Effect of transfusion of fresh frozen plasma on parameters of endothelial condition and inflammatory status in non-bleeding critically ill patients: a prospective substudy of a randomized trial

Introduction Much controversy exists on the effect of a fresh frozen plasma (FFP) transfusion on systemic inflammation and endothelial damage. Adverse effects of FFP have been well described, including acute lung injury. However, it is also suggested that a higher amount of FFP decreases mortality i...

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Published in:	Critical care (London, England) Vol. 19; no. 1; p. 163
Main Authors:	Straat, Marleen, Müller, Marcella CA, Meijers, Joost CM, Arbous, Mendi S, Spoelstra - de Man, Angelique ME, Beurskens, Charlotte JP, Vroom, Margreeth B, Juffermans, Nicole P
Format:	Journal Article
Language:	English
Published:	London BioMed Central 15.04.2015 BioMed Central Ltd Springer Nature B.V
Subjects:	Acute respiratory distress syndrome Analysis Blood coagulation factor VIII Blood Component Transfusion - methods Blood products Care and treatment Critical care Critical Care Medicine Critical Illness - therapy Cytokines Emergency Medicine Endothelial Cells - drug effects Endothelial Cells - metabolism Endothelium Evidence-based medicine Health aspects Health risk assessment Heart surgery Humans Inflammation Inflammation - complications Inflammation - etiology Intensive Intensive care Intensive Care Units - utilization International Normalized Ratio Ligands Medicine & Public Health Mortality Multiple organ dysfunction syndrome Netherlands Patients Permeability Plasma Plasma - drug effects Plasma - metabolism Prospective Studies Risk factors Trauma Tumor Necrosis Factor-alpha Tumor necrosis factor-TNF Von Willebrand factor Netherlands Abciximab Thrombotic Thrombocytopenic Purpura Massive Transfusion Fresh Freeze Plasma
ISSN:	1364-8535, 1466-609X, 1364-8535, 1466-609X, 1366-609X
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Summary:	Introduction Much controversy exists on the effect of a fresh frozen plasma (FFP) transfusion on systemic inflammation and endothelial damage. Adverse effects of FFP have been well described, including acute lung injury. However, it is also suggested that a higher amount of FFP decreases mortality in trauma patients requiring a massive transfusion. Furthermore, FFP has an endothelial stabilizing effect in experimental models. We investigated the effect of fresh frozen plasma transfusion on systemic inflammation and endothelial condition. Methods A prospective predefined substudy of a randomized trial in coagulopathic non-bleeding critically ill patients receiving a prophylactic transfusion of FFP (12 ml/kg) prior to an invasive procedure. Levels of inflammatory cytokines and markers of endothelial condition were measured in paired samples of 33 patients before and after transfusion. The statistical tests used were paired t test or the Wilcoxon signed-rank test. Results At baseline, systemic cytokine levels were mildly elevated in critically ill patients. FFP transfusion resulted in a decrease of levels of TNF-α (from 11.3 to 2.3 pg/ml, P = 0.01). Other cytokines were not affected. FFP also resulted in a decrease in systemic syndecan-1 levels (from 675 to 565 pg/ml, P = 0.01) and a decrease in factor VIII levels (from 246 to 246%, P <0.01), suggestive of an improved endothelial condition. This was associated with an increase in ADAMTS13 levels (from 24 to 32%, P <0.01) and a concomitant decrease in von Willebrand factor (vWF) levels (from 474 to 423%, P <0.01). Conclusions A fixed dose of FFP transfusion in critically ill patients decreases syndecan-1 and factor VIII levels, suggesting a stabilized endothelial condition, possibly by increasing ADAMTS13, which is capable of cleaving vWF. Trial registrations Trialregister.nl NTR2262 , registered 26 March 2010 and Clinicaltrials.gov NCT01143909 , registered 14 June 2010.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 content type line 14 ObjectType-Feature-3 ObjectType-Evidence Based Healthcare-1 ObjectType-Article-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3
ISSN:	1364-8535 1466-609X 1364-8535 1466-609X 1366-609X
DOI:	10.1186/s13054-015-0828-6