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

Mark R. Looney, Nareg Roubinian, Ognjen Gajic, Michael A. Gropper, Rolf D. Hubmayr, Clifford A. Lowell, Peter Bacchetti, Gregory Wilson, Monique Koenigsberg, Deanna C. Lee, Ping Wu, Barbara Grimes, Philip J. Norris, Edward L. Murphy, Manish J. Gandhi, Jeffrey L. Winters, David C. Mair, Randy M. Schuller, Nora V. Hirschler, Rosa Sanchez RosenMichael A. Matthay, Pearl Toy

Research output: Contribution to journalArticle

42 Scopus citations

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).

Original languageEnglish (US)
Pages (from-to)1676-1687
Number of pages12
JournalCritical care medicine
Volume42
Issue number7
DOIs
StatePublished - Jul 2014

Keywords

  • acute lung injury
  • human leukocyte antigen
  • human neutrophil antigen
  • pulmonary edema
  • transfusion reaction
  • transfusion-related acute lung injury

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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    Looney, M. R., Roubinian, N., Gajic, O., Gropper, M. A., Hubmayr, R. D., Lowell, C. A., Bacchetti, P., Wilson, G., Koenigsberg, M., Lee, D. C., Wu, P., Grimes, B., Norris, P. J., Murphy, E. L., Gandhi, M. J., Winters, J. L., Mair, D. C., Schuller, R. M., Hirschler, N. V., ... Toy, P. (2014). Prospective study on the clinical course and outcomes in transfusion-related acute lung injury. Critical care medicine, 42(7), 1676-1687. https://doi.org/10.1097/CCM.0000000000000323