Background: Transfusion-related acute lung injury (TKALI) and transfusion-associated circulatory overload (TACO) commonly complicate transfusion in critically ill patients. Prior outcome studies of TACO and TKALI have focused on short-term morbidity and mortality, but the longterm survival and quality of life (QOL) of these patients remain unknown. Methods: In a nested case-control study, we compared survival and QOL between critically ill medical patients who developed pulmonary edema after transfusion (TKALI or TACO) and medical critically ill transfused controls, matched by age, gender, and admission diagnostic group. QOL in survivors was assessed with a 36-item short form health survey I year after initial hospitalization. Results: Hospital, 1-year, and 2-year mortality among the 74 TRALI cases and 74 matched controls were 43.2% vs 24.3% (P= .020), 63.8% vs 46.4% (P= .037) and 74.3% vs 54.3% (P= .031), whereas among the 51 TACO cases and 51 matched controls these values were 7.8% vs 11.8% (P= .727), 38.0% vs 28.0% (P= .371), and 44.9% vs 38.8% (P= .512). When adjusted for age and baseline severity of illness in a Cox proportional hazard analysis, the development of TKALI remained associated with decreased survival (hazard ratio 1.86; 95% CI, 1.19-2.93; P = .006). Both TRALI (P = .006, P = .03) and TACO (P = .03, P = .049) were associated with prolonged ICU and hospital lengths of stay. Conclusions: In critically ill medical patients, development of TRALI, but not TACO, is independently associated with decreased long-term survival.
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
- Critical Care and Intensive Care Medicine
- Cardiology and Cardiovascular Medicine