Platelet-To-Red Blood Cell Ratio and Clinical Outcomes Among Massively Transfused Trauma Patients

The association between the platelet-to-red blood cell (PLT:RBC) ratio and clinical outcomes in massively transfused trauma patients within the intensive care unit (ICU) remains unclear. This study aimed to evaluate the association.

This retrospective cohort study utilized the MIMIC-IV version 3.1 database. Trauma patients aged ≥16 y who were admitted to the ICU at hospital admission and received massive transfusion (total volume of red blood cells and plasma ≥2000 mL) within 24 h of ICU admission were included. These patients were stratified into the low-ratio (<1:5; n = 111) group and the high-ratio (≥1:5; n = 57) group based on the 24-h PLT:RBC volume ratio. The primary outcome was 28-d all-cause mortality. The secondary outcomes included blood product consumption, 28-d ICU-free and hospital-free days, and a composite adverse outcome (severe acute kidney injury, sepsis, or prolonged mechanical ventilation).

A total of 168 patients were included. After adjustment, the high-ratio (PLT:RBC) transfusion strategy was not significantly associated with 28-d mortality (adjusted odds ratio, 1.59; P = 0.253), the composite adverse outcome (adjusted odds ratio, 1.62; P = 0.339), 28-d ICU-free days (adjusted mean difference, -2.14; P = 0.215), or 28-d hospital-free days (adjusted mean difference, -1.78; P = 0.164). Nevertheless, the high-ratio (PLT:RBC) transfusion strategy was significantly associated with a 33% reduction in total RBC consumption (adjusted ratio, 0.67; P < 0.001) and a 20% reduction in total blood product consumption during the ICU stay (adjusted ratio, 0.80; P = 0.037).

The high PLT:RBC ratio transfusion strategy used in massively transfused trauma patients may be associated with lower blood product consumption but is not significantly associated with mortality or adverse outcomes.