Differentiating pulmonary transfusion reactions using recipient and transfusion factors

the TRALI Study Group

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

BACKGROUND: It is increasingly recognized that recipient risk factors play a prominent role in possible transfusion-related acute lung injury (pTRALI) and transfusion-associated circulatory overload (TACO). We hypothesized that both transfusion and recipient factors including natriuretic peptides could be used to distinguish TRALI from TACO and pTRALI. STUDY DESIGN AND METHODS: We performed a post hoc analysis of a case-control study of pulmonary transfusion reactions conducted at the University of California at San Francisco and Mayo Clinic, Rochester. We evaluated clinical data and brain natriuretic peptides (BNP) levels drawn after transfusion in patients with TRALI (n = 21), pTRALI (n = 26), TACO (n = 22), and controls (n = 24). Logistic regression and receiver operating characteristics curve analyses were used to determine the accuracy of clinical and biomarker predictors in differentiating TRALI from TACO and pTRALI. RESULTS: We found that pTRALI and TACO were associated with older age, higher fluid balance, and elevated BNP levels relative to those of controls and TRALI. The following variables were useful in distinguishing cases of pTRALI and TACO from TRALI: age more than 70 years, BNP levels more than 1000 pg/mL, 24-hour fluid balance of more than 3 L, and a lower number of transfused blood components. Using the above variables, our logistic model had a 91% negative predictive value in the differential diagnosis of TRALI. CONCLUSIONS: Models incorporating readily available clinical and biomarker data can be used to differentiate transfusion-related respiratory complications. Additional studies examining recipient risk factors and the likelihood of TRALI may be useful in decision making regarding donor white blood cell antibody testing.

Original languageEnglish (US)
Pages (from-to)1684-1690
Number of pages7
JournalTransfusion
Volume57
Issue number7
DOIs
StatePublished - Jul 1 2017

Fingerprint

Acute Lung Injury
Lung
Brain Natriuretic Peptide
Water-Electrolyte Balance
Biomarkers
Logistic Models
Natriuretic Peptides
San Francisco
ROC Curve
Transfusion Reaction
Case-Control Studies
Decision Making
Leukocytes
Differential Diagnosis
Tissue Donors
Antibodies

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Hematology

Cite this

Differentiating pulmonary transfusion reactions using recipient and transfusion factors. / the TRALI Study Group.

In: Transfusion, Vol. 57, No. 7, 01.07.2017, p. 1684-1690.

Research output: Contribution to journalArticle

the TRALI Study Group. / Differentiating pulmonary transfusion reactions using recipient and transfusion factors. In: Transfusion. 2017 ; Vol. 57, No. 7. pp. 1684-1690.
@article{9d43765c95bc42ba9a5d06dd4f4a88c3,
title = "Differentiating pulmonary transfusion reactions using recipient and transfusion factors",
abstract = "BACKGROUND: It is increasingly recognized that recipient risk factors play a prominent role in possible transfusion-related acute lung injury (pTRALI) and transfusion-associated circulatory overload (TACO). We hypothesized that both transfusion and recipient factors including natriuretic peptides could be used to distinguish TRALI from TACO and pTRALI. STUDY DESIGN AND METHODS: We performed a post hoc analysis of a case-control study of pulmonary transfusion reactions conducted at the University of California at San Francisco and Mayo Clinic, Rochester. We evaluated clinical data and brain natriuretic peptides (BNP) levels drawn after transfusion in patients with TRALI (n = 21), pTRALI (n = 26), TACO (n = 22), and controls (n = 24). Logistic regression and receiver operating characteristics curve analyses were used to determine the accuracy of clinical and biomarker predictors in differentiating TRALI from TACO and pTRALI. RESULTS: We found that pTRALI and TACO were associated with older age, higher fluid balance, and elevated BNP levels relative to those of controls and TRALI. The following variables were useful in distinguishing cases of pTRALI and TACO from TRALI: age more than 70 years, BNP levels more than 1000 pg/mL, 24-hour fluid balance of more than 3 L, and a lower number of transfused blood components. Using the above variables, our logistic model had a 91{\%} negative predictive value in the differential diagnosis of TRALI. CONCLUSIONS: Models incorporating readily available clinical and biomarker data can be used to differentiate transfusion-related respiratory complications. Additional studies examining recipient risk factors and the likelihood of TRALI may be useful in decision making regarding donor white blood cell antibody testing.",
author = "{the TRALI Study Group} and Roubinian, {Nareg H.} and Looney, {Mark R.} and Sheila Keating and Kor, {Daryl J} and Lowell, {Clifford A.} and Ognjen Gajic and Rolf Hubmayr and Michael Gropper and Monique Koenigsberg and Wilson, {Gregory A.} and {A. Matthay}, Michael and Pearl Toy and Murphy, {Edward L.}",
year = "2017",
month = "7",
day = "1",
doi = "10.1111/trf.14118",
language = "English (US)",
volume = "57",
pages = "1684--1690",
journal = "Transfusion",
issn = "0041-1132",
publisher = "Wiley-Blackwell",
number = "7",

}

TY - JOUR

T1 - Differentiating pulmonary transfusion reactions using recipient and transfusion factors

AU - the TRALI Study Group

AU - Roubinian, Nareg H.

