Older Blood Is Associated With Increased Mortality and Adverse Events in Massively Transfused Trauma Patients: Secondary Analysis of the PROPPR Trial

PROPPR Study Group

Research output: Contribution to journalArticle

3 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)650-661
Number of pages12
JournalAnnals of Emergency Medicine
Volume73
Issue number6
DOIs
StatePublished - Jun 1 2019

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Mortality
Odds Ratio
Confidence Intervals
Wounds and Injuries
Injury Severity Score
Compassion Fatigue
Trauma Centers
Critical Illness
Blood Transfusion
Hospitalization
Blood Platelets
Logistic Models
Clinical Trials
Survival
Therapeutics

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Older Blood Is Associated With Increased Mortality and Adverse Events in Massively Transfused Trauma Patients : Secondary Analysis of the PROPPR Trial. / PROPPR Study Group.

In: Annals of Emergency Medicine, Vol. 73, No. 6, 01.06.2019, p. 650-661.

Research output: Contribution to journalArticle

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title = "Older Blood Is Associated With Increased Mortality and Adverse Events in Massively Transfused Trauma Patients: Secondary Analysis of the PROPPR Trial",
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.",
author = "{PROPPR Study Group} and Jones, {Allison R.} and Patel, {Rakesh P.} and Marques, {Marisa B.} and Donnelly, {John P.} and Griffin, {Russell L.} and Pittet, {Jean Francois} and Kerby, {Jeffrey D.} and Stephens, {Shannon W.} and DeSantis, {Stacia M.} and Hess, {John R.} and Wang, {Henry E.} and Holcomb, {John B.} and Wade, {Charles E.} and {del Junco}, {Deborah J.} and Fox, {Erin E.} and Nena Matijevic and Jeanette Podbielski and Beeler, {Angela M.} and Tilley, {Barbara C.} and Sarah Baraniuk and Hongjian Zhu and Joshua Nixon and Roann Seay and Appana, {Savitri N.} and Hui Yang and Gonzalez, {Michael O.} and Lisa Baer and Wang, {Yao Wei W.} and Hula, {Brittany S.} and Elena Espino and An Nguyen and Nicholas Pawelczyk and Arora-Nutall, {Kisha D.} and Rishika Sharma and Cardenas, {Jessica C.} and Elaheh Rahbar and Tyrone Burnett and David Clark and {van Belle}, Gerald and Susanne May and Brian Leroux and David Hoyt and Judy Powell and Kellie Sheehan and Alan Hubbard and Arkin, {Adam P.} and Jeanne Callum and Cotton, {Bryan A.} and Laura Vincent and Terence OKeeffe",
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T1 - Older Blood Is Associated With Increased Mortality and Adverse Events in Massively Transfused Trauma Patients

T2 - Secondary Analysis of the PROPPR Trial

AU - PROPPR Study Group

AU - Jones, Allison R.

AU - Patel, Rakesh P.

AU - Marques, Marisa B.

AU - Donnelly, John P.

AU - Griffin, Russell L.

AU - Pittet, Jean Francois

AU - Kerby, Jeffrey D.

AU - Stephens, Shannon W.

AU - DeSantis, Stacia M.

AU - Hess, John R.

AU - Wang, Henry E.

AU - Holcomb, John B.

AU - Wade, Charles E.

AU - del Junco, Deborah J.

AU - Fox, Erin E.

AU - Matijevic, Nena

AU - Podbielski, Jeanette

AU - Beeler, Angela M.

AU - Tilley, Barbara C.

AU - Baraniuk, Sarah

AU - Zhu, Hongjian

AU - Nixon, Joshua

AU - Seay, Roann

AU - Appana, Savitri N.

AU - Yang, Hui

AU - Gonzalez, Michael O.

AU - Baer, Lisa

AU - Wang, Yao Wei W.

AU - Hula, Brittany S.

AU - Espino, Elena

AU - Nguyen, An

AU - Pawelczyk, Nicholas

AU - Arora-Nutall, Kisha D.

AU - Sharma, Rishika

AU - Cardenas, Jessica C.

AU - Rahbar, Elaheh

AU - Burnett, Tyrone

AU - Clark, David

AU - van Belle, Gerald

AU - May, Susanne

AU - Leroux, Brian

AU - Hoyt, David

AU - Powell, Judy

AU - Sheehan, Kellie

AU - Hubbard, Alan

AU - Arkin, Adam P.

AU - Callum, Jeanne

AU - Cotton, Bryan A.

AU - Vincent, Laura

AU - OKeeffe, Terence

PY - 2019/6/1

Y1 - 2019/6/1

N2 - 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.

AB - 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.

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