title: Association of RBC transfusion with mortality in patients with acute lung injury.
abstract: BACKGROUND
  RBC transfusion has been associated with increased morbidity and mortality in a variety of clinical settings. We assessed the effect of RBC transfusion on in-hospital mortality in patients with acute lung injury (ALI).
  
  
  METHODS
  Cohort study of 248 consecutive patients with ALI. RBC transfusion was evaluated as both dichotomous and continuous variables, with outcome being in-hospital mortality adjusted for clinical confounders and length of total hospital stay.
  
  
  RESULTS
  Overall in-hospital mortality rate was 39.5%. Of these patients, 207 of 248 patients (83.5%) received > or = 1 U of packed RBCs. The transfusion of any packed RBCs was associated with an increased risk of death (adjusted odds ratio [OR], 3.12; 95% confidence interval [CI], 1.28 to 7.58; p < 0.001). The overall OR per unit was 1.06 (95% CI, 1.04 to 1.09; p < 0.001) in the complete multivariable model. Transfusion after ALI onset was associated with an adjusted OR of 1.13 (95% CI, 1.07 to 1.20; p < 0.001), while transfusion before ALI onset was not associated with higher risk. The adjusted OR per unit of nonleukoreduced RBC transfused was 1.14 (95% CI, 1.07 to 1.21; p < 0.001), while the adjusted OR for leukoreduced cells per unit transfused was 1.06 (95% CI, 1.03 to 1.09; p < 0.001).
  
  
  CONCLUSIONS
  Transfusion of RBCs in patients with ALI was associated with increased in-hospital mortality. This risk occurred with RBC transfusion after the onset of ALI, and was greater for nonleukoreduced than for leukoreduced RBCs. Aggressive transfusion strategies in patients with established ALI should be questioned, pending further study.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, MSTF Bldg, Room 800, 685 W Baltimore St, Baltimore, MD 21201, USA. gnetzer@medicine.umaryland.edu
authors.forename: Giora
authors.initials: G
authors.lastname: Netzer
authors.forename: Chirag V
authors.initials: CV
authors.lastname: Shah
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Iwashyna
authors.forename: Paul N
authors.initials: PN
authors.lastname: Lanken
authors.forename: Barbara
authors.initials: B
authors.lastname: Finkel
authors.forename: Barry
authors.initials: B
authors.lastname: Fuchs
authors.forename: Wensheng
authors.initials: W
authors.lastname: Guo
authors.forename: Jason D
authors.initials: JD
authors.lastname: Christie
mesh_terms: D000328:Adult; D016638:Critical Illness; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D047589:Leukocyte Reduction Procedures; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000401:mortality*; D012307:Risk Factors; D016019:Survival Analysis