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Recipient clinical risk factors predominate in possible transfusion-related acute lung injury.

  • Author(s): Toy, Pearl
  • Bacchetti, Peter
  • Grimes, Barbara
  • Gajic, Ognjen
  • Murphy, Edward L
  • Winters, Jeffrey L
  • Gropper, Michael A
  • Hubmayr, Rolf D
  • Matthay, Michael A
  • Wilson, Gregory
  • Koenigsberg, Monique
  • Lee, Deanna C
  • Hirschler, Nora V
  • Lowell, Clifford A
  • Schuller, Randy M
  • Gandhi, Manish J
  • Norris, Philip J
  • Mair, David C
  • Sanchez Rosen, Rosa
  • Looney, Mark R
  • et al.
Abstract

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.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).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).Recipient risk factors for ARDS rather than transfusion risk factors predominate in pTRALI.

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