AU - Looney, Mark R.

AU - Keating, Sheila

AU - Kor, Daryl J

AU - Lowell, Clifford A.

AU - Gajic, Ognjen

AU - Hubmayr, Rolf

AU - Gropper, Michael

AU - Koenigsberg, Monique

AU - Wilson, Gregory A.

AU - A. Matthay, Michael

AU - Toy, Pearl

AU - Murphy, Edward L.

PY - 2017/7/1

Y1 - 2017/7/1

N2 - BACKGROUND: It is increasingly recognized that recipient risk factors play a prominent role in possible transfusion-related acute lung injury (pTRALI) and transfusion-associated circulatory overload (TACO). We hypothesized that both transfusion and recipient factors including natriuretic peptides could be used to distinguish TRALI from TACO and pTRALI. STUDY DESIGN AND METHODS: We performed a post hoc analysis of a case-control study of pulmonary transfusion reactions conducted at the University of California at San Francisco and Mayo Clinic, Rochester. We evaluated clinical data and brain natriuretic peptides (BNP) levels drawn after transfusion in patients with TRALI (n = 21), pTRALI (n = 26), TACO (n = 22), and controls (n = 24). Logistic regression and receiver operating characteristics curve analyses were used to determine the accuracy of clinical and biomarker predictors in differentiating TRALI from TACO and pTRALI. RESULTS: We found that pTRALI and TACO were associated with older age, higher fluid balance, and elevated BNP levels relative to those of controls and TRALI. The following variables were useful in distinguishing cases of pTRALI and TACO from TRALI: age more than 70 years, BNP levels more than 1000 pg/mL, 24-hour fluid balance of more than 3 L, and a lower number of transfused blood components. Using the above variables, our logistic model had a 91% negative predictive value in the differential diagnosis of TRALI. CONCLUSIONS: Models incorporating readily available clinical and biomarker data can be used to differentiate transfusion-related respiratory complications. Additional studies examining recipient risk factors and the likelihood of TRALI may be useful in decision making regarding donor white blood cell antibody testing.

AB - BACKGROUND: It is increasingly recognized that recipient risk factors play a prominent role in possible transfusion-related acute lung injury (pTRALI) and transfusion-associated circulatory overload (TACO). We hypothesized that both transfusion and recipient factors including natriuretic peptides could be used to distinguish TRALI from TACO and pTRALI. STUDY DESIGN AND METHODS: We performed a post hoc analysis of a case-control study of pulmonary transfusion reactions conducted at the University of California at San Francisco and Mayo Clinic, Rochester. We evaluated clinical data and brain natriuretic peptides (BNP) levels drawn after transfusion in patients with TRALI (n = 21), pTRALI (n = 26), TACO (n = 22), and controls (n = 24). Logistic regression and receiver operating characteristics curve analyses were used to determine the accuracy of clinical and biomarker predictors in differentiating TRALI from TACO and pTRALI. RESULTS: We found that pTRALI and TACO were associated with older age, higher fluid balance, and elevated BNP levels relative to those of controls and TRALI. The following variables were useful in distinguishing cases of pTRALI and TACO from TRALI: age more than 70 years, BNP levels more than 1000 pg/mL, 24-hour fluid balance of more than 3 L, and a lower number of transfused blood components. Using the above variables, our logistic model had a 91% negative predictive value in the differential diagnosis of TRALI. CONCLUSIONS: Models incorporating readily available clinical and biomarker data can be used to differentiate transfusion-related respiratory complications. Additional studies examining recipient risk factors and the likelihood of TRALI may be useful in decision making regarding donor white blood cell antibody testing.

UR - http://www.scopus.com/inward/record.url?scp=85018772447&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85018772447&partnerID=8YFLogxK

U2 - 10.1111/trf.14118

DO - 10.1111/trf.14118

M3 - Article

C2 - 28470756

AN - SCOPUS:85018772447

VL - 57

SP - 1684

EP - 1690

JO - Transfusion

JF - Transfusion

SN - 0041-1132

IS - 7

ER -