Prospective study on the clinical course and outcomes in transfusion-related acute lung injury*

Crit Care Med. 2014 Jul;42(7):1676-87. doi: 10.1097/CCM.0000000000000323.

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).

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Lung Injury / etiology*
  • Acute Lung Injury / immunology
  • Acute Lung Injury / physiopathology*
  • Adolescent
  • Adult
  • Aged
  • Cytokines / metabolism
  • Female
  • Humans
  • Intensive Care Units / statistics & numerical data*
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Patient Discharge / statistics & numerical data
  • Prospective Studies
  • Respiration, Artificial
  • Risk Factors
  • Transfusion Reaction*

Substances

  • Cytokines