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Purpose <p>Although balanced transfusion protocols (platelet concentrate (PC): red blood cell (RBC) = 1:1) are standard for severe trauma, the impact of a higher PC: RBC ratio (&gt; 1:1) on survival remains unclear. This study aimed to investigate the effectiveness of a high PC to RBC among severely injured patients requiring massive transfusion.</p> Methods <p>We performed a retrospective cohort study using the Japan Trauma Data Bank (2019–2023). Adult patients receiving massive transfusion (&gt; = 10 units of RBC) within the first 24&#xa0;h of injury were included. Patients were classified into high PC (&gt; 1) and low PC groups (&lt; = 1). The primary outcome was 24-hour mortality, analyzed using inverse probability of treatment weighting and modified Poisson regression. Additionally, we performed spline curve analysis to investigate the nonlinear relationship between the PC: RBC ratio and outcome.</p> Results <p>Among 3,067 patients (mean age 57.1 years, 67.2% male), 934 were in the high PC group and 2,133 in the low PC group. The high PC group had lower 24-hour mortality (8.9% vs. 15.7%). Adjusted analysis showed a significantly lower risk of mortality in the high PC group (risk ratio 0.54; 95% CI 0.43–0.69). A nonlinear analysis suggested that increasing PC: RBC ratio was associated with lower mortality.</p> Conclusion <p>A high PC: RBC ratio was associated with lower 24-hour mortality in severely injured patients requiring massive transfusion, suggesting that a higher PC strategy may improve outcomes.</p>

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Association between high ratio of platelet concentrate to red blood cell and survival among massively transfused patients

  • 期刊论文

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  • 发表日期：

    2026年4月17日

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  • Makoto Aoki,
  • Yohei Okada,
  • Gaku Fujiwara,
  • Morihiro Katsura,
  • Shokei Matsumoto,
  • Tetsuro Kiyozumi,
  • Satoshi Tomura,
  • Kazuhide Matsushima

摘要

Purpose

Although balanced transfusion protocols (platelet concentrate (PC): red blood cell (RBC) = 1:1) are standard for severe trauma, the impact of a higher PC: RBC ratio (> 1:1) on survival remains unclear. This study aimed to investigate the effectiveness of a high PC to RBC among severely injured patients requiring massive transfusion.

Methods

We performed a retrospective cohort study using the Japan Trauma Data Bank (2019–2023). Adult patients receiving massive transfusion (> = 10 units of RBC) within the first 24 h of injury were included. Patients were classified into high PC (> 1) and low PC groups (< = 1). The primary outcome was 24-hour mortality, analyzed using inverse probability of treatment weighting and modified Poisson regression. Additionally, we performed spline curve analysis to investigate the nonlinear relationship between the PC: RBC ratio and outcome.

Results

Among 3,067 patients (mean age 57.1 years, 67.2% male), 934 were in the high PC group and 2,133 in the low PC group. The high PC group had lower 24-hour mortality (8.9% vs. 15.7%). Adjusted analysis showed a significantly lower risk of mortality in the high PC group (risk ratio 0.54; 95% CI 0.43–0.69). A nonlinear analysis suggested that increasing PC: RBC ratio was associated with lower mortality.

Conclusion

A high PC: RBC ratio was associated with lower 24-hour mortality in severely injured patients requiring massive transfusion, suggesting that a higher PC strategy may improve outcomes.