Effect of high intraoperative plasma dose on the prognosis of patients undergoing blood transfusion during perioperative period

Objective To explore the relationship between the intraoperative plasma transfusion volume, the changes of blood coagulation test values and the clinical prognosis of surgical patients, so as to provide a theoretical basis for guiding the rational use of blood during the operation. Methods The clinical data of 556 surgical patients who received plasma infusion from January 2017 to December 2020 in Sun Yat-sen Memorial Hospital were collected. Patients were divided into low plasma dose group (<15 mL/kg) and high plasma dose group (≥15 mL/kg). The univariate regression analysis, logistic multivariate regression analysis and linear regression analysis were used to explore the relationship of plasma dose, the changes of coagulation indicators and the clinical prognosis. Results A total of 556 surgical patients were included in the study and the median (interquartile range) of plasma transfusion volume for all patients during the operation was 10.5 (8.5~14.0) mL/kg. In multivariate regression analysis, an increase of 1 mL/kg of intraoperative plasma dose resulted in an increased risk of red blood cell infusion within 24 hours after surgery[OR(95% CI) 1.16(1.01, 1.33), P<0.05], an increase in the ICU stays[Mean(95%CI) 0.19(0.03, 0.35), P<0.05] and an increase in the hospitalization days[Mean(95%CI) 0.55(0.27, 0.81), P<0.05]. The preoperative INR value increased the risk of red blood cell infusion within 24 hours after surgery[OR(95% CI) 1.82(1.33, 2.50), P<0.05], and increased the hospital mortality of postoperative patients[OR (95% CI) 2.15 (1.09, 4.24), P<0.05]; the decrease in INR reduced the risk of red blood cell infusion in patients 24 hours after surgery[OR(95% CI) 0.47(0.27, 0.84), P<0.05]and reduced hospital mortality[OR(95% CI) 0.23(0.13, 0.50), P<0.05]. Conclusion In surgical patients undergoing intraoperative plasma infusion, abnormal preoperative INR value and high intraoperative plasma infusion are related to poor clinical prognosis, while INR decrease (preoperative-postoperative) was related to better clinical results.