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Open Access

Age of thawed plasma does not affect clinical outcomes or biomarker expression in patients receiving prehospital thawed plasma: a PAMPer secondary analysis

Katherine M Reitz, Danielle S Gruen, Frances Guyette, Joshua B Brown, Mark H Yazer, Yoram Vodovotz, Pär I Johanssen, Jakob Stensballe, Brian Daley, Richard S Miller, Brian G Harbrecht, Jeffrey Claridge, Herb A Phelan, Matthew D Neal, Brian S Zuckerbraun, Jason L Sperry
DOI: 10.1136/tsaco-2020-000648 Published 11 February 2021
Katherine M Reitz
1Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Danielle S Gruen
1Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Frances Guyette
2Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Joshua B Brown
1Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Mark H Yazer
3Department of Pathology, University of Pittsburgh and the Institute for Transfusion Medicine, Pittsburgh, Pennsylvania, USA
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Yoram Vodovotz
1Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Pär I Johanssen
4Capital Region Blood Bank, Section for Transfusion Medicine, University of Copenhagen, Kobenhavn, Denmark
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Jakob Stensballe
4Capital Region Blood Bank, Section for Transfusion Medicine, University of Copenhagen, Kobenhavn, Denmark
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Brian Daley
5The University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Richard S Miller
6Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Brian G Harbrecht
7University of Louisville, Louisville, Kentucky, USA
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Jeffrey Claridge
8Surgery, MetroHealth Medical Center, Cleveland, Ohio, USA
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Herb A Phelan
9Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Matthew D Neal
1Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Brian S Zuckerbraun
1Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Jason L Sperry
1Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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  • Figure 1
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    Figure 1

    Principal cohort. HEMS, helicopter emergency services; PAMPer, Prehospital Air Medical Plasma; T0, time 0.

  • Figure 2
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    Figure 2

    Kaplan-Meier survival analysis for the primary cohort (panel A; n=501) and subgroup (panel B; n=127).

  • Figure 3
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    Figure 3

    Adjusted T0 markers for subgroup (Injury Severity Score >30; n=56). Mean adjusted marker values estimated using linear regression controlling for Injury Severity Score, hospital admission Injury Severity Score, presence of a systolic blood pressure <70 mm Hg, international ratio, and transfusions with error bars representing the SD and statistically significant co-efficient p values. Units for all interleukins, TNF-α, MCP-1, MIG, and GM-CSF are in pg/mL, except IL-23, which is in ng/mL. All cell death marker units are in ng/mL, except VEGF which is in pg/mL. DNA (histone-complexed) is reported as relative units. GM-CSF, granulocyte-macrophage colony-stimulating factor; hcDNA, histone-complexed DNA; IL, interleukin; MCP-1, monocyte chemoattractant protein; MIG, INF-gamma; s100a, human S100 calcium-binding protein A10; suPAR, soluble urokinase receptor; TM, thrombomodulin; TNF-α, tumor necrosing factor-α; VEGF, vascular endothelial growth factor.

Tables

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  • Table 1

    Patient and injury characteristics—principal analysis cohort (n=501)

    VariablePlasma groupP value
    YOUNGOLD
    Demographicsn=93n=137
     Age, years, mean (SD)45.7 (17.7)45.3 (17.2)0.84
     Male gender, No. (%)65 (70)99 (72)0.70
     Race, No. (%)0.21
      White88 (95)119 (87)
      Black4 (4)10 (7)
      Other0 (0)0 (0)
      Unknown0 (0)2 (1)
      Hispanic, No. (%)2 (2.3)4 (3.1)0.71
     Current smoking, No. (%)41 (54)42 (41)0.09
     Body mass index, mean (SD)30.7 (9.5)30.0 (6.5)0.58
    Prehospital and injury
     Penetrating injury, No. (%)20 (22)26 (19)0.64
     Injury severity score, median (IQR)22.0 (13.0, 34.0)22.0 (16.0, 29.0)0.59
     Traumatic brain injury, No. (%)17 (36.2)19 (34.5)0.86
     Hospital transfer, No. (%)22 (23.7)30 (22.1)0.78
     Prehospital interval, median (IQR)3 (3.2)4 (2.9)0.89
    Hospital
     Admission heart rate, mean (SD)105.2 (31.7)101.9 (28.9)0.41
     Admission systolic blood pressure, mean (SD)100.7 (39.2)100.7 (40.8)1.00
     Admission INR, median (IQR)1.2 (1.1, 1.4)1.2 (1.1, 1.3)0.58
     Admission hemoglobin, median (IQR)10.9 (9.0, 13.3)10.8 (9.4, 12.7)0.88
     Admission rapid thromboelastography
      Lysis at 30 min, %, median (IQR)0.1 (0.0, 1.4)0.2 (0.0, 1.1)0.75
      Max amplitude, min, median (IQR)59.6 (52.0, 63.5)56.4 (47.8, 64.7)0.48
      Alpha angle, degrees, median (IQR)70.8 (62.3, 74.9)70.2 (61.6, 74.7)0.60
      K-time, min, median (IQR)1.8 (1.2, 2.7)1.8 (1.2, 3.0)0.95
      Activated clotting time, median (IQR)113.0 (97.0, 136.0)113.0 (105.0, 136.0)0.46
     PRBC in 24 hours, median (IQR)3.0 (2.0, 6.0)2.0 (0.0, 7.0)0.35
     Plasma in 24 hours, median (IQR)0.0 (0.0, 3.0)0.0 (0.0, 3.0)0.90
     Platelets in 24 hours, median (IQR)0.0 (0.0, 1.0)0.0 (0.0, 1.0)0.63
     Crystalloid in 24 hours, median (IQR)4434 (2372, 6200)4375 (2200, 6600)0.96
     Multisystem organ failure, No. (%)61 (65.6)84 (61.3)0.51
    • No., number; PRBC, packed red blood cells.

