OBJECTIVES: To determine the incidence, risk factors, and outcome of transfusion-related acute lung injury in a cohort of critically ill patients. DESIGN: In a retrospective cohort study, patients with transfusion-related acute lung injury were identified using the consensus criteria of acute lung injury within 6 hrs after transfusion. Inclusion criterion was a length of intensive care unit admission >48 hrs. Patients developing transfusion-related acute lung injury were matched (on age, sex, and admission diagnosis) to transfused control subjects and patients developing acute lung injury from another origin. SETTING: Tertiary referral hospital. PATIENTS: All first-admitted patients from November 1, 2004, until October 1, 2007, to the intensive care unit. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 5208 admitted patients, 2024 patients had a length of stay >48 hrs, of whom 109 were suspected transfusion-related acute lung injury cases. Compared with transfused control subjects, risk factors for transfusion-related acute lung injury were emergency cardiac surgery (odds ratio, 17.6 [1.8-168.5]), hematologic malignancy (odds ratio, 13.1 [2.7-63.8]), massive transfusion (odds ratio, 4.5 [2.1-9.8]), sepsis (odds ratio, 2.5 [1.2-5.2]), mechanical ventilation (odds ratio, 3.0 [1.3-7.1], and high Acute Physiology and Chronic Health Evaluation II score (odds ratio, 1.1 [1.0-1.1]; p < .03 for all). The volume of platelets and plasma transfused was associated with transfusion-related acute lung injury in the univariate analysis. However, this association disappeared in the multivariate analysis. Compared with acute lung injury control subjects, risk factors for transfusion-related acute lung injury were sepsis (odds ratio, 2.4 [1.1-5.3]) and high Acute Physiology and Chronic Health Evaluation II score (odds ratio, 1.1 [1.0-1.1]), whereas pneumonia (odds ratio, 0.4 [0.2-0.7]) was a negative predictive factor. Patients with transfusion-related acute lung injury had a longer duration of mechanical ventilation compared with transfused control subjects and acute lung injury control subjects (231 [138-472] vs. 71 [46-163] and 70 [42-121] hrs, p < .001). Also, 90-day survival of patients with transfusion-related acute lung injury was lower compared with transfused control subjects and acute lung injury control subjects (53% vs. 75% and 83%, p < .02). CONCLUSIONS: Transfusion-related acute lung injury is common in critically ill patients. Transfusion-related acute lung injury may contribute to an adverse outcome associated with transfusion. This study identifies transfusion-related acute lung injury risk factors, which may aid in assessing the risks and benefits of transfusion in critically ill patients.
OBJECTIVES: To determine the incidence, risk factors, and outcome of transfusion-related acute lung injury in a cohort of critically illpatients. DESIGN: In a retrospective cohort study, patients with transfusion-related acute lung injury were identified using the consensus criteria of acute lung injury within 6 hrs after transfusion. Inclusion criterion was a length of intensive care unit admission >48 hrs. Patients developing transfusion-related acute lung injury were matched (on age, sex, and admission diagnosis) to transfused control subjects and patients developing acute lung injury from another origin. SETTING: Tertiary referral hospital. PATIENTS: All first-admitted patients from November 1, 2004, until October 1, 2007, to the intensive care unit. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 5208 admitted patients, 2024 patients had a length of stay >48 hrs, of whom 109 were suspected transfusion-related acute lung injury cases. Compared with transfused control subjects, risk factors for transfusion-related acute lung injury were emergency cardiac surgery (odds ratio, 17.6 [1.8-168.5]), hematologic malignancy (odds ratio, 13.1 [2.7-63.8]), massive transfusion (odds ratio, 4.5 [2.1-9.8]), sepsis (odds ratio, 2.5 [1.2-5.2]), mechanical ventilation (odds ratio, 3.0 [1.3-7.1], and high Acute Physiology and Chronic Health Evaluation II score (odds ratio, 1.1 [1.0-1.1]; p < .03 for all). The volume of platelets and plasma transfused was associated with transfusion-related acute lung injury in the univariate analysis. However, this association disappeared in the multivariate analysis. Compared with acute lung injury control subjects, risk factors for transfusion-related acute lung injury were sepsis (odds ratio, 2.4 [1.1-5.3]) and high Acute Physiology and Chronic Health Evaluation II score (odds ratio, 1.1 [1.0-1.1]), whereas pneumonia (odds ratio, 0.4 [0.2-0.7]) was a negative predictive factor. Patients with transfusion-related acute lung injury had a longer duration of mechanical ventilation compared with transfused control subjects and acute lung injury control subjects (231 [138-472] vs. 71 [46-163] and 70 [42-121] hrs, p < .001). Also, 90-day survival of patients with transfusion-related acute lung injury was lower compared with transfused control subjects and acute lung injury control subjects (53% vs. 75% and 83%, p < .02). CONCLUSIONS: Transfusion-related acute lung injury is common in critically illpatients. Transfusion-related acute lung injury may contribute to an adverse outcome associated with transfusion. This study identifies transfusion-related acute lung injury risk factors, which may aid in assessing the risks and benefits of transfusion in critically illpatients.
Authors: Andrew M Naidech; Storm M Liebling; Neil F Rosenberg; Paul F Lindholm; Richard A Bernstein; H Hunt Batjer; Mark J Alberts; Hau C Kwaan Journal: Neurocrit Care Date: 2012-02 Impact factor: 3.210
Authors: Grace M Thomas; Carla Carbo; Brian R Curtis; Kimberly Martinod; Irina B Mazo; Daphne Schatzberg; Stephen M Cifuni; Tobias A Fuchs; Ulrich H von Andrian; John H Hartwig; Richard H Aster; Denisa D Wagner Journal: Blood Date: 2012-05-17 Impact factor: 22.113
Authors: Anna L Peters; Emma K Van De Weerdt; Eline J Goudswaard; Jan M Binnekade; Jaap J Zwaginga; Erik A M Beckers; Sacha S Zeerleder; Marian G J Van Kraaij; Nicole P Juffermans; Alexander P J Vlaar Journal: Blood Transfus Date: 2017-04-05 Impact factor: 3.443
Authors: Mark R Looney; Nareg Roubinian; Ognjen Gajic; Michael A Gropper; Rolf D Hubmayr; Clifford A Lowell; Peter Bacchetti; Gregory Wilson; Monique Koenigsberg; Deanna C Lee; Ping Wu; Barbara Grimes; Philip J Norris; Edward L Murphy; Manish J Gandhi; Jeffrey L Winters; David C Mair; Randy M Schuller; Nora V Hirschler; Rosa Sanchez Rosen; Michael A Matthay; Pearl Toy Journal: Crit Care Med Date: 2014-07 Impact factor: 7.598