Transfusion-related acute lung injury in the critically ill: prospective nested case-control study.
BACKGROUND
Acute lung injury (ALI) that develops 6 hours after transfusion (TRALI) is the leading cause of transfusion-related mortality. Several transfusion characteristics have been postulated as risk factors for TRALI, but the evidence is limited to retrospective studies.


OBJECTIVE
To compare patient and transfusion risk factors between patients who do and do not develop ALI.


METHODS
In this prospective cohort study, consecutive transfused critically ill patients were closely observed for development of ALI. Donor samples were collected from the transfusion bags. Risk factors were compared between patients who developed ALI after transfusion and transfused control patients, matched by age, sex, and admission diagnosis.


RESULTS
Seventy-four of 901 transfused patients developed ALI within 6 hours of transfusion (8%). Compared with transfused control subjects, patients with ALI were more likely to have sepsis (37 vs. 22%, P = 0.016) and a history of chronic alcohol abuse (37 vs. 18%, P = 0.006). When adjusted for patient characteristics, transfusion of plasma from female donors (odds ratio [OR], 5.09; 95% confidence interval [95% CI], 1.37-18.85) rather than male donors (OR, 1.60; 95% CI, 0.76 to 3.37), number of pregnancies among the donors (OR, 1.19; 95% CI, 1.05 to 1.34), number of donor units positive for anti-granulocyte antibodies (OR, 4.85; 95% CI, 1.32-17.86) and anti-HLA class II antibodies (OR, 3.08; 95% CI, 1.15-8.25), and concentration of lysophosphatidylcholine in the donor product (OR, 1.69; 95% CI, 1.10 to 2.59) were associated with the development of ALI.


CONCLUSIONS
Both patient and transfusion risk factors determine the probability of ALI after transfusion. Transfusion factors represent attractive targets for the prevention of ALI.
Gajic
Ognjen
O
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. gajic.ognjen@mayo.edu
Rana
Rimki
R
Winters
Jeffrey L
JL
Yilmaz
Murat
M
Mendez
Jose L
JL
Rickman
Otis B
OB
O'Byrne
Megan M
MM
Evenson
Laura K
LK
Malinchoc
Michael
M
DeGoey
Steven R
SR
Afessa
Bekele
B
Hubmayr
Rolf D
RD
Moore
S Breanndan
SB
D000368:Aged; D001803:Blood Transfusion / Q000379:methods; D016022:Case-Control Studies; D015331:Cohort Studies; D003422:Critical Care; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012128:Respiratory Distress Syndrome / Q000453:epidemiology* / Q000628:therapy; D012307:Risk Factors; D013997:Time Factors; D065227:Transfusion Reaction; D016896:Treatment Outcome