Prospective study on the clinical course and outcomes in transfusion-related acute lung injury*.
OBJECTIVE
Transfusion-related acute lung injury is the leading cause of transfusion-related mortality. A prospective study using electronic surveillance was conducted at two academic medical centers in the United States with the objective to define the clinical course and outcomes in transfusion-related acute lung injury cases.


METHODS
Prospective case study with controls.


METHODS
University of California, San Francisco and Mayo Clinic, Rochester.


METHODS
We prospectively enrolled 89 patients with transfusion-related acute lung injury, 164 transfused controls, and 145 patients with possible transfusion-related acute lung injury.


METHODS
None.


RESULTS
Patients with transfusion-related acute lung injury had fever, tachycardia, tachypnea, hypotension, and prolonged hypoxemia compared with controls. Of the patients with transfusion-related acute lung injury, 29 of 37 patients (78%) required initiation of mechanical ventilation and 13 of 53 (25%) required initiation of vasopressors. Patients with transfusion-related acute lung injury and possible transfusion-related acute lung injury had an increased duration of mechanical ventilation and increased days in the ICU and hospital compared with controls. There were 15 of 89 patients with transfusion-related acute lung injury (17%) who died, whereas 61 of 145 patients with possible transfusion-related acute lung injury (42%) died and 7 of 164 of controls (4%) died. Patients with transfusion-related acute lung injury had evidence of more systemic inflammation with increases in circulating neutrophils and a decrease in platelets compared with controls. Patients with transfusion-related acute lung injury and possible transfusion-related acute lung injury also had a statistically significant increase in plasma interleukin-8, interleukin-10, and interleukin-1 receptor antagonist posttransfusion compared with controls.


CONCLUSIONS
In conclusion, transfusion-related acute lung injury produced a condition resembling the systemic inflammatory response syndrome and was associated with substantial in-hospital morbidity and mortality in patients with transfusion-related acute lung injury compared with transfused controls. Patients with possible transfusion-related acute lung injury had even higher in-hospital morbidity and mortality, suggesting that clinical outcomes in this group are mainly influenced by the underlying acute lung injury risk factor(s).
1Department of Medicine, University of California San Francisco, San Francisco, CA. 2Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA. 3Blood Systems Research Institute, San Francisco, CA. 4Department of Medicine, Mayo Clinic, Rochester, MN. 5Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA. 6Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA. 7Department of Anesthesia, Mayo Clinic, Rochester, MN. 8Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN. 9American Red Cross Neutrophil Reference Laboratory, St. Paul, MN. 10Blood Centers of the Pacific, San Francisco, CA.
Mark R
MR
Looney
Nareg
N
Roubinian
Ognjen
O
Gajic
Michael A
MA
Gropper
Rolf D
RD
Hubmayr
Clifford A
CA
Lowell
Peter
P
Bacchetti
Gregory
G
Wilson
Monique
M
Koenigsberg
Deanna C
DC
Lee
Ping
P
Wu
Barbara
B
Grimes
Philip J
PJ
Norris
Edward L
EL
Murphy
Manish J
MJ
Gandhi
Jeffrey L
JL
Winters
David C
DC
Mair
Randy M
RM
Schuller
Nora V
NV
Hirschler
Rosa Sanchez
RS
Rosen
Michael A
MA
Matthay
Pearl
P
Toy
D055371:Acute Lung Injury / Q000209:etiology* / Q000276:immunology / Q000503:physiopathology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D016207:Cytokines / Q000378:metabolism; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D011446:Prospective Studies; D012121:Respiration, Artificial; D012307:Risk Factors; D065227:Transfusion Reaction
D016207:Cytokines