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Credit: UAB Hospital
A new study suggests the risks and benefits of red blood cell (RBC) transfusions can vary considerably for patients with trauma and major bleeding, depending on the patients’ risk of death at baseline.
Patients with the highest predicted risk of death on arrival at a trauma center received the greatest benefit from RBC transfusions.
But among patients with the lowest predicted risk of death at baseline, transfusion was associated with a higher risk of death post-treatment.
Pablo Perel, MD, PhD, of the London School of Hygiene & Tropical Medicine in the UK, and his colleagues reported these findings in PLOS Medicine.
To conduct this study, the team used data from the CRASH-2 trial, which assessed the effect of tranexamic acid in trauma patients. The trial included 20,127 patients with significant bleeding who were treated at 274 hospitals in 40 countries.
Dr Perel and his colleagues used that data to evaluate the association between receiving an RBC transfusion and death from all causes at 28 days post-trauma. The findings were stratified by predicted risk of death based on clinical observations on arrival at the trauma center.
The researchers found that patients with the greatest predicted risk of dying—greater than 50%—had a smaller chance of death from all causes if they were transfused than if they were not. The odds ratio (OR) was 0.59.
For patients whose predicted risk of death ranged from 21% to 50%, there was no significant difference in their chance of dying whether they were transfused or not. The OR was 0.92.
But for patients with a lower risk of death at baseline, transfusion was associated with an increased risk of death.
Patients with a 6% to 20% risk of death at baseline had an OR of 2.31 if they received a transfusion. And for patients whose initial risk of death was below 6%, the OR for death associated with transfusion was 5.40.
In absolute figures, compared to no transfusion, RBC transfusion was associated with 5.1 more deaths per 100 patients in the group with the lowest predicted risk of death but with 11.9 fewer deaths per 100 patients in the group with the highest predicted risk of death.
The researchers noted that, although these data suggest RBC transfusion could be harmful for patients whose predicted risk of death is low, this study was observational. So the team cannot confirm a causal link, and a randomized trial investigating the association is warranted. 
Credit: UAB Hospital
A new study suggests the risks and benefits of red blood cell (RBC) transfusions can vary considerably for patients with trauma and major bleeding, depending on the patients’ risk of death at baseline.
Patients with the highest predicted risk of death on arrival at a trauma center received the greatest benefit from RBC transfusions.
But among patients with the lowest predicted risk of death at baseline, transfusion was associated with a higher risk of death post-treatment.
Pablo Perel, MD, PhD, of the London School of Hygiene & Tropical Medicine in the UK, and his colleagues reported these findings in PLOS Medicine.
To conduct this study, the team used data from the CRASH-2 trial, which assessed the effect of tranexamic acid in trauma patients. The trial included 20,127 patients with significant bleeding who were treated at 274 hospitals in 40 countries.
Dr Perel and his colleagues used that data to evaluate the association between receiving an RBC transfusion and death from all causes at 28 days post-trauma. The findings were stratified by predicted risk of death based on clinical observations on arrival at the trauma center.
The researchers found that patients with the greatest predicted risk of dying—greater than 50%—had a smaller chance of death from all causes if they were transfused than if they were not. The odds ratio (OR) was 0.59.
For patients whose predicted risk of death ranged from 21% to 50%, there was no significant difference in their chance of dying whether they were transfused or not. The OR was 0.92.
But for patients with a lower risk of death at baseline, transfusion was associated with an increased risk of death.
Patients with a 6% to 20% risk of death at baseline had an OR of 2.31 if they received a transfusion. And for patients whose initial risk of death was below 6%, the OR for death associated with transfusion was 5.40.
In absolute figures, compared to no transfusion, RBC transfusion was associated with 5.1 more deaths per 100 patients in the group with the lowest predicted risk of death but with 11.9 fewer deaths per 100 patients in the group with the highest predicted risk of death.
The researchers noted that, although these data suggest RBC transfusion could be harmful for patients whose predicted risk of death is low, this study was observational. So the team cannot confirm a causal link, and a randomized trial investigating the association is warranted.
Credit: UAB Hospital
A new study suggests the risks and benefits of red blood cell (RBC) transfusions can vary considerably for patients with trauma and major bleeding, depending on the patients’ risk of death at baseline.
Patients with the highest predicted risk of death on arrival at a trauma center received the greatest benefit from RBC transfusions.
But among patients with the lowest predicted risk of death at baseline, transfusion was associated with a higher risk of death post-treatment.
Pablo Perel, MD, PhD, of the London School of Hygiene & Tropical Medicine in the UK, and his colleagues reported these findings in PLOS Medicine.
To conduct this study, the team used data from the CRASH-2 trial, which assessed the effect of tranexamic acid in trauma patients. The trial included 20,127 patients with significant bleeding who were treated at 274 hospitals in 40 countries.
Dr Perel and his colleagues used that data to evaluate the association between receiving an RBC transfusion and death from all causes at 28 days post-trauma. The findings were stratified by predicted risk of death based on clinical observations on arrival at the trauma center.
The researchers found that patients with the greatest predicted risk of dying—greater than 50%—had a smaller chance of death from all causes if they were transfused than if they were not. The odds ratio (OR) was 0.59.
For patients whose predicted risk of death ranged from 21% to 50%, there was no significant difference in their chance of dying whether they were transfused or not. The OR was 0.92.
But for patients with a lower risk of death at baseline, transfusion was associated with an increased risk of death.
Patients with a 6% to 20% risk of death at baseline had an OR of 2.31 if they received a transfusion. And for patients whose initial risk of death was below 6%, the OR for death associated with transfusion was 5.40.
In absolute figures, compared to no transfusion, RBC transfusion was associated with 5.1 more deaths per 100 patients in the group with the lowest predicted risk of death but with 11.9 fewer deaths per 100 patients in the group with the highest predicted risk of death.
The researchers noted that, although these data suggest RBC transfusion could be harmful for patients whose predicted risk of death is low, this study was observational. So the team cannot confirm a causal link, and a randomized trial investigating the association is warranted.