ArticleEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2026
Association between high ratio of platelet concentrate to red blood cell and survival among massively transfused patients.
Article in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeAlthough 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.
methodsWe 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.
resultsAmong 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.
conclusionA 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.
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