Association of Whole Blood on Mortality and Inhospital Complications: A Statewide Analysis

Abstract

Introduction: Whole blood (WB) transfusion is increasingly used in the civilian trauma population compared to standard component therapy (CT). Prior prospective observational and retrospective studies have shown a mortality benefit. We aim to assess statewide clinical outcomes associated with WB use in an adult trauma population.

Methods: This is a retrospective cohort study of the Pennsylvania Trauma Outcomes Study registry from 2019 to 2022. Adult trauma patients (≥18 y) who received at least one transfusion within the first 4 h following injury were included. Patients were grouped into WB ± CT and CT only and propensity matched in a 1:1 manner. Associations of WB on mortality and inhospital complications were analyzed using univariable and multivariable analyses.

Results: Five thousand, four hundred sixty-four patients met the inclusion criteria (mean age 50, 74% male, median ISS 21) with 2186 included in analysis following propensity matching. Mean WB transfused was 2.4 units with a WB to total transfusion volume ratio of 0.6. CT resuscitation was balanced with a packed red blood cell to fresh frozen plasma and platelets ratio <1.5 for all groups. WB was not associated with a decreased odds of mortality (odds ratio [OR] 1.29 (0.96-1.72), P = 0.09), acute kidney injury (OR 1.26 (0.74-2.14), P = 0.39), infection (OR 1.34 (0.81-2.11), P = 0.28) or venous thromboembolism (OR 1.49 (0.99-2.23), P = 0.06). Similar outcomes in mortality were observed for patients requiring massive transfusions (OR 1.20 (0.86-1.69), P = 0.28), and patients with a high shock index (OR 1.31 (0.89-1.92), P = 0.17).

Conclusions: This study demonstrates that WB is not associated with improved mortality compared to CT alone. Ongoing research is needed to further classify which populations benefit from receiving WB.

Keywords: Complications; Component therapy; Mortality; Shock; Transfusion; Trauma; Whole blood.