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.
N1 - Funding Information:
This research is funded by the National Heart, Lung, and Blood Institute, United States (NHLBI; R21 HL109479 ), awarded to The University of Texas Health Science Center at Houston (UTHealth). The authors also acknowledge the support provided by the Biostatistics/Epidemiology/Research Design (BERD) component of the Center for Clinical and Translational Sciences (CCTS) for this project. CCTS is mainly funded by the United States NIH Centers for Translational Science Award (NIH CTSA) grant (UL1 RR024148), awarded to UTHealth in 2006 by the National Center for Research Resources (NCRR) and its renewal (UL1 TR000371) by the National Center for Advancing Translational Sciences (NCATS), United States. Appendix A
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
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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 -