BLOOD-TRANSFUSION - AN INDEPENDENT RISK FACTOR FOR POSTINJURY MULTIPLE ORGAN FAILURE

Objective: To determine if blood transfusion is a consistent risk fact or for postinjury multiple organ failure (MOF), independent of other s hock indexes. Design: A 55-month inception cohort study ending on Augu st 30, 1995. Data characterizing postinjury MOF were prospectively col lected. Multiple logistic regression analysis was performed on 5 sets of data. Set 1 included admission data (age, sex, comorbidity, injury mechanism, Glasgow Coma Scale, Injury Severity Score, and systolic blo od pressure determined in the emergency department) plus the amount of blood transfused within the first 12 hours. In the subsequent 4 data sets, other indexes of shock (early base deficit, early lactate level, late base deficit, and late lactate level) were sequentially added. A dditionally, the same multiple logistic regression analyses were perfo rmed with early MOF and late MOF as the outcome variables. Setting: De nver General Hospital, Denver, Colo,is a regional level I trauma cente r. Patients: Five hundred thirteen consecutive trauma patients admitte d to the trauma intensive care unit with an Injury Severity Score grea ter than 15 who were older than 16 years and who survived longer than 48 hours. Interventions: None. Main Outcome Measures: The relationship of blood transfusions and other shock indexes with the outcome variab le, MOF. Results: A dose-response relationship between early blood tra nsfusion and the later development of MOF was identified. Despite the inclusion of other indexes of shock, blood transfusion was identified as an independent risk factor in 13 of the 15 multiple logistic regres sion models tested; the odds ratios were high, especially in the early MOF models. Conclusion: Blood transfusion is an early consistent risk factor for postinjury MOF, independent of other indexes of shock.