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2026, Number 3

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Med Crit 2026; 40 (3)

Predictive value of coagulation tests for transfusion requirements in critically ill patients: a retrospective cohort analysis

Arechiga CAE, Zaragoza JJ, González LEMM, Torres LL, Cambrón P, Rodríguez GJH

Language: Spanish
References: 25
Page: 177-183
PDF size: 970.89 Kb.


ABSTRACT

Introduction: fresh frozen plasma (FFP) and cryoprecipitate transfusion is frequent in critically ill patients, although conventional coagulation tests such as INR, aPTT, and platelet count have widespread use. This study aimed to assess their ability to predict transfusion requirements. Material and methods: a retrospective cohort was conducted including 526 adult Intensive Care Unit patients (January 2024-May 2025). After applying exclusion criteria and removing incomplete records, 314 patients comprised the final cohort. The primary outcome was transfusion of fresh frozen plasma (FFP) or cryoprecipitate within the first 48 hours. A logistic regression model was built and internally validated using bootstrapping (1,000 replicates). Model performance was assessed by discrimination (AUC) and calibration (Hosmer-Lemeshow test). Results: among 314 patients with complete data, 45 (14.3%) received a transfusion. The only independent predictor was active bleeding (OR 6.27, 95%CI 2.47-15.93, p < 0.001). INR and platelet count were not significant predictors. The final model showed acceptable discrimination (AUC 0.69, 95%CI 0.60-0.77) and good calibration (Hosmer-Lemeshow p = 0.17). Conclusions: conventional coagulation tests demonstrated limited predictive value for guiding plasma transfusion, with active bleeding being the only clinically relevant factor. These findings support a restrictive approach and highlight the need for more precise hemostatic tools, such as thromboelastography.


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