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Fresh Frozen Plasma Is Independently Associated With a Higher Risk of Multiple Organ Failure and Acute Respiratory Distress Syndrome

Watson, Gregory A. MD; Sperry, Jason L. MD, MPH; Rosengart, Matthew R. MD, MPH; Minei, Joseph P. MD; Harbrecht, Brian G. MD; Moore, Ernest E. MD; Cuschieri, Joseph MD; Maier, Ronald V. MD; Billiar, Timothy R. MD; Peitzman, Andrew B. MDThe Inflammation and the Host Response to Injury Investigators

Journal of Trauma and Acute Care Surgery: August 2009 - Volume 67 - Issue 2 - p 221-230
doi: 10.1097/TA.0b013e3181ad5957
Original Article

Background: Blood transfusion is known to be an independent risk factor for mortality, multiple organ failure (MOF), acute respiratory distress syndrome (ARDS), and nosocomial infection after injury. Less is known about the independent risks associated with plasma-rich transfusion components including fresh frozen plasma (FFP), platelets (PLTS), and cryoprecipitate (CRYO) after injury. We hypothesized that plasma-rich transfusion components would be independently associated with a lower risk of mortality but result in a greater risk of morbid complications.

Methods: Data were obtained from a multicenter prospective cohort study evaluating clinical outcomes in bluntly injured adults with hemorrhagic shock. All patients required blood transfusion for enrollment. Patients with isolated traumatic brain injury and those not surviving beyond 48 hours were excluded. Cox proportional hazard regression models were used to estimate the outcome risks (per unit) associated with plasma-rich transfusion requirements during the initial 24 hours after injury after controlling for important confounders.

Results: For the entire study population (n = 1,175), 65%, 41%, and 28% of patients received FFP, PLTS and CRYO, respectively. There was no association with plasma-rich transfusion components and mortality or nosocomial infection. For every unit given, FFP was independently associated with a 2.1% and 2.5% increased risk of MOF and ARDS, respectively. CRYO was associated with a 4.4% decreased risk of MOF (per unit), and PLTS were not associated with any of the outcomes examined. When early deaths (within 48 hours) were included in the model, FFP was associated with a 2.9% decreased risk of mortality per unit transfused.

Conclusions: In patients who survive their initial injury, FFP was independently associated with a greater risk of developing MOF and ARDS, whereas CRYO was associated with a lower risk of MOF. Further investigation into the mechanisms by which these plasma-rich component transfusions are associated with these effects are required.

From the Division of General Surgery and Trauma, Department of Surgery (G.A.W., J.L.S., M.R.R., T.R.B., A.B.P.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Division of Burn, Trauma, Critical Care, Department of Surgery (J.P.M.), University of Texas Southwestern Medical Center, Dallas, Texas; Division of General Surgery and Trauma, Department of Surgery (B.G.H.), University of Louisville, Louisville, Kentucky; Department of Surgery (E.E.M.), Denver Health Medical Center and The University of Colorado Health Sciences Center, Denver, Colorado; and Division of General Surgery and Trauma (J.C., R.V.M.), Harborview Medical Center and Department of Surgery (J.C., R.V.M.), University of Washington, Seattle, Washington.

Submitted for publication October 6, 2008.

Accepted for publication March 5, 2009.

The first two authors contributed equally to this work.

Presented at the 67th Annual Meeting of the American Association for the Surgery of Trauma, September 24–27, 2008, Maui, Hawaii.

Supported by the National Institutes of Health (NIH NIGMS U54 GM062119-1 and NIH KL2 RR024154-03).

Address for reprints: Jason L. Sperry, MD, MPH, Division of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213; email:

© 2009 Lippincott Williams & Wilkins, Inc.