TY - JOUR
T1 - Contemporary Risk Factors and Outcomes of Transfusion-Associated Circulatory Overload
AU - National Heart, Lung, and Blood Institute (NHLBI) Recipient Epidemiology and Donor Evaluation Study-III (REDS-III)
AU - Roubinian, Nareg H.
AU - Hendrickson, Jeanne E.
AU - Triulzi, Darrell J.
AU - Gottschall, Jerome L.
AU - Michalkiewicz, Michael
AU - Chowdhury, Dhuly
AU - Kor, Daryl J.
AU - Looney, Mark R.
AU - Matthay, Michael A.
AU - Kleinman, Steven H.
AU - Brambilla, Donald
AU - Murphy, Edward L.
N1 - Funding Information:
Drs. Roubinian, Hendrickson, Triulzi, Gottschall, Michalkiewicz, Kor, Looney, Matthay, Brambilla, Kleinman, and Murphy received support for article research from the National Institutes of Health (NIH). Drs. Roubinian, Hendrickson, and Looney’s institutions received funding from the NIH. Drs. Kor, Brambilla, and Murphy’s institutions received funding from the National Heart, Lung, and Blood Institute (NHLBI). Dr. Brambilla disclosed work for hire. Dr. Kor received funding from NHLBI and UptoDate (royalties). Dr. Matthay’s institution received funding from a GlaxoSmithKline grant and an Amgen grant, and he received funding from consulting for Bayer, Cerus Therapeutics, Boehringer-Ingelheim, Copyright © 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Funding Information:
1Blood Systems Research Institute, San Francisco, CA. 2Kaiser Permanente Division of Research and Medical Center, Oakland, CA. 3Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA. 4Department of Laboratory Medicine, Yale University, New Haven, CT. 5Department of Pathology, Institute for Transfusion Medicine, Pittsburgh, PA. 6Department of Pathology, BloodCenter of Wisconsin, Milwaukee, WI. 7Aurora Research Institute, Milwaukee, WI. 8RTI International, Rockville, MD. 9Department of Anesthesia, Mayo Clinic, Rochester, MN. 10Department of Medicine, University of California, San Francisco, San Francisco, California. 11Department of Pathology and Laboratory Medicine, University of British Columbia, Victoria, BC, Canada. Drs. Roubinian and Murphy designed and supervised the study, reviewed the data, and drafted the article. Drs. Kor, Looney, and Matthay adjudicated cases. Drs. Chowdhury and Brambilla organized the data collection and statistical analyses. Drs. Hendrickson, Triulzi, and Gottschall collected data. All authors contributed to the final version of the article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal). Supported, in part, by research contracts from the National Heart, Lung, and Blood Institute (NHLBI Contracts HHSN2682011000002I, HHSN2682011000003I, HHSN2682011000004I, HHSN268201 1000005I, and HHSN268201100006I for the Recipient Epidemiology and Donor Evaluation Study-III). The funding source designated an investigator-led steering committee, which independently oversaw the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, and approval of the article; and decision to submit the article for publication.
Publisher Copyright:
© 2018 Lippincott Williams and Wilkins. All rights reserved.
PY - 2018/4/1
Y1 - 2018/4/1
N2 - Objectives: Transfusion-associated circulatory overload is characterized by hydrostatic pulmonary edema following blood transfusion. Restrictive transfusion practice may affect the occurrence and severity of transfusion-associated circulatory overload in critically ill patients. We sought to examine contemporary risk factors and outcomes for transfusion-associated circulatory overload. Design: Case-control study. Setting: Four tertiary care hospitals. Patients: We prospectively enrolled 200 patients with transfusion-associated circulatory overload identified by active surveillance and 405 controls matched by transfusion intensity. Interventions: None. Measurements and Main Results: Among 20,845 transfused patients who received 128,263 blood components from May 2015 until July 2016, transfusion-associated circulatory overload incidence was one case per 100 transfused patients. In addition to cardiovascular comorbidities, multivariable analysis identified the following independent predictors of transfusion-associated circulatory overload: acute kidney injury, emergency surgery, pretransfusion diuretic use, and plasma transfusion - the latter especially in females. Compared with matched controls, transfusion-associated circulatory overload cases were more likely to require mechanical ventilation (71% vs 49%; p < 0.001), experienced longer intensive care and hospital lengths of stay following transfusion, and had higher mortality (21% vs 11%; p = 0.02) even after adjustment for other potentially confounding variables. Conclusions: Despite restrictive transfusion practice, transfusionassociated circulatory overload remains a frequent complication of transfusion and is an independent risk factor for in-hospital morbidity and mortality. In addition to cardiovascular and renal risk factors, plasma transfusion was associated with transfusion-associated circulatory overload after controlling for other covariates. Additional research is needed to examine the benefit of reduced erythrocyte or plasma exposure in patients at high risk for transfusion-associated circulatory overload.
AB - Objectives: Transfusion-associated circulatory overload is characterized by hydrostatic pulmonary edema following blood transfusion. Restrictive transfusion practice may affect the occurrence and severity of transfusion-associated circulatory overload in critically ill patients. We sought to examine contemporary risk factors and outcomes for transfusion-associated circulatory overload. Design: Case-control study. Setting: Four tertiary care hospitals. Patients: We prospectively enrolled 200 patients with transfusion-associated circulatory overload identified by active surveillance and 405 controls matched by transfusion intensity. Interventions: None. Measurements and Main Results: Among 20,845 transfused patients who received 128,263 blood components from May 2015 until July 2016, transfusion-associated circulatory overload incidence was one case per 100 transfused patients. In addition to cardiovascular comorbidities, multivariable analysis identified the following independent predictors of transfusion-associated circulatory overload: acute kidney injury, emergency surgery, pretransfusion diuretic use, and plasma transfusion - the latter especially in females. Compared with matched controls, transfusion-associated circulatory overload cases were more likely to require mechanical ventilation (71% vs 49%; p < 0.001), experienced longer intensive care and hospital lengths of stay following transfusion, and had higher mortality (21% vs 11%; p = 0.02) even after adjustment for other potentially confounding variables. Conclusions: Despite restrictive transfusion practice, transfusionassociated circulatory overload remains a frequent complication of transfusion and is an independent risk factor for in-hospital morbidity and mortality. In addition to cardiovascular and renal risk factors, plasma transfusion was associated with transfusion-associated circulatory overload after controlling for other covariates. Additional research is needed to examine the benefit of reduced erythrocyte or plasma exposure in patients at high risk for transfusion-associated circulatory overload.
KW - Blood component transfusion
KW - Outcomes
KW - pulmonary edema
KW - risk factors
KW - transfusion reaction
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U2 - 10.1097/CCM.0000000000002948
DO - 10.1097/CCM.0000000000002948
M3 - Article
C2 - 29300236
AN - SCOPUS:85055225767
VL - 46
SP - 577
EP - 585
JO - Critical Care Medicine
JF - Critical Care Medicine
SN - 0090-3493
IS - 4
ER -