OVERTRANSFUSION COMES AT A SIGNIFICANT COST: THE DOSE-DEPENDENT RELATIONSHIP BETWEEN BLOOD TRANSFUSIONS AND INFECTIONS AFTER TRAUMA
Charlie Nederpelt, Majed El Hechi, Alexander Bonde, Napaporn Kongkaewpaisan, Nikolaos Kokoroskos, April Mendoza, Noelle Saillant, Martin Rosenthal, Peter Fagenholz, David King, David Chang, George Velmahos, Haytham Kaafarani
Objectives: We sought to quantify the cumulative and independent impact of transfusion within the first 24 hours of admission on the risk of infection in trauma patients.
Methods:
We included all patients included in TQIP (2013-2016) who received blood transfusion in the first 4 hours. Patients who died within 48 hours, were transferred from another hospital, or had incomplete or wrongly coded information on transfusion volume were excluded. Patients were divided into 20 cohorts based on total blood product volume transfused in the first 24 hours. A composite infection variable (INF) was created, including all infections (e.g. SSI, pneumonia, UTI, sepsis). Stepwise multivariable logistic regression was performed to study the relationship between blood transfusion and INF, controlling for demographics (e.g. age, gender), comorbidities, injury severity [e.g. vital signs, mechanism, injury severity scale (ISS)], and operative and angiographic interventions.
Results:
Of 1,002,595 patients, 40,829 met inclusion criteria. Mean age was 42+19 years, 75% were male, 68% had blunt trauma, and mean ISS was 25[17-34]. The odds ratio of INF increased incrementally from 1.23 (95% CI: 1.11–1.37) for 2 units transfused to 4.89 (95% CI: 2.72–8.80) for 40 units transfused. Each additional unit increased the odds of INF by 4.9%.
Conclusion:
Controlling for relevant confounders, transfusion of the bleeding trauma patient comes at the expense of a dose dependent increased risk of infectious complications.
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