Risk factors and outcome of transfusion-related acute lung injury in the critically ill: a nested case-control study.
OBJECTIVE
To determine the incidence, risk factors, and outcome of transfusion-related acute lung injury in a cohort of critically ill patients.


METHODS
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.


METHODS
Tertiary referral hospital.


METHODS
All first-admitted patients from November 1, 2004, until October 1, 2007, to the intensive care unit.


METHODS
None.


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.
Vlaar
Alexander P J
AP
Intensive Care Department, Academic Medical Center, Amsterdam, The Netherlands.
Binnekade
Jan M
JM
Prins
David
D
van Stein
Danielle
D
Hofstra
Jorrit J
JJ
Schultz
Marcus J
MJ
Juffermans
Nicole P
NP
D018806:APACHE; D055371:Acute Lung Injury / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D000328:Adult; D000368:Aged; D001810:Blood Volume; D016022:Case-Control Studies; D015331:Cohort Studies; D016638:Critical Illness; D003430:Cross-Sectional Studies; D017707:Erythrocyte Transfusion / Q000009:adverse effects; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010949:Plasma; D017713:Platelet Transfusion / Q000009:adverse effects; D011379:Prognosis; D012121:Respiration, Artificial; D012307:Risk Factors; D018805:Sepsis / Q000150:complications / Q000453:epidemiology; D065227:Transfusion Reaction