  • Table 2

    Model estimation coefficients for markers at T0—YOUNG vs OLD plasma age

    Plasma group (n=137)ISS >30 plasma subgroup (n=56)
    MarkerCoefficient95% CIP valueCoefficient95% CIP value
    Lower limitUpper limitLower limitUpper limit
    IL-1b0.456−2.7623.6730.7814.3941.0277.7610.011
    IL-20.064−1.7911.9190.9462.4140.2624.5650.028
    IL-4−20.063−66.49926.3730.39739.613.48265.7180.003
    IL-5−2.664−8.3693.0410.362.6670.9214.4130.003
    IL-635.696−158.755230.1470.7197.664−384.257399.5860.969
    IL-74.116−2.28110.5130.20711.494−0.9623.9470.07
    IL-86.21−11.60624.0260.494−28.604−86.98529.7760.337
    IL-92.725−18.02323.4730.79725.2382.17148.3040.032
    IL-1060.645−102.332223.6220.466−19.358−285.774247.0580.887
    IL-17a1.457−3.8766.790.5926.270.112.4390.046
    IL-17e69.021−38.997177.0390.21308.579103.895513.2640.003
    IL-219.08−22.3440.50.57147.90511.95983.8520.009
    IL-22104.23−248.61457.0710.563715.174165.9191264.4290.011
    IL-231.042−6.3058.390.78112.7255.13920.3110.001
    IL-2751.292−453.426556.0090.842977.828137.8871817.7690.023
    IL-3310.925−39.26361.1120.6795.0532.919157.180.003
    GM-CSF−7.832−20.5634.90.22814.6295.47823.780.002
    MCP-1366.455−29.438762.3490.07−28.592−912.995855.8110.949
    MIG4285.834−3033.50811 605.1760.25114 107.398−9169.34137 384.1370.235
    TNF-α0.964−11.01312.940.8755.174−28.07338.4210.76
    Adiponectin−1736.773−3848.6375.0550.107−355.837−2733.7422022.0670.769
    hcDNA−8.264−18.5462.0170.115−34.837−49.677−19.9980
    S100A10−0.717−2.0270.5930.284−0.892−2.0030.2180.115
    suPAR−0.374−0.9240.1770.1830.351−0.641.3430.487
    Syndecan-12.035−23.87827.9490.878−54.767−96.663−12.8720.01
    TM0.103−1.2041.410.8770.92−1.0792.9190.367
    VEGF81.405−103.409266.2180.3882.333−276.162280.8290.987
    • GM-CSF, granulocyte-macrophage colony-stimulating factor; hcDNA, histone-complexed DNA; IL, interleukin; ISS, Injury Severity Score; MCP-1, monocyte chemoattractant protein; MIG, INF-gamma; S100A10, human S100 calcium-binding protein A10; suPAR, soluble urokinase receptor; TM, thrombomodulin; TNF-α, tumor necrosing factor-α; VEGF, vascular endothelial growth factor.

