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Prospective Study on the Clinical Course and Outcomes in Transfusion-Related Acute Lung Injury.
Crit Care Med. 2014 Apr 25;
Authors: Looney MR, Roubinian N, Gajic O, Gropper MA, Hubmayr RD, Lowell CA, Bacchetti P, Wilson G, Koenigsberg M, Lee DC, Wu P, Grimes B, Norris PJ, Murphy EL, Gandhi MJ, Winters JL, Mair DC, Schuller RM, Hirschler NV, Rosen RS, Matthay MA, Toy P, for the Transfusion-Related Acute Lung Injury Study Group
Abstract
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.
DESIGN:: Prospective case study with controls.
SETTING:: University of California, San Francisco and Mayo Clinic, Rochester.
PATIENTS:: We prospectively enrolled 89 patients with transfusion-related acute lung injury, 164 transfused controls, and 145 patients with possible transfusion-related acute lung injury.
INTERVENTIONS:: None.
MEASUREMENTS AND MAIN 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).
PMID: 24776608 [PubMed - as supplied by publisher]