Therapeutic target of high fresh frozen plasma to red blood cell ratio in severe blunt trauma
Main finding · In-hospital mortality, therapeutic target subgroup (lactate ≥ 4.5 mmol/L and GCS ≤ 12; 20.7% of validation cohort)Result — go to the resultRisk difference −13.3% 95% CI −22.4 to −4.2%Authors' conclusion
High FFP-to-RBC transfusion ratios may confer the greatest benefit in patients with impaired consciousness and metabolic acidosis.
Study context
- Population
- Adults with severe blunt trauma (Injury Severity Score ≥ 16) who received transfusions, Japan Trauma Data Bank (2019–2023)
- Participants
- 6,679 adults
- Exposure
- High-FFP vs low-FFP transfusion
- Outcome
- In-hospital mortality; heterogeneous treatment effects (conditional average treatment effects (CATEs)) and subgroups with greatest survival benefit
Methodological detailsmulticentre, causal forest machine learning, derivation and validation cohorts
- Multicentre
- Causal forest machine learning
- Derivation and validation cohorts
Main finding
As reported in the abstract
In-hospital mortality, therapeutic target subgroup (lactate ≥ 4.5 mmol/L and GCS ≤ 12; 20.7% of validation cohort)
Risk difference
−13.3%
95% CI −22.4 to −4.2%
high-FFP vs low-FFP
risk difference −13.3% (95% CI −22.4 to −4.2%)
Observational data: associations, not effects.
Further findings
| Outcome | Risk difference (95% CI) | |
|---|---|---|
| In-hospital mortality, overall cohortNNT 32.1 | −3.3% (−6.7 to 0.5%) | |
| −10−505Difference (linear scale) |
- In-hospital mortality, overall cohort — In-hospital mortality, derivation cohort
- 23.3%
- In-hospital mortality, overall cohort — In-hospital mortality, validation cohort
- 23.2%
In-hospital mortality, overall cohort
- Results consistent across sensitivity analyses
Original publication
Therapeutic target of high fresh frozen plasma to red blood cell ratio in severe blunt trauma. Crit Care. Published 16 October 2025. doi:10.
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