenas, Elaheh Rahbar, Tyrone Burnett, David Clark, Gerald van Belle, Susanne May, Brian Leroux, David Hoyt, Judy Powell, Kellie Sheehan, Alan Hubbard, Adam P. Arkin, Jeanne Callum, Bryan A. Cotton, Laura Vincent, Timothy Welch, Tiffany Poole, Evan G. Pivalizza, Sam D. Gumbert, Yu Bai, James J. McCarthy, Amy Noland, Rhonda Hobbs, Eileen M. Bulger, Patricia Klotz, Lindsay Cattin, Keir J. Warner, Angela Wilson, David Boman, Nathan White, Andreas Grabinsky, Jennifer A. Daniel-Johnson, Mitchell J. Cohen, Rachael A. Callcut, Mary Nelson, Brittney Redick, Amanda Conroy, Marc P. Steurer, Preston C. Maxim, Eberhard Fiebig, Joanne Moore, Eireen Mallari, Peter Muskat, Jay A. Johannigman, Bryce R.H. Robinson, Richard D. Branson, Dina Gomaa, Christopher Barczak, Suzanne Bennett, Patricia M. Carey, Christopher N. Miller, Helen Hancock, Carolina Rodriguez, Kenji Inaba, Jay G. Zhu, Monica D. Wong, Michael Menchine, Kelly Katzberg, Sean O. Henderson, Rodney McKeever, Ira A. Shulman, Janice M. Nelson, Christopher W. Tuma, Cheryl Y. Matsushita, Thomas M. Scalea, Deborah M. Stein, Cynthia K. Shaffer, Christine Wade, Anthony V. Herrera, Seeta Kallam, Sarah E. Wade, Samuel M. Galvagno, Magali J. Fontaine, Janice M. Hunt, Rhonda K. Cooke, Timothy C. Fabian, Jordan A. Weinberg, Martin A. Croce, Suzanne Wilson, Stephanie Panzer-Baggett, Lynda Waddle-Smith, Sherri Flax, Karen J. Brasel, Pamela Walsh, David Milia, Allia Nelson, Olga Kaslow, Tom P. Aufderheide, Jerome L. Gottschall, Erica Carpenter, Terence O’Keeffe, Laurel L. Rokowski, Kurt R. Denninghoff, Daniel T. Redford, Deborah J. Novak, Susan Knoll, Patrick L. Bosarge, Albert T. Pierce, Carolyn R. Williams, Martin A. Schreiber, Jennifer M. Watters, Samantha J. Underwood, Tahnee Groat, Craig Newgard, Matthias Merkel, Richard M. Scanlan, Beth Miller, Sandro Rizoli, Homer Tien, Barto Nascimento, Sandy Trpcic, Skeeta Sobrian-Couroux, Marciano Reis, Adic Pérez, Susan E. Belo, Lisa Merkley, and Connie Colavecchia
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Adult ,Male ,medicine.medical_specialty ,Critical Illness ,Logistic regression ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Trauma Centers ,Randomized controlled trial ,law ,Secondary analysis ,Internal medicine ,Odds Ratio ,medicine ,Humans ,Blood Transfusion ,Hospital Mortality ,030212 general & internal medicine ,Adverse effect ,business.industry ,030208 emergency & critical care medicine ,Odds ratio ,Middle Aged ,Revised Trauma Score ,Confidence interval ,Blood Preservation ,Emergency Medicine ,Injury Severity Score ,Female ,business - Abstract
Study objective The transfusion of older packed RBCs may be harmful in critically ill patients. We seek to determine the association between packed RBC age and mortality among trauma patients requiring massive packed RBC transfusion. Methods We analyzed data from the Pragmatic, Randomized Optimal Platelet and Plasma Ratios trial. Subjects in the parent trial included critically injured adult patients admitted to 1 of 12 North American Level I trauma centers who received at least 1 unit of packed RBCs and were predicted to require massive blood transfusion. The primary exposure was volume of packed RBC units transfused during the first 24 hours of hospitalization, stratified by packed RBC age category: 0 to 7 days, 8 to 14 days, 15 to 21 days, and greater than or equal to 22 days. The primary outcome was 24-hour mortality. We evaluated the association between transfused volume of each packed RBC age category and 24-hour survival, using random-effects logistic regression, adjusting for total packed RBC volume, patient age, sex, race, mechanism of injury, Injury Severity Score, Revised Trauma Score, clinical site, and trial treatment group. Results The 678 patients included in the analysis received a total of 8,830 packed RBC units. One hundred patients (14.8%) died within the first 24 hours. On multivariable analysis, the number of packed RBCs greater than or equal to 22 days old was independently associated with increased 24-hour mortality (adjusted odds ratio [OR] 1.05 per packed RBC unit; 95% confidence interval [CI] 1.01 to 1.08): OR 0.97 for 0 to 7 days old (95% CI 0.88 to 1.08), OR 1.04 for 8 to 14 days old (95% CI 0.99 to 1.09), and OR 1.02 for 15 to 21 days old (95% CI 0.98 to 1.06). Results of sensitivity analyses were similar only among patients who received greater than or equal to 10 packed RBC units. Conclusion Increasing quantities of older packed RBCs are associated with increased likelihood of 24-hour mortality in trauma patients receiving massive packed RBC transfusion (≥10 units), but not in those who receive fewer than 10 units.
- Published
- 2019
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