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 |
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| Main Authors: | , , , , , , , |
| Format: | Journal Article |
| Language: | English |
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London
BioMed Central
15.04.2015
BioMed Central Ltd Springer Nature B.V |
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| ISSN: | 1364-8535, 1466-609X, 1364-8535, 1466-609X, 1366-609X |
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| Abstract | 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. |
|---|---|
| AbstractList | 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. 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-[alpha] (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. 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. 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. At baseline, systemic cytokine levels were mildly elevated in critically ill patients. FFP transfusion resulted in a decrease of levels of TNF-[alpha] (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). 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. 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. 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. 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). 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. Trialregister.nl NTR2262, registered 26 March 2010 and Clinicaltrials.gov NCT01143909, registered 14 June 2010. Abbreviations ADAMTS13: a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 APACHE IV score: acute physiology and chronic health evaluation IV score DIC: disseminated intravascular coagulation ELISA: enzyme-linked immunosorbent assay FFP: fresh frozen plasma ICU: intensive care unit IL-1: interleukin 1 IL-10: interleukin 10 IL-1RA: interleukin 1 receptor antagonist IL-1?: interleukin 1 beta IL-8: interleukin 8 INR: international normalized ratio IQR: interquartile range ISTH: International Society on Thrombosis and Haemostasis LMWH: low-molecular-weight heparin MCP-1: monocyte chemotactic protein 1 MIP-1A: macrophage inflammatory proteins 1A sCD40L: soluble CD40 ligand SD: standard deviation SOFA score: sequential organ failure assessment score TNF-?: tumor necrosis factor alpha TRALI: transfusion-related acute lung injury vWF: von Willebrand factor vWF: Risk factors and outcome of transfusion-related acute lung injury in the critically ill: a nested case-control study. Transfusion-related acute lung injury in cardiac surgery patients is characterized by pulmonary inflammation and coagulopathy: a prospective nested case-control study. 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.INTRODUCTIONMuch 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.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.METHODSA 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.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).RESULTSAt 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).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.CONCLUSIONSA 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.Trialregister.nl NTR2262, registered 26 March 2010 and Clinicaltrials.gov NCT01143909, registered 14 June 2010.TRIAL REGISTRATIONSTrialregister.nl NTR2262, registered 26 March 2010 and Clinicaltrials.gov NCT01143909, registered 14 June 2010. |
| ArticleNumber | 163 |
| Audience | Academic |
| Author | Spoelstra - de Man, Angelique ME Arbous, Mendi S Beurskens, Charlotte JP Juffermans, Nicole P Straat, Marleen Müller, Marcella CA Meijers, Joost CM Vroom, Margreeth B |
| Author_xml | – sequence: 1 givenname: Marleen surname: Straat fullname: Straat, Marleen email: m.straat@amc.uva.nl organization: Department of Intensive Care Medicine, Academic Medical Center, Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center – sequence: 2 givenname: Marcella CA surname: Müller fullname: Müller, Marcella CA organization: Department of Intensive Care Medicine, Academic Medical Center, Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center – sequence: 3 givenname: Joost CM surname: Meijers fullname: Meijers, Joost CM organization: Department of Experimental Vascular Medicine, Academic Medical Center – sequence: 4 givenname: Mendi S surname: Arbous fullname: Arbous, Mendi S organization: Department of Intensive Care Medicine, Leiden University Medical Center – sequence: 5 givenname: Angelique ME surname: Spoelstra - de Man fullname: Spoelstra - de Man, Angelique ME organization: Department of Intensive Care Medicine, VU Medical Center – sequence: 6 givenname: Charlotte JP surname: Beurskens fullname: Beurskens, Charlotte JP organization: Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center – sequence: 7 givenname: Margreeth B surname: Vroom fullname: Vroom, Margreeth B organization: Department of Intensive Care Medicine, Academic Medical Center – sequence: 8 givenname: Nicole P surname: Juffermans fullname: Juffermans, Nicole P organization: Department of Intensive Care Medicine, Academic Medical Center, Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/25880761$$D View this record in MEDLINE/PubMed |
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| Copyright | Straat et al.; licensee BioMed Central. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( ) applies to the data made available in this article, unless otherwise stated. COPYRIGHT 2015 BioMed Central Ltd. Copyright BioMed Central 2015 Straat et al.; licensee BioMed Central. 2015 |
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| Keywords | Abciximab Thrombotic Thrombocytopenic Purpura Massive Transfusion Fresh Freeze Plasma |
| Language | English |
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Much controversy exists on the effect of a fresh frozen plasma (FFP) transfusion on systemic inflammation and endothelial damage. Adverse effects... Much controversy exists on the effect of a fresh frozen plasma (FFP) transfusion on systemic inflammation and endothelial damage. Adverse effects of FFP have... Introduction Much controversy exists on the effect of a fresh frozen plasma (FFP) transfusion on systemic inflammation and endothelial damage. Adverse effects... Abbreviations ADAMTS13: a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 APACHE IV score: acute physiology and chronic health... |
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| SubjectTerms | 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 |
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| Title | 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 |
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