Document Detail


Risk factors and outcome of transfusion-related acute lung injury in the critically ill: a nested case-control study.
MedLine Citation:
PMID:  20035217     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To determine the incidence, risk factors, and outcome of transfusion-related acute lung injury in a cohort of critically ill patients.
DESIGN: In a retrospective cohort study, patients with transfusion-related acute lung injury were identified using the consensus criteria of acute lung injury within 6 hrs after transfusion. Inclusion criterion was a length of intensive care unit admission >48 hrs. Patients developing transfusion-related acute lung injury were matched (on age, sex, and admission diagnosis) to transfused control subjects and patients developing acute lung injury from another origin.
SETTING: Tertiary referral hospital.
PATIENTS: All first-admitted patients from November 1, 2004, until October 1, 2007, to the intensive care unit.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Of 5208 admitted patients, 2024 patients had a length of stay >48 hrs, of whom 109 were suspected transfusion-related acute lung injury cases. Compared with transfused control subjects, risk factors for transfusion-related acute lung injury were emergency cardiac surgery (odds ratio, 17.6 [1.8-168.5]), hematologic malignancy (odds ratio, 13.1 [2.7-63.8]), massive transfusion (odds ratio, 4.5 [2.1-9.8]), sepsis (odds ratio, 2.5 [1.2-5.2]), mechanical ventilation (odds ratio, 3.0 [1.3-7.1], and high Acute Physiology and Chronic Health Evaluation II score (odds ratio, 1.1 [1.0-1.1]; p < .03 for all). The volume of platelets and plasma transfused was associated with transfusion-related acute lung injury in the univariate analysis. However, this association disappeared in the multivariate analysis. Compared with acute lung injury control subjects, risk factors for transfusion-related acute lung injury were sepsis (odds ratio, 2.4 [1.1-5.3]) and high Acute Physiology and Chronic Health Evaluation II score (odds ratio, 1.1 [1.0-1.1]), whereas pneumonia (odds ratio, 0.4 [0.2-0.7]) was a negative predictive factor. Patients with transfusion-related acute lung injury had a longer duration of mechanical ventilation compared with transfused control subjects and acute lung injury control subjects (231 [138-472] vs. 71 [46-163] and 70 [42-121] hrs, p < .001). Also, 90-day survival of patients with transfusion-related acute lung injury was lower compared with transfused control subjects and acute lung injury control subjects (53% vs. 75% and 83%, p < .02).
CONCLUSIONS: Transfusion-related acute lung injury is common in critically ill patients. Transfusion-related acute lung injury may contribute to an adverse outcome associated with transfusion. This study identifies transfusion-related acute lung injury risk factors, which may aid in assessing the risks and benefits of transfusion in critically ill patients.
Authors:
Alexander P J Vlaar; Jan M Binnekade; David Prins; Danielle van Stein; Jorrit J Hofstra; Marcus J Schultz; Nicole P Juffermans
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Critical care medicine     Volume:  38     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-02-19     Completed Date:  2010-03-15     Revised Date:  2011-03-23    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  771-8     Citation Subset:  AIM; IM    
Affiliation:
Intensive Care Department, Academic Medical Center, Amsterdam, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
APACHE
Acute Lung Injury / epidemiology*,  etiology,  mortality
Adult
Aged
Blood Transfusion / adverse effects*
Blood Volume
Case-Control Studies
Cohort Studies
Critical Illness*
Cross-Sectional Studies
Erythrocyte Transfusion / adverse effects
Female
Hospital Mortality
Hospitals, University
Humans
Incidence
Intensive Care Units / statistics & numerical data
Male
Middle Aged
Netherlands
Plasma
Platelet Transfusion / adverse effects
Prognosis
Respiration, Artificial
Risk Factors
Sepsis / complications,  epidemiology
Comments/Corrections
Comment In:
Crit Care Med. 2011 Mar;39(3):610-1; author reply 611   [PMID:  21330877 ]
Crit Care Med. 2010 Mar;38(3):981-2   [PMID:  20168153 ]

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