Comprehensive Summary
In their study, Peng et al. conducted a retrospective multicenter cohort study to assess outcomes associated with different platelet-to-red blood cell (PLT/RBC) ratios in trauma patients requiring massive transfusion. Using 2014–2018 National Trauma Database records, the authors analyzed associations between PLT/RBC ratio and 24-hour and 30-day mortality, as well as adverse events including pulmonary embolism, deep vein thrombosis, acute kidney injury, sepsis, and acute respiratory distress syndrome. Among 9,330 patients, a PLT/RBC ratio ≥0.7 was associated with significantly lower mortality, with benefits plateauing beyond a ratio of ~1.5. Specifically, patients in the high-ratio group had lower 24-hour mortality (22.2% vs 37.9%) and improved 30-day survival (8% absolute difference) compared with the low-ratio group. While the increased survival outcomes are significant, higher ratios (>0.7) were also linked to increased complications, including pulmonary embolism, DVT, ARDS, acute kidney injury, and sepsis. Overall, a PLT/RBC ratio ≥0.7 was associated with improved 24-hour and 30-day survival but carried higher risks of adverse events compared with lower ratios.
Outcomes and Implications
As presented by Peng et al., Trauma is the leading cause of adult mortality in the U.S., with uncontrolled hemorrhage accounting for up to 40% of deaths. Higher PLT/RBC ratios may improve survival, suggesting that optimizing transfusion practices could reduce trauma-related deaths. Although the optimal PLT/RBC ratio remains undefined, this study suggests that ratios between 0.7 and 1.5 are linked to lower mortality. Further prospective research is needed to refine transfusion protocols and balance survival benefits against risks and blood supply demands.