{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T15:27:45Z","timestamp":1772724465966,"version":"3.50.1"},"reference-count":56,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n To date, no studies have focused on the fresh frozen plasma (FFP)\u2013to\u2013red blood cell (RBC) transfusion ratio in patients with severe traumatic brain injury (TBI). Herein, the authors investigated the relationship between the FFP-to-RBC ratio and neurological outcomes, including mortality, in patients with severe TBI (Glasgow Coma Scale [GCS] score < 9).<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n This multicenter, retrospective, observational study used data from the Japan Trauma Data Bank from 2019 to 2023. The study included patients aged \u2265 18 years with severe TBI (defined as a GCS score < 9 and an Abbreviated Injury Scale [AIS] score > 2) without severe extracranial injury (AIS score > 2). The high-ratio group was defined as having an FFP-to-RBC ratio > 1, and the low-ratio group was defined as having a ratio of 1 or less. The association between the FFP-to-RBC ratio and outcomes was evaluated using propensity score\u2013based inverse probability of treatment weighting. The primary outcome was in-hospital mortality, and the secondary outcome was a poor neurological outcome at discharge (defined as a Glasgow Outcome Scale score of 1\u20133).<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n A total of 1007 patients were included in the analysis. Compared with the low-ratio group, the high-ratio group showed no significant differences in in-hospital mortality (adjusted odds ratio [aOR] 0.91, 95% CI 0.69\u20131.22) or poor neurological outcome (aOR 1.12, 95% CI 0.76\u20131.64).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n The authors found no association between FFP-to-RBC transfusion ratio and neurological outcomes, including in-hospital mortality, in severe TBI.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.5.jns25939","type":"journal-article","created":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T01:41:00Z","timestamp":1758332460000},"page":"131-138","source":"Crossref","is-referenced-by-count":0,"title":["Association between the fresh frozen plasma\u2013to\u2013red blood cell transfusion ratio and neurological outcomes in patients with severe traumatic brain injury"],"prefix":"10.3171","volume":"144","author":[{"given":"Shu","family":"Utsumi","sequence":"first","affiliation":[{"name":"Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima Prefecture; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shingo","family":"Ohki","sequence":"additional","affiliation":[{"name":"Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima Prefecture; and"},{"name":"Department of Critical Care Medicine, Shonan Kamakura General Hospital, Kamakura, Kanagawa Prefecture, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nobuaki","family":"Shime","sequence":"additional","affiliation":[{"name":"Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima Prefecture; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"12","key":"b1","series-title":"Lancet Neurol","first-page":"949","article-title":"Traumatic brain injury: a global challenge","volume":"16","author":"Johnson WD","year":"2017","unstructured":"Johnson WD, Griswold DP. Traumatic brain injury: a global challenge. Lancet Neurol. 2017;16(12):949\u2013950."},{"issue":"4","key":"b2","series-title":"J Neurol Surg","first-page":"1080","article-title":"Estimating the global incidence of traumatic brain injury","volume":"130","author":"Dewan M","year":"2018","unstructured":"Dewan M, Rattani A, Gupta S, Estimating the global incidence of traumatic brain injury. J Neurol Surg. 2018;130(4):1080\u20131097."},{"issue":"10210","key":"b3","series-title":"Lancet","first-page":"1713","article-title":"Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial","volume":"394","year":"2019","unstructured":"Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial. Lancet. 2019;394(10210):1713\u20131723."},{"key":"b4","series-title":"World Neurosurg","first-page":"481","article-title":"Impact of intracranial pressure and invasive cerebral oxygenation monitoring in patients with severe traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials","volume":"190","author":"Utsumi S","year":"2024","unstructured":"Utsumi S, Okajima K, Amagasa S. Impact of intracranial pressure and invasive cerebral oxygenation monitoring in patients with severe traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials. World Neurosurg. 2024;190:481\u2013486.e2."},{"issue":"1","key":"b5","series-title":"Crit Care","first-page":"170","article-title":"Targeted temperature control following traumatic brain injury: ESICM\/NACCS best practice consensus recommendations","volume":"28","author":"Lavinio A","year":"2024","unstructured":"Lavinio A, Coles JP, Robba C, Targeted temperature control following traumatic brain injury: ESICM\/NACCS best practice consensus recommendations. Crit Care. 2024;28(1):170."