Abstract: Objective To investigate the clinical application of fresh frozen plasma (FFP) in pediatric patients with sepsis and its association with prognosis. Methods A retrospective analysis was conducted on 262 pediatric patients with sepsis admitted to the PICU of Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology between January 2023 and December 2024. Patients were categorized into an FFP transfusion group and a non-transfusion group based on whether they received FFP during hospitalization. Differences in characteristics, laboratory findings, clinical interventions, and prognostic outcomes between the two groups were compared. Results Significant differences were observed between the transfusion group (n=87) and the non-transfusion group (n=175) in laboratory parameters, including white blood cell count (P=0.007), platelet count (P=0.000), coagulation function (P=0.000), clinical interventions (P=0.000), and prognosis (P=0.000). Multivariate binary logistic regression analysis revealed that FFP transfusion (HR 6.079, 95%CI 1.336-27.661, P=0.020), mechanical ventilation (HR 16.107, 95%CI 4.637-55.949, P=0.000), and PRISM Ⅲ score≥15 (HR 7.865, 95%CI 1.539-40.208, P=0.013) were independent predictors of in-hospital mortality in pediatric patients with sepsis. Additionally, FFP transfusion (HR 3.242, 95%CI 1.277-8.227, P=0.013), lactate dehydrogenase levels (HR 1.001, 95%CI 1.000-1.002, P=0.018), and PRISM Ⅲ score≥15 (HR 5.308, 95%CI 1.420-19.840, P=0.013) were identified as independent predictors of multiple organ dysfunction syndrome (MODS). Except for children over 10 years old, the transfusion group exhibited significantly higher mortality and MODS rates across all age groups (all P<0.05). Notably, children receiving FFP doses>60 mL/kg, frequency>3 times, or FFP infusion within 24 hours demonstrated the highest mortality and MODS rates. Conclusion FFP transfusion is significantly associated with increased in-hospital mortality and MODS occurrence in pediatric patients with sepsis, suggesting that clinicians should evaluate the necessity of FFP administration to reduce its irrational use.

Key words: Fresh frozen plasma, Sepsis, Pediatrics, In-hospital mortality, Multiple organ dysfunction syndrome