The survival impact of plasma to red blood cell ratio in massively transfused non-trauma patients.

ABSTRACT

PURPOSE: High ratios of Plasma to Packed Red Blood Cells (FFPPRBC) improve survival in massively transfused trauma patients. We hypothesized that non-trauma patients also benefit from this transfusion strategy. METHODS: Non-trauma patients requiring massive transfusion from November 2003 to September 2011 were reviewed. Logistic regression was performed to identify independent predictors of mortality. The population was stratified using two FFPPRBC ratio cut-offs (12 and 13) and adjusted mortality derived. RESULTS: Over 8 years, 29 % (260/908) of massively transfused surgical patients were non-trauma patients. Mortality decreased with increasing FFPPRBC ratios (45 % for ratio ≤18, 33 % for ratio >18 and ≤13, 27 % for ratio >13 and ≤12 and 25 % for ratio >12). Increasing FFPPRBC ratio independently predicted survival (AOR [95 % CI] 1.91 [1.35-2.71]; p < 0.001). Patients achieving a ratio >13 had improved survival (AOR [95 % CI] 3.24 [1.24-8.47]; p = 0.016). CONCLUSION: In non-trauma patients undergoing massive transfusion, increasing FFPPRBC ratio was associated with improved survival. A ratio >13 significantly improved survival probability.