title: Fresh-frozen plasma and platelet transfusions are associated with development of acute lung injury in critically ill medical patients.
abstract: BACKGROUND
  Transfusion has long been identified as a risk factor for acute lung injury (ALI)/ARDS. No study has formally evaluated the transfusion of specific blood products as a risk factor for ALI/ARDS in critically ill medical patients.
  
  
  METHODS
  In this single-center retrospective cohort study, 841 consecutive critically ill patients were studied for the development of ALI/ARDS. Patients who received blood product transfusions were compared with those who did not, in univariate and multivariate propensity analyses.
  
  
  RESULTS
  Two hundred ninety-eight patients (35%) received blood transfusions. Transfused patients were older (mean [+/- SD] age, 67 +/- 17 years vs 62 +/- 19 years; p < 0.001) and had higher acute physiologic and chronic health evaluation (APACHE) III scores (74 +/- 32 vs 58 +/- 23; p < 0.001) than those who had not received transfusions. ALI/ARDS developed more commonly (25% vs 18%; p = 0.025) in patients exposed to transfusion. Seventeen patients received massive RBC transfusions (ie, > 10 U of blood transfused within 24 h), of whom 13 also received fresh-frozen plasma (FFP) and 11 received platelet transfusions. When adjusted for the probability of transfusion and other ALI/ARDS risk factors, any transfusion was associated with the development of ALI/ARDS (odds ratio [OR], 2.14; 95% confidence interval [CI], 1.24 to 3.75). Among those patients receiving individual blood products, ALI/ARDS was more likely to develop in patients who received FFP transfusions (OR, 2.48; 95% CI, 1.29 to 4.74) and platelet transfusions (OR, 3.89; 95% CI, 1.36 to 11.52) than in those who received only RBC transfusions (OR, 1.39; 95% CI, 0.79 to 2.43).
  
  
  CONCLUSIONS
  Transfusion is associated with an increased risk of the development of ALI/ARDS in critically ill medical patients. The risk is higher with transfusions of plasma-rich blood products, FFP, and platelets, than with RBCs.
authors.affiliation: Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Hasrat
authors.initials: H
authors.lastname: Khan
authors.forename: Jon
authors.initials: J
authors.lastname: Belsher
authors.forename: Murat
authors.initials: M
authors.lastname: Yilmaz
authors.forename: Bekele
authors.initials: B
authors.lastname: Afessa
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Winters
authors.forename: S Breanndan
authors.initials: SB
authors.lastname: Moore
authors.forename: Rolf D
authors.initials: RD
authors.lastname: Hubmayr
authors.forename: Ognjen
authors.initials: O
authors.lastname: Gajic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016638:Critical Illness / Q000628:therapy*; D017707:Erythrocyte Transfusion / Q000009:adverse effects; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008171:Lung Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010949:Plasma; D017713:Platelet Transfusion / Q000009:adverse effects*; D012128:Respiratory Distress Syndrome / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors