ImportanceCurrent trauma-care protocols advocate early administration of fresh frozen plasma (FFP) in a ratio close to 1:1 with red blood cells (RBCs) to manage trauma-induced coagulopathy in patients with severe blunt trauma. However, the benefits of a higher FFP to RBC ratio have not yet been established.ObjectiveTo investigate the effectiveness of a high FFP to RBC transfusion ratio in the treatment of severe blunt trauma and explore the nonlinear relationship between the ratio of blood products used and patient outcomes.Design, Setting, and ParticipantsThis was a multicenter cohort study retrospectively analyzing data from the Japan Trauma Data Bank, including adult patients with severe blunt trauma without severe head injury (Injury Severity Score ≥16 and head Abbreviated Injury Scale <3) between 2019 and 2022.ExposuresPatients were categorized into 2 groups based on the ratio of FFP to RBC: the high-FFP group (ratio >1) and the low-FFP group (ratio ≤1).Main Outcomes and MeasuresAll-cause in-hospital mortality was the primary outcome. Additionally, the occurrence of transfusion-related adverse events was evaluated.ResultsAmong the 1954 patients (median [IQR] age, 61 [41-77] years; 1243 male [63.6%]) analyzed, 976 (49.9%) had a high FFP to RBC ratio. Results from logistic regression, weighted by inverse probability treatment weighting, demonstrated an association between the group with a high-FFP ratio and lower in-hospital mortality (odds ratio, 0.73; 95% CI, 0.56-0.93) compared with a low-FFP ratio. Nonlinear trends were noted, suggesting a potential ceiling effect on transfusion benefits.Conclusions and RelevanceIn this cohort study, a high FFP to RBC ratio was associated with favorable survival in patients with severe blunt trauma. These outcomes highlight the importance of revising the current transfusion protocols to incorporate a high FFP to RBC ratio, warranting further research on optimal patient treatment.

中文翻译：

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钝挫伤中新鲜冰冻血浆与红细胞的高比值和生存结局


重要性目前的创伤护理方案提倡以接近 1：1 的比例早期施用新鲜冰冻血浆 （FFP） 和红细胞 （RBC），以治疗严重钝挫伤患者的创伤性凝血病。然而，较高的 FFP/RBC 比值的好处尚未确定。目的探讨高 FFP 与 RBC 输注比值治疗严重钝挫伤的有效性，并探讨所用血液制品比值与患者预后之间的非线性关系。设计、设置和参与者这是一项多中心队列研究，回顾性分析了来自日本创伤数据库的数据，包括没有严重头部损伤的严重钝挫伤成年患者（损伤严重程度评分 ≥16 和头部缩写损伤量表 <3） 在 2019 年至 2022 年期间，暴露根据 FFP 与 RBC 的比率将患者分为 2 组：高 FFP 组（比率 >1） 和低 FFP 组（比率 ≤1）。主要结局和指标全因院内死亡率是主要结局。此外，还评估了输血相关不良事件的发生率。结果在分析的 1954 例患者 （中位 [IQR] 年龄，61 [41-77] 岁;1243 例男性 [63.6%]） 中，976 例 （49.9%） 具有较高的 FFP 与 RBC 比值。由逆概率治疗加权的 logistic 回归结果表明，与低 FFP 比相比，高 FFP 比值组与较低院内死亡率 （比值比，0.73;95% CI，0.56-0.93） 之间存在关联。注意到非线性趋势，表明对输血益处的潜在上限效应。结论和相关性在这项队列研究中，高 FFP 与 RBC 比值与严重钝挫伤患者的良好生存率相关。 这些结果突出了修改当前输血方案以纳入高 FFP 与 RBC 比率的重要性，因此需要进一步研究最佳患者治疗。