CAN EARLY AGGRESSIVE ADMINISTRATION OF FRESH FROZEN PLASMA IMPROVE OUTCOMES IN SEVERE TRAUMA?

Abstract

  Background : This study investigated to the effect of high ratio of FFP to RBC within the first 6 h and 24 h after admission on mortality in patients with severe trauma (ISS≥16), mostly consisted with blunt trauma patients. Methods : This retrospective observational study included 207 (97 % blunt trauma) trauma patients with ISS≥16 requiring transfusion of RBCs within the first 24 h. Receiver operating characteristic (ROC) curve analysis was performed to calculate cut–off values for the FFP/RBC ratio at the first 6 h as an independent variable for outcome at discharge as a response variable. Thereafter, the patients were divided into two groups according to the FFP/RBC ratio cut–off value. These two groups were matched by caliper propensity score matching (PSM). Differences in the survival time between the two groups were compared by the log–rank test. Results : The area under the curve (AUC) was 0.56, and the FFP/RBC ratio was 1.0 at maximum sensitivity (0.59) and specificity (0.67). Based on this value of the ratio, all patients were divided into two groups, with an FFP/RBC ratio≥1 or with an FFP/RBC ratio<1, and analyzed using Propensity Score Matching (PSM) and Inverse Probability of Treatment Weighting (IPTW). The unadjusted hazard ratio was 0.44, and the hazard ratio after adjustment was 0.32. The hazard ratio was 0.38 by PSM and 0.41 by IPTW. The survival rate was significantly higher in patients with an FFP/RBC ratio≥1 within the first 6 h. Conclusion : Patients transfused with an FFP/RBC ratio≥1 within the first 6 h had a hazard ratio of about 0.4. In other words, their risk of death was reduced by about 60%. Even in the population in which a distribution ratio of patients with blunt trauma was very high, the transfusion of an FFP/RBC ratio≥1 within the first 6 h could improve the outcome of blunt trauma patients who have ISS≥16 and need a transfusion within 24 h.