我们的目的是探讨FFP输血与有显著凝血功能障碍的DC患者预后之间的关系。在倾向评分匹配(PSM)后,对总共693例具有明显凝血功能障碍的DC患者进行了分析,每组233例患者。接受FFP输血的患者与接受PSM常规治疗的患者相匹配。回归分析显示FFP输血在30天内无益处(HR:1.08,95%CI0.83-1.4),90天(HR:1.03,95%CI0.80-1.31)和住院(HR:1.30,95%CI0.90-1.89)死亡率,与肝功能衰竭风险增加相关(OR:3.00,95%CI1.78-5.07),肾衰竭(OR:1.90,95%CI1.13-3.18),凝血失败(OR:2.55,95%CI1.52-4.27),呼吸衰竭(OR:1.76,95%CI1.15-2.69),和循环衰竭(OR:2.15,95%CI1.27-3.64),甚至与LOSICU(β:2.61,95%CI1.59-3.62)和LOS医院(β:6.59,95%CI2.62-10.57)的延长有关。在敏感性分析中,多变量分析(HR:1.09,95CI0.86,1.38),IPTW(HR:1.11,95CI0.95-1.29)和CAPS(HR:1.09,95%CI0.86-1.38)显示FFP输注对30天死亡率没有有益影响。平滑曲线拟合显示肝功能衰竭的风险,肾衰竭和循环衰竭增加了3%,分别为2%和2%。FFP输血每增加1ml/kg。我们发现两组在第0、3、7、14天的CLIF-SOFA和MELD评分没有显着差异。与常规组相比,INR,APTT,FFP输血组TBIL显著升高,而PaO2/FiO2在14天内显著下降。总之,FFP输血对30天没有有益作用,90天,住院死亡率,与LOSICU和LOS医院的时间延长有关,肝功能衰竭的风险增加,肾衰竭,凝血失败,呼吸衰竭和循环衰竭事件。然而,大,多中心,随机对照试验,未来仍需要前瞻性队列研究和外部验证来验证FFP输血的疗效。
We aimed to explore the association between FFP transfusion and outcomes of DC patients with significant coagulopathy. A total of 693 DC patients with significant coagulopathy were analyzed with 233 patients per group after propensity score matching (PSM). Patients who received FFP transfusion were matched with those receiving conventional therapy via PSM. Regression analysis showed FFP transfusion had no benefit in 30-day (HR: 1.08, 95% CI 0.83-1.4), 90-day (HR: 1.03, 95% CI 0.80-1.31) and in-hospital(HR: 1.30, 95% CI 0.90-1.89) mortality, associated with increased risk of liver failure (OR: 3.00, 95% CI 1.78-5.07), kidney failure (OR: 1.90, 95% CI 1.13-3.18), coagulation failure (OR: 2.55, 95% CI 1.52-4.27), respiratory failure (OR: 1.76, 95% CI 1.15-2.69), and circulatory failure (OR: 2.15, 95% CI 1.27-3.64), and even associated with prolonged the LOS ICU (β: 2.61, 95% CI 1.59-3.62) and LOS hospital (β: 6.59, 95% CI 2.62-10.57). In sensitivity analysis, multivariate analysis (HR: 1.09, 95%CI 0.86, 1.38), IPTW (HR: 1.11, 95%CI 0.95-1.29) and CAPS (HR: 1.09, 95% CI 0.86-1.38) showed FFP transfusion had no beneficial effect on the 30-day mortality. Smooth curve fitting demonstrated the risk of liver failure, kidney failure and circulatory failure increased by 3%, 2% and 2% respectively, for each 1 ml/kg increase in FFP transfusion. We found there was no significant difference of CLIF-SOFA and MELD score between the two group on day 0, 3, 7, 14. Compared with the conventional group, INR, APTT, and TBIL in the FFP transfusion group significantly increased, while PaO2/FiO2 significantly decreased within 14 days. In conclusion, FFP transfusion had no beneficial effect on the 30-day, 90-day, in-hospital mortality, was associated with prolonged the LOS ICU and LOS hospital, and the increased risk of liver failure, kidney failure, coagulation failure, respiratory failure and circulatory failure events. However, large, multi-center, randomized controlled trials, prospective cohort studies and external validation are still needed to verify the efficacy of FFP transfusion in the future.