Association between the fresh frozen plasma-to-red blood cell transfusion ratio and neurological outcomes in patients with severe traumatic brain injury.

Abstract

To date, no studies have focused on the fresh frozen plasma (FFP)-to-red blood cell (RBC) transfusion ratio in patients with severe traumatic brain injury (TBI). Herein, the authors investigated the relationship between the FFP-to-RBC ratio and neurological outcomes, including mortality, in patients with severe TBI (Glasgow Coma Scale [GCS] score < 9). This multicenter, retrospective, observational study used data from the Japan Trauma Data Bank from 2019 to 2023. The study included patients aged ≥ 18 years with severe TBI (defined as a GCS score < 9 and an Abbreviated Injury Scale [AIS] score > 2) without severe extracranial injury (AIS score > 2). The high-ratio group was defined as having an FFP-to-RBC ratio > 1, and the low-ratio group was defined as having a ratio of 1 or less. The association between the FFP-to-RBC ratio and outcomes was evaluated using propensity score-based inverse probability of treatment weighting. The primary outcome was in-hospital mortality, and the secondary outcome was a poor neurological outcome at discharge (defined as a Glasgow Outcome Scale score of 1-3). A total of 1007 patients were included in the analysis. Compared with the low-ratio group, the high-ratio group showed no significant differences in in-hospital mortality (adjusted odds ratio [aOR] 0.91, 95% CI 0.69-1.22) or poor neurological outcome (aOR 1.12, 95% CI 0.76-1.64). The authors found no association between FFP-to-RBC transfusion ratio and neurological outcomes, including in-hospital mortality, in severe TBI.