  • Table 3

    Patient and injury characteristics—subgroup (Injury Severity Score >30, n=127)

    VariablePlasma groupP value
    YOUNGOLD
    Demographicsn=30n=34
     Age, years, mean (SD)40.0 (14.8)41.9 (19.4)0.65
     Male gender, No. (%)18 (60)23 (68)0.52
     Race, No. (%)0.15
      White29 (97)29 (85)
      Black0 (0)4 (12)
      Unknown1 (3)1 (3)
      Hispanic, No. (%)0 (0.0)0 (0.0)0.34
     Current smoking, No. (%)13 (59)13 (54)0.74
     Body mass index, mean (SD)30.2 (9.8)29.6 (7.4)0.84
    Prehospital and injury
     Penetrating injury, No. (%)4 (13)3 (9)0.56
     Injury severity score, median (IQR)43.0 (35.0, 50.0)41.0 (34.0, 45.0)0.26
     Traumatic brain injury, No. (%)8 (50.0)7 (58.3)0.66
     Admission heart rate, mean (SD)112.5 (29.6)98.9 (34.1)0.10
     Admission systolic blood pressure, mean (SD))91.8 (33.1)94.3 (51.4)0.83
     Hospital transfer, No. (%)6 (20.0)7 (21.2)0.47
     Prehospital interval, median (IQR)41.5 (32.8, 54.6)40.4 (32.8, 48.1)0.48
    Hospital
     Admission INR, median (IQR)1.2 (1.1, 1.5)1.2 (1.1, 1.3)0.72
     Admission hemoglobin, median (IQR)11.2 (10.3, 12.6)10.2 (8.9, 11.4)0.084
     Admission rapid thromboelastography
      Lysis at 30 min, %, median (IQR)0.2 (0.0, 0.9)0.2 (0.0, 2.5)0.85
      Max amplitude, min, median (IQR)59.6 (53.0, 61.5)55.0 (49.1, 60.6)0.42
      Alpha angle, degrees, median (IQR)70.0 (68.5, 73.9)68.2 (61.9, 74.2)0.79
      K-time, min, median (IQR)1.8 (1.4, 1.8)2.0 (1.5, 2.7)0.65
      Activated clotting time, median (IQR)117.0 (109.0, 124.5)113.0 (89.0, 136.0)0.64
     PRBC in 24 hours, median (IQR)4.0 (2.0, 11.0)4.5 (2.0, 10.0)0.90
     Plasma in 24 hours, median (IQR)2.0 (0.0, 4.0)0.5 (0.0, 4.0)0.95
     Platelets in 24 hours, median (IQR)0.0 (0.0, 1.0)0.0 (0.0, 1.0)0.78
     Crystalloid in 24 hours, median (IQR)5110.0 (3200.0, 6647.0)4437.5 (1500.0, 7050.0)0.49
     Multisystem organ failure, No. (%)20 (66.7)25 (73.5)0.55
    • INR, international ratio; No., number; PRBC, packed red blood cells.

Supplementary Materials

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    [tsaco-2020-000648supp001.pdf]

Additional Files

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Age of thawed plasma does not affect clinical outcomes or biomarker expression in patients receiving prehospital thawed plasma: a PAMPer secondary analysis
Katherine M Reitz, Danielle S Gruen, Frances Guyette, Joshua B Brown, Mark H Yazer, Yoram Vodovotz, Pär I Johanssen, Jakob Stensballe, Brian Daley, Richard S Miller, Brian G Harbrecht, Jeffrey Claridge, Herb A Phelan, Matthew D Neal, Brian S Zuckerbraun, Jason L Sperry
Trauma Surg Acute Care Open Feb 2021, 6 (1) e000648; DOI: 10.1136/tsaco-2020-000648

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Age of thawed plasma does not affect clinical outcomes or biomarker expression in patients receiving prehospital thawed plasma: a PAMPer secondary analysis
Katherine M Reitz, Danielle S Gruen, Frances Guyette, Joshua B Brown, Mark H Yazer, Yoram Vodovotz, Pär I Johanssen, Jakob Stensballe, Brian Daley, Richard S Miller, Brian G Harbrecht, Jeffrey Claridge, Herb A Phelan, Matthew D Neal, Brian S Zuckerbraun, Jason L Sperry
Trauma Surg Acute Care Open Feb 2021, 6 (1) e000648; DOI: 10.1136/tsaco-2020-000648
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Age of thawed plasma does not affect clinical outcomes or biomarker expression in patients receiving prehospital thawed plasma: a PAMPer secondary analysis
Katherine M Reitz, Danielle S Gruen, Frances Guyette, Joshua B Brown, Mark H Yazer, Yoram Vodovotz, Pär I Johanssen, Jakob Stensballe, Brian Daley, Richard S Miller, Brian G Harbrecht, Jeffrey Claridge, Herb A Phelan, Matthew D Neal, Brian S Zuckerbraun, Jason L Sperry
Trauma Surgery & Acute Care Open Feb 2021, 6 (1) e000648; DOI: 10.1136/tsaco-2020-000648
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