},{"issue":"8","key":"b6","series-title":"N Engl J Med","first-page":"722","article-title":"Liberal or restrictive transfusion strategy in patients with traumatic brain injury","volume":"391","author":"Turgeon AF","year":"2024","unstructured":"Turgeon AF, Fergusson DA, Clayton L, Liberal or restrictive transfusion strategy in patients with traumatic brain injury. N Engl J Med. 2024;391(8):722\u2013735."},{"issue":"19","key":"b7","series-title":"JAMA","first-page":"1623","article-title":"Restrictive vs liberal transfusion strategy in patients with acute brain injury","volume":"332","author":"Taccone FS","year":"2024","unstructured":"Taccone FS, Rynkowski CB, M\u00f8ller K, Restrictive vs liberal transfusion strategy in patients with acute brain injury. JAMA. 2024;332(19):1623\u20131633."},{"issue":"5","key":"b8","series-title":"J Am Coll Surg","first-page":"809","article-title":"Early resuscitation with fresh frozen plasma for traumatic brain injury combined with hemorrhagic shock improves neurologic recovery","volume":"220","author":"Halaweish I","year":"2015","unstructured":"Halaweish I, Bambakidis T, He W, Early resuscitation with fresh frozen plasma for traumatic brain injury combined with hemorrhagic shock improves neurologic recovery. J Am Coll Surg. 2015;220(5):809\u2013819."},{"issue":"2","key":"b9","series-title":"Surgery","first-page":"538","article-title":"Early plasma transfusion is associated with improved survival after isolated traumatic brain injury in patients with multifocal intracranial hemorrhage","volume":"161","author":"Chang R","year":"2017","unstructured":"Chang R, Folkerson LE, Sloan D, Early plasma transfusion is associated with improved survival after isolated traumatic brain injury in patients with multifocal intracranial hemorrhage. 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Crit Care. 2011;15(1):R68."},{"issue":"11","key":"b12","series-title":"JAMA Surg","first-page":"1272","article-title":"High fresh frozen plasma to red blood cell ratio and survival outcomes in blunt trauma","volume":"159","author":"Fujiwara G","year":"2024","unstructured":"Fujiwara G, Okada Y, Ishii W, High fresh frozen plasma to red blood cell ratio and survival outcomes in blunt trauma. JAMA Surg. 2024;159(11):1272\u20131280."},{"issue":"9","key":"b13","series-title":"JAMA Netw Open","first-page":"e1912076","article-title":"Association of early, high plasma-to-red blood cell transfusion ratio with mortality in adults with severe bleeding after trauma","volume":"2","author":"Roquet F","year":"2019","unstructured":"Roquet F, Neuschwander A, Hamada S, Association of early, high plasma-to-red blood cell transfusion ratio with mortality in adults with severe bleeding after trauma. 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J Neurosurg. 1973;39(2):178\u2013180."},{"issue":"6","key":"b16","series-title":"J Trauma","first-page":"1254","article-title":"Early coagulopathy after traumatic brain injury: the role of hypoperfusion and the protein C pathway","volume":"63","author":"Cohen MJ","year":"2007","unstructured":"Cohen MJ, Brohi K, Ganter MT, Early coagulopathy after traumatic brain injury: the role of hypoperfusion and the protein C pathway. J Trauma. 2007;63(6):1254\u20131261."},{"issue":"8","key":"b17","series-title":"Lancet Neurol","first-page":"630","article-title":"Coagulopathy and haemorrhagic progression in traumatic brain injury: advances in mechanisms, diagnosis, and management","volume":"16","author":"Maegele M","year":"2017","unstructured":"Maegele M, Sch\u00f6chl H, Menovsky T, Coagulopathy and haemorrhagic progression in traumatic brain injury: advances in mechanisms, diagnosis, and management. Lancet Neurol. 2017;16(8):630\u2013647."},{"key":"b18","article-title":"Japan Trauma Data Bank","unstructured":"Japan Trauma Data Bank. Accessed June 5, 2025.https:\/\/www.jtcr-jatec.org\/traumabank\/dataroom\/data\/JTDB2023e.pdf"},{"issue":"9596","key":"b19","series-title":"Lancet","first-page":"1453","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"370","author":"von Elm E","year":"2007","unstructured":"von Elm E, Altman DG, Egger M, The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453\u20131457."},{"issue":"6-7","key":"b20","series-title":"J Neurotrauma","first-page":"563","article-title":"The American Association of Neurological Surgeons. The joint section on neurotrauma and critical care. 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Rev Recent Clin Trials. 2020;15(1):70\u201375."},{"issue":"1","key":"b27","series-title":"Am J Emerg Med","first-page":"38","article-title":"Coagulopathy as a predictor of mortality after penetrating traumatic brain injury","volume":"36","author":"Folkerson LE","year":"2018","unstructured":"Folkerson LE, Sloan D, Davis E, Coagulopathy as a predictor of mortality after penetrating traumatic brain injury. Am J Emerg Med. 2018;36(1):38\u201342."