101. Characterizing red blood cell age exposure in massive transfusion therapy: the scalar age of blood index (SBI).
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DeSantis, Stacia M., Brown, Derek W., Jones, Allison R., Yamal, Jose‐Miguel, Pittet, Jean‐Francois, Patel, Rakesh P., Wade, Charles E., Holcomb, John B., Wang, Henry, Yamal, Jose-Miguel, Pittet, Jean-Francois, and PROPPR Study Group
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RED blood cell transfusion ,ERYTHROCYTE aging ,HEMORRHAGIC shock treatment ,MORTALITY - Abstract
Background: The mortality of trauma patients requiring massive transfusion to treat hemorrhagic shock approaches 17% at 24 hours and 26% at 30 days. The use of stored RBCs is limited to less than 42 days, so older RBCs are delivered first to rapidly bleeding trauma patients. Patients who receive a greater quantity of older RBCs may have a higher risk for mortality.Methods and Materials: Characterizing blood age exposure requires accounting for the age of each RBC unit and the quantity of transfused units. To address this challenge, a novel Scalar Age of Blood Index (SBI) that represents the relative distribution of RBCs received is introduced and applied to a secondary analysis of the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) randomized controlled trial (NCT01545232, https://clinicaltrials.gov/ct2/show/NCT01545232). The effect of the SBI is assessed on the primary PROPPR outcome, 24-hour and 30-day mortality.Results: The distributions of blood storage ages successfully maps to a parameter (SBI) that fully defines the blood age curve for each patient. SBI was a significant predictor of 24-hour and 30-day mortality in an adjusted model that had strong predictive ability (odds ratio, 1.15 [1.01-1.29], p = 0.029, C-statistic, 0.81; odds ratio, 1.14 [1.02-1.28], p = 0.019, C-statistic, 0.88, respectively).Conclusion: SBI is a simple scalar metric of blood age that accounts for the relative distribution of RBCs among age categories. Transfusion of older RBCs is associated with 24-hour and 30-day mortality, after adjustment for total units and clinical covariates. [ABSTRACT FROM AUTHOR]- Published
- 2019
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