Estimating the ratio of multivariate recurrent event rates with application to a blood transfusion study

Jing Ning, Mohammad H. Rahbar, Sangbum Choi, Jin Piao, Chuan Hong, Deborah J. Del Junco, Elaheh Rahbar, Erin E. Fox, John B. Holcomb, Mei Cheng Wang

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


In comparative effectiveness studies of multicomponent, sequential interventions like blood product transfusion (plasma, platelets, red blood cells) for trauma and critical care patients, the timing and dynamics of treatment relative to the fragility of a patient's condition is often overlooked and underappreciated. While many hospitals have established massive transfusion protocols to ensure that physiologically optimal combinations of blood products are rapidly available, the period of time required to achieve a specified massive transfusion standard (e.g. a 1:1 or 1:2 ratio of plasma or platelets:red blood cells) has been ignored. To account for the time-varying characteristics of transfusions, we use semiparametric rate models for multivariate recurrent events to estimate blood product ratios. We use latent variables to account for multiple sources of informative censoring (early surgical or endovascular hemorrhage control procedures or death). The major advantage is that the distributions of latent variables and the dependence structure between the multivariate recurrent events and informative censoring need not be specified. Thus, our approach is robust to complex model assumptions. We establish asymptotic properties and evaluate finite sample performance through simulations, and apply the method to data from the PRospective Observational Multicenter Major Trauma Transfusion study.

Original languageEnglish
Pages (from-to)1969-1981
Number of pages13
JournalStatistical Methods in Medical Research
Issue number4
Publication statusPublished - 2017 Aug 1
Externally publishedYes

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research is funded by the National Heart, Lung and Blood Institute (NHLBI; R21 HL109479), awarded to The University of Texas Health Science Center at Houston (UTHSC-H). We also acknowledge that the data used in this paper are from the PROMMTT study, which was funded by the U.S. Army Medical Research and Materiel Command subcontract W81XWH-08-C-0712. Infrastructure for the PROMMTT Data Coordinating Center was supported by CTSA funds from NIH/NCATS grant UL1 TR000371. The views and opinions expressed in this manuscript are those of the authors and do not reflect the official policy or position of the NHLBI, NIH, NCATS, the Army Medical Department, Department of the Army, the Department of Defense, or the United States Government.

Publisher Copyright:
© The Author(s) 2017.


  • Informative censoring
  • multivariate recurrent event
  • rate ratio
  • transfusion medicine

ASJC Scopus subject areas

  • Epidemiology
  • Statistics and Probability
  • Health Information Management


Dive into the research topics of 'Estimating the ratio of multivariate recurrent event rates with application to a blood transfusion study'. Together they form a unique fingerprint.

Cite this