Sex-based utilization and outcomes of cold-stored whole blood for trauma resuscitation: Analysis of a prospective multicenter study.

IF 2.9 2区医学 Q2 CRITICAL CARE MEDICINE

Journal of Trauma and Acute Care Surgery Pub Date : 2025-02-01 Epub Date: 2024-09-03 DOI:10.1097/TA.0000000000004431

Shea Gallagher, Joshua Dilday, Chaiss Ugarte, Stephen Park, Anaar Siletz, Kazuhide Matsushima, Morgan Schellenberg, Kenji Inaba, Joshua P Hazelton, John Oh, Jennifer Gurney, Matthew J Martin

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引用次数: 0

Abstract

Background: Resuscitation with cold-stored whole blood (WB) has outcome benefits, but benefits varied by patient sex is unknown. There are also concerns about alloimmunization risk for premenopausal females given WB, leading to some protocols excluding this cohort. We sought to analyze WB utilization, outcomes, and disparities by patient sex.

Methods: This is a secondary analysis of a prospective multicenter study of WB resuscitation. Patients were stratified by sex and compared by transfusion strategy of WB or component therapy (CT). Generalized estimated equation models using inverse probability of treatment weighting were utilized.

Results: There were 1,617 patients (83% male; 17% female) included. Females were less likely to receive WB versus males (55% vs. 76%; p < 0.001), with wide variability between individual centers (0%-33% female vs. 66%-100% male, p < 0.01). Male WB had more blunt trauma (45% vs. 31%) and higher shock index (1.0 vs. 0.8) compared with the male CT cohort (all p < 0.05) but similar Injury Severity Score. The female WB cohort was older (53 vs. 36) and primarily blunt trauma (77% vs. 62%) compared with the female CT cohort (all p < 0.05) but had similar shock index and Injury Severity Score. Male WB had lower early and overall mortality (27% vs. 42%), but a higher rate of acute kidney injury (16% vs. 6%) vs. the male CT cohort (all p < 0.01). Female cohorts had no difference in mortality, but the WB cohort had higher bleeding complications. Whole blood use was independently associated with decreased mortality (OR, 0.6; p < 0.01) for males but not for females (OR, 0.9; p = 0.78).

Conclusion: Whole blood was independently associated with a decreased mortality for males with no difference identified for females. Whole blood was significantly less utilized in females and showed wide variability between centers. Further study of the impact of patient sex on outcomes with WB and WB utilization is needed.

Level of evidence: Prognostic and Epidemiological; Level IV.

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创伤复苏中冷藏全血的性别使用情况和结果：前瞻性多中心研究分析。

背景：使用冷藏全血（WB）进行复苏对结果有益处，但不同性别患者的益处却不尽相同。此外，人们还担心绝经前女性使用 WB 会有同种免疫风险，因此一些方案将这一人群排除在外。我们试图分析 WB 的使用情况、结果以及不同性别患者的差异：这是对一项前瞻性多中心 WB 复苏研究的二次分析。根据性别对患者进行分层，并按照WB或成分疗法（CT）的输血策略进行比较。采用反概率治疗加权的广义估计方程模型：共纳入 1617 名患者（83% 为男性；17% 为女性）。与男性相比，女性接受 WB 的可能性较低（55% 对 76%；P < 0.001），各中心之间的差异很大（0%-33% 女性对 66%-100% 男性，P < 0.01）。与男性 CT 患者相比，男性 WB 患者的钝性创伤更多（45% 对 31%），休克指数更高（1.0 对 0.8）（均 p <0.05），但损伤严重程度评分相似。与 CT 女性队列相比，WB 女性队列年龄更大（53 岁对 36 岁），主要是钝性创伤（77% 对 62%）（所有 p <0.05），但休克指数和损伤严重程度评分相似。与 CT 男性队列相比，WB 男性队列的早期死亡率和总死亡率较低（27% 对 42%），但急性肾损伤发生率较高（16% 对 6%）（所有 p 均小于 0.01）。女性队列的死亡率没有差异，但 WB 队列的出血并发症较高。全血的使用与男性死亡率的降低（OR，0.6；P < 0.01）独立相关，但与女性死亡率的降低（OR，0.9；P = 0.78）无关：结论：男性全血与死亡率的降低密切相关，而女性全血与死亡率的降低无差异。女性使用全血的比例明显较低，而且不同中心之间的差异很大。需要进一步研究患者性别对全血和全血利用率的影响：预后/流行病学；IV 级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Trauma and Acute Care Surgery 医学-外科

CiteScore

6.00

自引率

11.80%

发文量

637

审稿时长

2.7 months

期刊介绍： The Journal of Trauma and Acute Care Surgery® is designed to provide the scientific basis to optimize care of the severely injured and critically ill surgical patient. Thus, the Journal has a high priority for basic and translation research to fulfill this objectives. Additionally, the Journal is enthusiastic to publish randomized prospective clinical studies to establish care predicated on a mechanistic foundation. Finally, the Journal is seeking systematic reviews, guidelines and algorithms that incorporate the best evidence available.