Incidence and transfusion risk factors for transfusion-associated circulatory overload among medical intensive care unit patients.
BACKGROUND
Transfusion-associated circulatory overload (TACO) is a frequent complication of blood transfusion. Investigations identifying risk factors for TACO in critically ill patients are lacking.


METHODS
We performed a 2-year prospective cohort study of consecutive patients receiving blood product transfusion in the medical intensive care unit (ICU) of the tertiary care institution. Patients were followed for development of transfusion-related complications. TACO was defined as acute hydrostatic pulmonary edema occurring within 6 hours of transfusion. In a nested case-control design, transfusion characteristics were compared between cases (TACO) and controls after matching by age, sex, and ICU admission diagnostic category. In a secondary analysis, patient characteristics before transfusion were compared between cases (TACO) and randomly selected controls.


RESULTS
Fifty-one of 901 (6%) transfused patients developed TACO. Compared with matched controls, TACO cases had a more positive fluid balance (1.4 L vs. 0.8 L, p = 0.003), larger amount of plasma transfused (0.4 L vs. 0.07 L, p = 0.007), and faster rate of blood component transfusion (225 mL/hr vs. 168 mL/hr, p = 0.031). In a secondary analysis comparing TACO cases and random controls, left ventricular dysfunction before transfusion (odds ratio [OR], 8.23; 95% confidence interval [CI], 3.36-21.97) and plasma ordered for the reversal of anticoagulant (OR, 4.31; 95% CI, 1.45-14.30) were significantly related to the development of TACO.


CONCLUSIONS
Volume of transfused plasma and the rate of transfusion were identified as transfusion-specific risk factors for TACO. Left ventricular dysfunction and fresh-frozen plasma ordered for the reversal of anticoagulant were strong predictors of TACO before the onset of transfusion.
Li
Guangxi
G
Division of Pulmonary and Critical Care Medicine, Mayo Epidemiology and Translational Research in Intensive Care, Mayo Clinic, Rochester, Minnesota, USA. li.guangxi@mayo.edu
Rachmale
Sonal
S
Kojicic
Marija
M
Shahjehan
Khurram
K
Malinchoc
Michael
M
Kor
Daryl J
DJ
Gajic
Ognjen
O
D055371:Acute Lung Injury / Q000453:epidemiology* / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects; D001810:Blood Volume; D002318:Cardiovascular Diseases / Q000453:epidemiology; D016022:Case-Control Studies; D015897:Comorbidity; D016638:Critical Illness; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000209:etiology; D010949:Plasma; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000453:epidemiology* / Q000209:etiology; D012128:Respiratory Distress Syndrome / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D065227:Transfusion Reaction; D018487:Ventricular Dysfunction, Left / Q000209:etiology
D000925:Anticoagulants