Transfusion-related acute lung injury in the critically ill: prospective nested case-control study.

@article{citeulike:2673386, abstract = {RATIONALE: Acute lung injury (ALI) that develops 6 hours after transfusion (TRALI) is the leading cause of transfusion-related mortality. Several transfusion characteristics have been postulated as risk factors for TRALI, but the evidence is limited to retrospective studies. OBJECTIVES: To compare patient and transfusion risk factors between patients who do and do not develop ALI. METHODS: In this prospective cohort study, consecutive transfused critically ill patients were closely observed for development of ALI. Donor samples were collected from the transfusion bags. Risk factors were compared between patients who developed ALI after transfusion and transfused control patients, matched by age, sex, and admission diagnosis. MEASUREMENTS AND MAIN RESULTS: Seventy-four of 901 transfused patients developed ALI within 6 hours of transfusion (8\%). Compared with transfused control subjects, patients with ALI were more likely to have sepsis (37 vs. 22\%, P = 0.016) and a history of chronic alcohol abuse (37 vs. 18\%, P = 0.006). When adjusted for patient characteristics, transfusion of plasma from female donors (odds ratio [OR], 5.09; 95\% confidence interval [95\% CI], 1.37-18.85) rather than male donors (OR, 1.60; 95\% CI, 0.76 to 3.37), number of pregnancies among the donors (OR, 1.19; 95\% CI, 1.05 to 1.34), number of donor units positive for anti-granulocyte antibodies (OR, 4.85; 95\% CI, 1.32-17.86) and anti-HLA class II antibodies (OR, 3.08; 95\% CI, 1.15-8.25), and concentration of lysophosphatidylcholine in the donor product (OR, 1.69; 95\% CI, 1.10 to 2.59) were associated with the development of ALI. CONCLUSIONS: Both patient and transfusion risk factors determine the probability of ALI after transfusion. Transfusion factors represent attractive targets for the prevention of ALI.}, address = {Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. gajic.ognjen@mayo.edu}, author = {Gajic, O. and Rana, R. and Winters, J. L. and Yilmaz, M. and Mendez, J. L. and Rickman, O. B. and O'Byrne, M. M. and Evenson, L. K. and Malinchoc, M. and DeGoey, S. R. and Afessa, B. and Hubmayr, R. D. and Moore, S. B. }, citeulike-article-id = {2673386}, doi = {http://dx.doi.org/10.1164/rccm.200702-271OC}, issn = {1535-4970}, journal = {American journal of respiratory and critical care medicine}, keywords = {transfusion}, month = {November}, number = {9}, pages = {886--891}, posted-at = {2008-04-15 14:05:27}, priority = {2}, title = {Transfusion-related acute lung injury in the critically ill: prospective nested case-control study.}, url = {http://dx.doi.org/10.1164/rccm.200702-271OC}, volume = {176}, year = {2007} }

TY - JOUR ID - citeulike:2673386 L3 - citeulike-article-id:2673386 TI - Transfusion-related acute lung injury in the critically ill: prospective nested case-control study. JF - American journal of respiratory and critical care medicine VL - 176 IS - 9 SP - 886 EP - 891 AD - Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. gajic.ognjen@mayo.edu SN - 1535-4970 N2 - RATIONALE: Acute lung injury (ALI) that develops 6 hours after transfusion (TRALI) is the leading cause of transfusion-related mortality. Several transfusion characteristics have been postulated as risk factors for TRALI, but the evidence is limited to retrospective studies. OBJECTIVES: To compare patient and transfusion risk factors between patients who do and do not develop ALI. METHODS: In this prospective cohort study, consecutive transfused critically ill patients were closely observed for development of ALI. Donor samples were collected from the transfusion bags. Risk factors were compared between patients who developed ALI after transfusion and transfused control patients, matched by age, sex, and admission diagnosis. MEASUREMENTS AND MAIN RESULTS: Seventy-four of 901 transfused patients developed ALI within 6 hours of transfusion (8%). Compared with transfused control subjects, patients with ALI were more likely to have sepsis (37 vs. 22%, P = 0.016) and a history of chronic alcohol abuse (37 vs. 18%, P = 0.006). When adjusted for patient characteristics, transfusion of plasma from female donors (odds ratio [OR], 5.09; 95% confidence interval [95% CI], 1.37-18.85) rather than male donors (OR, 1.60; 95% CI, 0.76 to 3.37), number of pregnancies among the donors (OR, 1.19; 95% CI, 1.05 to 1.34), number of donor units positive for anti-granulocyte antibodies (OR, 4.85; 95% CI, 1.32-17.86) and anti-HLA class II antibodies (OR, 3.08; 95% CI, 1.15-8.25), and concentration of lysophosphatidylcholine in the donor product (OR, 1.69; 95% CI, 1.10 to 2.59) were associated with the development of ALI. CONCLUSIONS: Both patient and transfusion risk factors determine the probability of ALI after transfusion. Transfusion factors represent attractive targets for the prevention of ALI. KW - transfusion AU - Gajic, O AU - Rana, R AU - Winters, JL AU - Yilmaz, M AU - Mendez, JL AU - Rickman, OB AU - O'Byrne, MM AU - Evenson, LK AU - Malinchoc, M AU - DeGoey, SR AU - Afessa, B AU - Hubmayr, RD AU - Moore, SB PY - 2007/11/01/ UR - http://dx.doi.org/10.1164/rccm.200702-271OC ER -