Abstract
Objective Transfusion research seeks to improve survival for severely injured and hemorrhaging patients using optimal plasma and platelet ratios over red blood cells (RBCs). However, most published studies comparing different ratios are plagued with serious bias and ignore time-varying effects. We applied joint recurrent event frailty models to increase validity and clinical utility. Study Design and Setting Using the PRospective Observational Multicenter Major Trauma Transfusion study data, our joint random-effects models estimated the association of (1) clinical covariates with transfusion rate intensities and (2) varying plasma:RBC and platelet:RBC ratios with survival over the 24 hours after hospital admission. Along with survival time, baseline patient vital signs, laboratory values, and longitudinal data on types and volumes of transfusions were included. Results Baseline systolic blood pressure, heart rate, pH, and hemoglobin were significantly associated with RBC transfusion rates. Increased transfusion rates (per hour) of plasma (P = 0.05), platelets (P < 0.001), or RBCs were associated with increased 24-hour mortality. Higher ratios of plasma:RBC (P = 0.107) and platelet:RBC (P < 0.001) were associated with reduced mortality in a time-varying pattern (P < 0.001). Conclusions The proposed joint analysis of transfusion rates and ratios offers a more valid statistical approach to evaluate survival effects in the presence of informative censoring by early death.
| Original language | English |
|---|---|
| Pages (from-to) | 52-59.e1 |
| Journal | Journal of Clinical Epidemiology |
| Volume | 77 |
| DOIs | |
| Publication status | Published - 2016 Sep 1 |
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Keywords
- Hemorrhage
- Joint modeling
- Multivariate recurrent events
- Survival analysis
- Transfusion ratio
- Trauma
ASJC Scopus subject areas
- Epidemiology
Cite this
Recurrent event frailty models reduced time-varying and other biases in evaluating transfusion protocols for traumatic hemorrhage. / Choi, Sangbum; Rahbar, Mohammad H.; Ning, Jing; del Junco, Deborah J.; Rahbar, Elaheh; Hong, Chuan; Piao, Jin; Fox, Erin E.; Holcomb, John B.
In: Journal of Clinical Epidemiology, Vol. 77, 01.09.2016, p. 52-59.e1.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Recurrent event frailty models reduced time-varying and other biases in evaluating transfusion protocols for traumatic hemorrhage
AU - Choi, Sangbum
AU - Rahbar, Mohammad H.
AU - Ning, Jing
AU - del Junco, Deborah J.
AU - Rahbar, Elaheh
AU - Hong, Chuan
AU - Piao, Jin
AU - Fox, Erin E.
AU - Holcomb, John B.
PY - 2016/9/1
Y1 - 2016/9/1
N2 - Objective Transfusion research seeks to improve survival for severely injured and hemorrhaging patients using optimal plasma and platelet ratios over red blood cells (RBCs). However, most published studies comparing different ratios are plagued with serious bias and ignore time-varying effects. We applied joint recurrent event frailty models to increase validity and clinical utility. Study Design and Setting Using the PRospective Observational Multicenter Major Trauma Transfusion study data, our joint random-effects models estimated the association of (1) clinical covariates with transfusion rate intensities and (2) varying plasma:RBC and platelet:RBC ratios with survival over the 24 hours after hospital admission. Along with survival time, baseline patient vital signs, laboratory values, and longitudinal data on types and volumes of transfusions were included. Results Baseline systolic blood pressure, heart rate, pH, and hemoglobin were significantly associated with RBC transfusion rates. Increased transfusion rates (per hour) of plasma (P = 0.05), platelets (P < 0.001), or RBCs were associated with increased 24-hour mortality. Higher ratios of plasma:RBC (P = 0.107) and platelet:RBC (P < 0.001) were associated with reduced mortality in a time-varying pattern (P < 0.001). Conclusions The proposed joint analysis of transfusion rates and ratios offers a more valid statistical approach to evaluate survival effects in the presence of informative censoring by early death.
AB - Objective Transfusion research seeks to improve survival for severely injured and hemorrhaging patients using optimal plasma and platelet ratios over red blood cells (RBCs). However, most published studies comparing different ratios are plagued with serious bias and ignore time-varying effects. We applied joint recurrent event frailty models to increase validity and clinical utility. Study Design and Setting Using the PRospective Observational Multicenter Major Trauma Transfusion study data, our joint random-effects models estimated the association of (1) clinical covariates with transfusion rate intensities and (2) varying plasma:RBC and platelet:RBC ratios with survival over the 24 hours after hospital admission. Along with survival time, baseline patient vital signs, laboratory values, and longitudinal data on types and volumes of transfusions were included. Results Baseline systolic blood pressure, heart rate, pH, and hemoglobin were significantly associated with RBC transfusion rates. Increased transfusion rates (per hour) of plasma (P = 0.05), platelets (P < 0.001), or RBCs were associated with increased 24-hour mortality. Higher ratios of plasma:RBC (P = 0.107) and platelet:RBC (P < 0.001) were associated with reduced mortality in a time-varying pattern (P < 0.001). Conclusions The proposed joint analysis of transfusion rates and ratios offers a more valid statistical approach to evaluate survival effects in the presence of informative censoring by early death.
KW - Hemorrhage
KW - Joint modeling
KW - Multivariate recurrent events
KW - Survival analysis
KW - Transfusion ratio
KW - Trauma
UR - http://www.scopus.com/inward/record.url?scp=84976471157&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84976471157&partnerID=8YFLogxK
U2 - 10.1016/j.jclinepi.2016.03.029
DO - 10.1016/j.jclinepi.2016.03.029
M3 - Article
C2 - 27134138
AN - SCOPUS:84976471157
VL - 77
SP - 52-59.e1
JO - Journal of Clinical Epidemiology
JF - Journal of Clinical Epidemiology
SN - 0895-4356
ER -