Transfusion-related acute lung injury in ICU patients admitted with gastrointestinal bleeding.
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.
Benson
Alexander B
AB
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.
Austin
Gregory L
GL
Division of Gastroenterology and Hepatology, University of Colorado Denver, Aurora, CO, 80045, USA.
Berg
Mary
M
Department of Pathology, University of Colorado Denver, Aurora, CO, 80045, USA.
McFann
Kim K
KK
School of Public Health, University of Colorado Denver, Aurora, CO, 80045, USA.
Thomas
Sila
S
Bonfils Blood Center, Denver, CO, USA.
Ramirez
Gina
G
Bonfils Blood Center, Denver, CO, USA.
Rosen
Hugo
H
Division of Gastroenterology and Hepatology, University of Colorado Denver, Aurora, CO, 80045, USA.
Silliman
Christopher C
CC
Bonfils Blood Center, Denver, CO, USA.
Moss
Marc
M
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.
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