},{"issue":"10","key":"b28","series-title":"JAMA Netw Open","first-page":"e2016869","article-title":"Association of prehospital plasma with survival in patients with traumatic brain injury: a secondary analysis of the PAMPer cluster randomized clinical trial","volume":"3","author":"Gruen DS","year":"2020","unstructured":"Gruen DS, Guyette FX, Brown JB, Association of prehospital plasma with survival in patients with traumatic brain injury: a secondary analysis of the PAMPer cluster randomized clinical trial. JAMA Netw Open. 2020;3(10):e2016869."},{"issue":"12","key":"b1","series-title":"Lancet Neurol","first-page":"949","article-title":"Traumatic brain injury: a global challenge","volume":"16","author":"Johnson WD","year":"2017","unstructured":"Johnson WD, Griswold DP. Traumatic brain injury: a global challenge. Lancet Neurol. 2017;16(12):949\u2013950."},{"issue":"4","key":"b2","series-title":"J Neurol Surg","first-page":"1080","article-title":"Estimating the global incidence of traumatic brain injury","volume":"130","author":"Dewan M","year":"2018","unstructured":"Dewan M, Rattani A, Gupta S, Estimating the global incidence of traumatic brain injury. 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Crit Care. 2024;28(1):170."},{"issue":"8","key":"b6","series-title":"N Engl J Med","first-page":"722","article-title":"Liberal or restrictive transfusion strategy in patients with traumatic brain injury","volume":"391","author":"Turgeon AF","year":"2024","unstructured":"Turgeon AF, Fergusson DA, Clayton L, Liberal or restrictive transfusion strategy in patients with traumatic brain injury. N Engl J Med. 2024;391(8):722\u2013735."},{"issue":"19","key":"b7","series-title":"JAMA","first-page":"1623","article-title":"Restrictive vs liberal transfusion strategy in patients with acute brain injury","volume":"332","author":"Taccone FS","year":"2024","unstructured":"Taccone FS, Rynkowski CB, M\u00f8ller K, Restrictive vs liberal transfusion strategy in patients with acute brain injury. JAMA. 2024;332(19):1623\u20131633."},{"issue":"5","key":"b8","series-title":"J Am Coll Surg","first-page":"809","article-title":"Early resuscitation with fresh frozen plasma for traumatic brain injury combined with hemorrhagic shock improves neurologic recovery","volume":"220","author":"Halaweish I","year":"2015","unstructured":"Halaweish I, Bambakidis T, He W, Early resuscitation with fresh frozen plasma for traumatic brain injury combined with hemorrhagic shock improves neurologic recovery. 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Surgery. 2017;161(2):538\u2013545."},{"issue":"3","key":"b10","series-title":"J Trauma Acute Care Surg","first-page":"452","article-title":"Prevalence and outcomes of high versus low ratio plasma to red blood cell resuscitation in a multi-institutional cohort of severely injured children","volume":"97","author":"Mehl SC","year":"2024","unstructured":"Mehl SC, Vogel AM, Glasgow AE, Prevalence and outcomes of high versus low ratio plasma to red blood cell resuscitation in a multi-institutional cohort of severely injured children. J Trauma Acute Care Surg. 2024;97(3):452\u2013459."},{"issue":"1","key":"b11","series-title":"Crit Care","first-page":"R68","article-title":"Balanced massive transfusion ratios in multiple injury patients with traumatic brain injury","volume":"15","author":"Peiniger S","year":"2011","unstructured":"Peiniger S, Nienaber U, Lefering R, Balanced massive transfusion ratios in multiple injury patients with traumatic brain injury. 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JAMA Netw Open. 2019;2(9):e1912076."},{"issue":"12","key":"b14","series-title":"Injury","first-page":"1693","article-title":"Meta-analysis of plasma to red blood cell ratios and mortality in massive blood transfusions for trauma","volume":"44","author":"Bhangu A","year":"2013","unstructured":"Bhangu A, Nepogodiev D, Doughty H, Meta-analysis of plasma to red blood cell ratios and mortality in massive blood transfusions for trauma. Injury. 2013;44(12):1693\u20131699."},{"issue":"2","key":"b15","series-title":"J Neurosurg","first-page":"178","article-title":"Disseminated intravascular coagulation associated with massive brain injury","volume":"39","author":"Keimowitz RM","year":"1973","unstructured":"Keimowitz RM, Annis BL. Disseminated intravascular coagulation associated with massive brain injury. J Neurosurg. 1973;39(2):178\u2013180."},{"issue":"6","key":"b16","series-title":"J Trauma","first-page":"1254","article-title":"Early coagulopathy after traumatic brain injury: the role of hypoperfusion and the protein C pathway","volume":"63","author":"Cohen MJ","year":"2007","unstructured":"Cohen MJ, Brohi K, Ganter MT, Early coagulopathy after traumatic brain injury: the role of hypoperfusion and the protein C pathway. J Trauma. 2007;63(6):1254\u20131261."},{"issue":"8","key":"b17","series-title":"Lancet Neurol","first-page":"630","article-title":"Coagulopathy and haemorrhagic progression in traumatic brain injury: advances in mechanisms, diagnosis, and management","volume":"16","author":"Maegele M","year":"2017","unstructured":"Maegele M, Sch\u00f6chl H, Menovsky T, Coagulopathy and haemorrhagic progression in traumatic brain injury: advances in mechanisms, diagnosis, and management. 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