title: The incidence, risk factors, and outcome of transfusion-related acute lung injury in a cohort of cardiac surgery patients: a prospective nested case-control study.
abstract: Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related morbidity and mortality. Both antibodies and bioactive lipids that have accumulated during storage of blood have been implicated in TRALI pathogenesis. In a single-center, nested, case-control study, patients were prospectively observed for onset of TRALI according to the consensus definition. Of 668 patients, 16 patients (2.4%) developed TRALI. Patient-related risk factors for onset of TRALI were age and time on the cardiopulmonary bypass. Transfusion-related risk factors were total amount of blood products (odds ratio [OR] = 1.2; 95% confidence interval [CI], 1.03-1.44), number of red blood cells stored more than 14 days (OR = 1.6; 95% CI, 1.04-2.37), total amount of plasma (OR = 1.2; 95% CI, 1.03-1.44), presence of antibodies in donor plasma (OR = 8.8; 95% CI, 1.8-44), and total amount of transfused bioactive lipids (OR = 1.0; 95% CI, 1.00-1.07). When adjusted for patient risk factors, only the presence of antibodies in the associated blood products remained a risk factor for TRALI (OR = 14.2; 95% CI, 1.5-132). In-hospital mortality of TRALI was 13% compared with 0% and 3% in transfused and nontransfused patients, respectively (P < .05). In conclusion, the incidence of TRALI is high in cardiac surgery patients and associated with adverse outcome. Our results suggest that cardiac surgery patients may benefit from exclusion of blood products containing HLA/HNA antibodies.
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands. a.p.vlaar@amc.uva.nl
authors.forename: Alexander P J
authors.initials: AP
authors.lastname: Vlaar
authors.forename: Jorrit J
authors.initials: JJ
authors.lastname: Hofstra
authors.forename: Rogier M
authors.initials: RM
authors.lastname: Determann
authors.forename: Denise P
authors.initials: DP
authors.lastname: Veelo
authors.forename: Frederique
authors.initials: F
authors.lastname: Paulus
authors.forename: Wim
authors.initials: W
authors.lastname: Kulik
authors.forename: Johanna
authors.initials: J
authors.lastname: Korevaar
authors.forename: Bas A
authors.initials: BA
authors.lastname: de Mol
authors.forename: Marianne M W
authors.initials: MM
authors.lastname: Koopman
authors.forename: Leendert
authors.initials: L
authors.lastname: Porcelijn
authors.forename: Jan M
authors.initials: JM
authors.lastname: Binnekade
authors.forename: Margreeth B
authors.initials: MB
authors.lastname: Vroom
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: Schultz
authors.forename: Nicole P
authors.initials: NP
authors.lastname: Juffermans
mesh_terms: D055371:Acute Lung Injury / Q000453:epidemiology* / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D065227:Transfusion Reaction; D016896:Treatment Outcome