Gender-based differences in mortality in response to high product ratio massive transfusion

Area of Science:

• Trauma resuscitation
• Massive transfusion protocols
• Gender-specific medicine

Background:

• Massive transfusion (MT) protocols aim to improve outcomes in trauma patients.
• Recent data suggest higher ratios of plasma and platelets to red blood cells (RBCs) improve survival.
• Gender differences in trauma outcomes are established, but not well-studied in MT.

Purpose of the Study:

• To investigate gender-specific differences in mortality following high product ratio massive transfusions.
• To determine if the benefits of high plasma or platelet to RBC ratios differ between men and women.

Main Methods:

• Retrospective analysis of 704 massively transfused trauma patients from 23 Level I trauma centers.
• Comparison of mortality rates between high (≥ 1:2) and low (<1:2) plasma:RBC and platelet:RBC ratios.
• Independent analysis of outcomes in men and women using univariate and logistic regression.

Main Results:

• In males, high plasma:RBC ratios were associated with significantly lower 24-hour (20.6% vs 33.0%) and 30-day (34.9% vs 42.8%) mortality.
• High platelet:RBC ratios also reduced 24-hour (17.6% vs 31.5%) and 30-day (32.1% vs 42.2%) mortality in males.
• Females receiving high ratios showed no significant improvement in 24-hour or 30-day mortality.

Conclusions:

• High plasma:RBC and platelet:RBC ratios in massive transfusions appear to benefit men more than women.
• Potential gender-related differences in coagulability may explain these findings.
• Further research is warranted to explore gender-specific massive transfusion protocols.