Tehran University of Medical Sciences Iranian Journal of Allergy, Asthma and Immunology 1735-1502 0 0 2026 09 09 1 15 Mao Ye Department of Stomatology, Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science and Technology, Xianning, Hubei, China Wenzhao Hu Department of Blood Transfusion, Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science and Technology, Xianning, Hubei, China Chen Qin Department of Clinical Laboratory, Qingyang Second People's Hospital, Qingyang, Gansu, China Yue Wu Department of Cardiology, Hubei Provincial Third People's Hospital of Jianghan University, Wuhan, Hubei, China Xing Wu Department of Blood Transfusion, Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science and Technology, Xianning, Hubei, China 2026 04 13 2026 05 09 Massive blood transfusion (MBT) in severe trauma represents a major emergency-care challenge associated with high mortality and poor clinical outcomes. This retrospective cohort study enrolled 186 severe trauma patients treated at Xianning Central Hospital from January 2020 to January 2024, who were stratified into massive blood transfusion (MBT, ≥10 units RBCs within 24 h, n=72) and non-MBT (n=114) groups. The observed indicators included immune markers CD4+:CD8+ ratio, natural killer (NK) cells, immunoglobulin G (IgG), immunoglobulin A (IgA), and immunoglobulin M (IgM); inflammatory markers white blood cell (WBC) count, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6); trauma severity assessment indicators Injury Severity Score (ISS) and modified Trauma Induced Coagulopathy Clinical Score (mTICCS); and clinical events including transfusion adverse events and mechanical ventilation duration. Logistic regression identified independent MBT predictors; receiver operating characteristic (ROC) curves evaluated their predictive performance. The two groups showed comparable baseline characteristics. The MBT group presented a lower CD4+/CD8+ ratio, higher NLR, inflammatory factors, ISS and mTICCS, as well as more transfusion adverse events and longer ventilation duration. NLR ≥ 9.5, CD4+/CD8+ ≤ 0.7, ISS ≥ 25, and mTICCS ≥ 12 were independent MBT predictors. ROC analysis revealed favorable predictive performance for these indicators, with the highest AUC of 0.810 for mTICCS, followed by NLR (0.806) and CD4+:CD8+ ratio (0.800), with no significant predictive differences among them via DeLong test. This study demonstrates that admission immune-inflammatory status and trauma severity are reliable early biomarkers for predicting MBT in severe trauma patients. https://ijaai.tums.ac.ir/index.php/ijaai/article/view/4798 https://ijaai.tums.ac.ir/index.php/ijaai/article/download/4798/2417