title: Recipient clinical risk factors predominate in possible transfusion-related acute lung injury.
abstract: BACKGROUND
  Possible transfusion-related acute lung injury (pTRALI) cases by definition have a clear temporal relationship to an alternative recipient risk factor for acute respiratory distress syndrome (ARDS). We questioned whether transfusion factors are important for the development of pTRALI.
  
  
  METHODS
  In this nested case-control study, we prospectively identified 145 consecutive patients with pTRALI and randomly selected 163 transfused controls over a 4-year period at the University of California at San Francisco and the Mayo Clinic (Rochester, Minnesota).
  
  
  RESULTS
  For pTRALI, we found evidence against transfusion being important: receipt of plasma from female donors (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.29-2.3; p = 0.70), total number of units transfused (OR, 0.99; 95% CI, 0.89-1.10; p = 0.86), and number of red blood cell and whole blood units transfused (OR, 0.78; 95% CI, 0.59-1.03; p = 0.079). In contrast, we found that risk for pTRALI was associated with additional recipient factors: chronic alcohol abuse (OR, 12.5; 95% CI, 2.8-55; p < 0.001), current smoker (OR, 4.2; 95% CI, 1.67-10.8; p = 0.0024), shock before transfusion (OR, 4.6; 95% CI, 2.0-10.7; p < 0.001), and positive fluid balance before transfusion (OR, 1.32/L; 95% CI, 1.20-1.44; p < 0.001).
  
  
  CONCLUSIONS
  Recipient risk factors for ARDS rather than transfusion risk factors predominate in pTRALI.
authors.affiliation: Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California.
authors.forename: Pearl
authors.initials: P
authors.lastname: Toy
authors.affiliation: Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California.
authors.forename: Peter
authors.initials: P
authors.lastname: Bacchetti
authors.affiliation: Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California.
authors.forename: Barbara
authors.initials: B
authors.lastname: Grimes
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Ognjen
authors.initials: O
authors.lastname: Gajic
authors.affiliation: Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California.|Blood Systems Research Institute, San Francisco, California.
authors.forename: Edward L
authors.initials: EL
authors.lastname: Murphy
authors.affiliation: Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Winters
authors.affiliation: Department of Anesthesia and Perioperative Care, University of California at San Francisco, San Francisco, California.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gropper
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Rolf D
authors.initials: RD
authors.lastname: Hubmayr
authors.affiliation: Department of Medicine, University of California at San Francisco, San Francisco, California.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Matthay
authors.affiliation: Department of Anesthesia, Mayo Clinic, Rochester, Minnesota.
authors.forename: Gregory
authors.initials: G
authors.lastname: Wilson
authors.affiliation: Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California.
authors.forename: Monique
authors.initials: M
authors.lastname: Koenigsberg
authors.affiliation: Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California.
authors.forename: Deanna C
authors.initials: DC
authors.lastname: Lee
authors.affiliation: Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California.|Blood Centers of the Pacific, San Francisco, California.
authors.forename: Nora V
authors.initials: NV
authors.lastname: Hirschler
authors.affiliation: Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California.
authors.forename: Clifford A
authors.initials: CA
authors.lastname: Lowell
authors.affiliation: American Red Cross Neutrophil Reference Laboratory, North Central Blood Services, St Paul, Minnesota.
authors.forename: Randy M
authors.initials: RM
authors.lastname: Schuller
authors.affiliation: Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Manish J
authors.initials: MJ
authors.lastname: Gandhi
authors.affiliation: Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California.|Blood Systems Research Institute, San Francisco, California.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Norris
authors.affiliation: American Red Cross Neutrophil Reference Laboratory, North Central Blood Services, St Paul, Minnesota.
authors.forename: David C
authors.initials: DC
authors.lastname: Mair
authors.affiliation: Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California.|Blood Systems Research Institute, San Francisco, California.
authors.forename: Rosa
authors.initials: R
authors.lastname: Sanchez Rosen
authors.affiliation: Department of Medicine, University of California at San Francisco, San Francisco, California.|Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Looney
mesh_terms: D055371:Acute Lung Injury / Q000209:etiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D065227:Transfusion Reaction; D055815:Young Adult