Abstract
Objective
Transfusion research seeks to improve survival for severely injured and hemorrhaging
patients using optimal plasma and platelet ratios over red blood cells (RBCs). However,
most published studies comparing different ratios are plagued with serious bias and
ignore time-varying effects. We applied joint recurrent event frailty models to increase
validity and clinical utility.
Study Design and Setting
Using the PRospective Observational Multicenter Major Trauma Transfusion study data,
our joint random-effects models estimated the association of (1) clinical covariates
with transfusion rate intensities and (2) varying plasma:RBC and platelet:RBC ratios
with survival over the 24 hours after hospital admission. Along with survival time,
baseline patient vital signs, laboratory values, and longitudinal data on types and
volumes of transfusions were included.
Results
Baseline systolic blood pressure, heart rate, pH, and hemoglobin were significantly
associated with RBC transfusion rates. Increased transfusion rates (per hour) of plasma
(P = 0.05), platelets (P < 0.001), or RBCs were associated with increased 24-hour mortality. Higher ratios
of plasma:RBC (P = 0.107) and platelet:RBC (P < 0.001) were associated with reduced mortality in a time-varying pattern (P < 0.001).
Conclusions
The proposed joint analysis of transfusion rates and ratios offers a more valid statistical
approach to evaluate survival effects in the presence of informative censoring by
early death.
Keywords
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Article info
Publication history
Published online: April 28, 2016
Accepted:
March 11,
2016
Footnotes
Conflict of interest: None.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
