title: Transfusion-related acute lung injury: incidence and risk factors.
abstract: Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related mortality. To determine TRALI incidence by prospective, active surveillance and to identify risk factors by a case-control study, 2 academic medical centers enrolled 89 cases and 164 transfused controls. Recipient risk factors identified by multivariate analysis were higher IL-8 levels, liver surgery, chronic alcohol abuse, shock, higher peak airway pressure while being mechanically ventilated, current smoking, and positive fluid balance. Transfusion risk factors were receipt of plasma or whole blood from female donors (odds ratio = 4.5, 95% confidence interval [CI], 1.85-11.2, P = .001), volume of HLA class II antibody with normalized background ratio more than 27.5 (OR = 1.92/100 mL, 95% CI, 1.08-3.4, P = .03), and volume of anti-human neutrophil antigen positive by granulocyte immunofluoresence test (OR = 1.71/100 mL, 95% CI, 1.18-2.5, P = .004). Little or no risk was associated with older red blood cell units, noncognate or weak cognate class II antibody, or class I antibody. Reduced transfusion of plasma from female donors was concurrent with reduced TRALI incidence: 2.57 (95% CI, 1.72-3.86) in 2006 versus 0.81 (95% CI, 0.44-1.49) in 2009 per 10 000 transfused units (P = .002). The identified risk factors provide potential targets for reducing residual TRALI.
authors: Department of Laboratory Medicine, Box 0451, University of California–San Francisco, San Francisco, CA 94143-0451, USA. pearl.toy@ucsf.edu
authors: Pearl
authors: P
authors: Toy
authors: Ognjen
authors: O
authors: Gajic
authors: Peter
authors: P
authors: Bacchetti
authors: Mark R
authors: MR
authors: Looney
authors: Michael A
authors: MA
authors: Gropper
authors: Rolf
authors: R
authors: Hubmayr
authors: Clifford A
authors: CA
authors: Lowell
authors: Philip J
authors: PJ
authors: Norris
authors: Edward L
authors: EL
authors: Murphy
authors: Richard B
authors: RB
authors: Weiskopf
authors: Gregory
authors: G
authors: Wilson
authors: Monique
authors: M
authors: Koenigsberg
authors: Deanna
authors: D
authors: Lee
authors: Randy
authors: R
authors: Schuller
authors: Ping
authors: P
authors: Wu
authors: Barbara
authors: B
authors: Grimes
authors: Manish J
authors: MJ
authors: Gandhi
authors: Jeffrey L
authors: JL
authors: Winters
authors: David
authors: D
authors: Mair
authors: Nora
authors: N
authors: Hirschler
authors: Rosa
authors: R
authors: Sanchez Rosen
authors: Michael A
authors: MA
authors: Matthay
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D055371:Acute Lung Injury / Q000453:epidemiology* / Q000209:etiology*; D000328:Adult; D000368:Aged; D001803:Blood Transfusion / Q000706:statistics & numerical data; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012189:Retrospective Studies; D012307:Risk Factors; D065227:Transfusion Reaction; D055815:Young Adult