title: Transfusion-related acute lung injury in ICU patients admitted with gastrointestinal bleeding.
abstract: OBJECTIVE
  Transfusion of blood components is common in patients admitted to the intensive care unit (ICU) for gastrointestinal (GI) bleeding, yet the incidence and risk factors for development of transfusion-related acute lung injury (TRALI) in these patients are unknown.
  
  
  METHODS
  Patients admitted to a medical ICU for GI bleeding (n = 225) were analyzed for patient- and transfusion-specific risk factors for development of TRALI.
  
  
  RESULTS
  In transfused patients (n = 150), the incidence of TRALI was 15% [95% confidence interval (CI), 10-21%] and accounted for 76% (22/29) of all acute lung injury (ALI) cases. Transfused patients with end-stage liver disease (ESLD) (n = 72) developed TRALI more frequently than those without ESLD (29% versus 1%, p < 0.01). Fresh frozen plasma (FFP) was temporally associated with TRALI in 86% of cases. Transfusion-specific risk factors for development of TRALI included number of transfused units of FFP and nonleukoreduced red blood cells. Patient-specific risk factors included Model for End-Stage Liver Disease (MELD) score, admission serum albumin level, and presence of ALI risk factors.
  
  
  CONCLUSIONS
  TRALI is common in critically ill ESLD patients with gastrointestinal bleeding. Nonleukoreduced red blood cells and FFP are significant transfusion-specific risk factors and their use should be re-evaluated in bleeding patients with ESLD.
authors.affiliation: Division of Pulmonary Sciences and Critical Care, University of Colorado Denver, Anschutz Medical Campus Research 2, Box C272, 9th floor, 12770 East 19th Ave., Aurora, CO, 80045, USA. Alexander.benson@ucdenver.edu.
authors.forename: Alexander B
authors.initials: AB
authors.lastname: Benson
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado Denver, Aurora, CO, 80045, USA.
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Austin
authors.affiliation: Department of Pathology, University of Colorado Denver, Aurora, CO, 80045, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Berg
authors.affiliation: School of Public Health, University of Colorado Denver, Aurora, CO, 80045, USA.
authors.forename: Kim K
authors.initials: KK
authors.lastname: McFann
authors.affiliation: Bonfils Blood Center, Denver, CO, USA.
authors.forename: Sila
authors.initials: S
authors.lastname: Thomas
authors.affiliation: Bonfils Blood Center, Denver, CO, USA.
authors.forename: Gina
authors.initials: G
authors.lastname: Ramirez
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado Denver, Aurora, CO, 80045, USA.
authors.forename: Hugo
authors.initials: H
authors.lastname: Rosen
authors.affiliation: Bonfils Blood Center, Denver, CO, USA.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Silliman
authors.affiliation: Division of Pulmonary Sciences and Critical Care, University of Colorado Denver, Anschutz Medical Campus Research 2, Box C272, 9th floor, 12770 East 19th Ave., Aurora, CO, 80045, USA.
authors.forename: Marc
authors.initials: M
authors.lastname: Moss
mesh_terms: D055371:Acute Lung Injury / Q000150:complications / Q000209:etiology* / Q000503:physiopathology; D000368:Aged; D016913:Blood Component Transfusion / Q000009:adverse effects*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012307:Risk Factors