Impact of platelet transfusion on outcomes in trauma patients

Critical Care

J. Duranteau¹  B. Vigué¹  H. Nougue²  D. Garrigue³  A. Meyer⁴  M. Boutonnet⁵  E. Meaudre⁶  A. Culver⁷  E. Gaertner⁸  G. Audibert⁹  A. Godier^1,10  S. R. Hamada^1,11 

[1] AP-HP, Département d’Anesthésie Réanimation, Hôpital du Kremlin Bicêtre, Le Kremlin-Bicêtre, France;AP-HP, Service d’Anesthésie Réanimation, HEGP, Paris, France;CHU de Lille, Pôle d’Anesthésie Réanimation, 59000, Lille, France;Département d’Anesthésie Réanimation, CHU de Strasbourg Hautepierre, Strasbourg, France;Département d’Anesthésie Réanimation, HIA Percy, Clamart, France;Département d’Anesthésie Réanimation, HIA Saint Anne, Toulon, France;Département d’Anesthésie Réanimation, Hôpital Nord, Marseille, France;Département d’Anesthésie Réanimation, Hôpital de Colmar, Colmar, France;Département d’Anesthésie Réanimation, Hôpital de Nancy, Nancy, France;Service d’Anesthésie Réanimation Hôpital Européen Georges Pompidou APHP, INSERM UMRS-1140, Université de Paris, Paris, France;Service d’Anesthésie Réanimation Hôpital Européen Georges Pompidou APHP, Université de Paris, and CESP, INSERM U 10-18, Université Paris-Saclay, 20 Rue Leblanc, Hôpital Européen Georges Pompidou, 75015, Paris, France;

关键词: Trauma;    Haemorrhage;    Platelet count;    Platelet transfusion;    Outcome;   

DOI  :  10.1186/s13054-022-03928-y

来源: Springer

【 摘 要 】

BackgroundTrauma-induced coagulopathy includes thrombocytopenia and platelet dysfunction that impact patient outcome. Nevertheless, the role of platelet transfusion remains poorly defined. The aim of the study was 1/ to evaluate the impact of early platelet transfusion on 24-h all-cause mortality and 2/ to describe platelet count at admission (PCA) and its relationship with trauma severity and outcome.MethodsObservational study carried out on a multicentre prospective trauma registry. All adult trauma patients directly admitted in participating trauma centres between May 2011 and June 2019 were included. Severe haemorrhage was defined as ≥ 4 red blood cell units within 6 h and/or death from exsanguination. The impact of PCA and early platelet transfusion (i.e. within the first 6 h) on 24-h all-cause mortality was assessed using uni- and multivariate logistic regression.ResultsAmong the 19,596 included patients, PCA (229 G/L [189,271]) was associated with coagulopathy, traumatic burden, shock and bleeding severity. In a logistic regression model, 24-h all-cause mortality increased by 37% for every 50 G/L decrease in platelet count (OR 0.63 95% CI 0.57–0.70; p < 0.001). Regarding patients with severe hemorrhage, platelets were transfused early for 36% of patients. Early platelet transfusion was associated with a decrease in 24-h all-cause mortality (versus no or late platelets): OR 0.52 (95% CI 0.34–0.79; p < 0.05).ConclusionsPCA, although mainly in normal range, was associated with trauma severity and coagulopathy and was predictive of bleeding intensity and outcome. Early platelet transfusion within 6 h was associated with a decrease in mortality in patients with severe hemorrhage. Future studies are needed to determine which doses of platelet transfusion will improve outcomes after major trauma.

【 授权许可】

CC BY