Designing and Testing a Computer-Based Screening System for Transfusion-Related Acute Lung Injury

Finlay, Heather E.; Cassorla, Lydia; Feiner, John; Toy, Pearl

doi:10.1309/1xkq-kff8-3cbu-4d6h

Cited by 14 publications

(15 citation statements)

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“…Some investigators have used manual retrospective chart review 35 ; others have conducted prospective active surveillance 36 ; but few have used electronic algorithms in case identification. 38 As demonstrated previously, passive identification strategies are prone to underrecognition, particularly of less severe cases. Additionally, the populations in each study range from all transfused patients 36 to the critically ill 4 and, rarely, to surgical subsets, 31,32 with differing underlying risks for TRALI, thus limiting comparability.…”

Section: Discussionmentioning

confidence: 89%

Characterizing the Epidemiology of Postoperative Transfusion-related Acute Lung Injury

et al. 2015

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Background Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related death in the United States; however, it remains poorly characterized in surgical populations. To better inform perioperative transfusion practice, and to help mitigate perioperative TRALI, the authors aimed to better define its epidemiology before and after TRALI mitigation strategies were introduced. Methods This retrospective cohort study examined outcomes of adult patients undergoing noncardiac surgery with general anesthesia who received intraoperative transfusions during 2004 (n = 1,817) and 2011 (n = 1,562). The demographics and clinical characteristics of transfusion recipients, blood transfusion descriptors, and combined TRALI/possible TRALI incidence rates were evaluated. Univariate analyses were used to compare associations between patient characteristics, transfusion details, and TRALI mitigation strategies with TRALI/possible TRALI incidence rates in a before-and-after study design. Results The incidence of TRALI/possible TRALI was 1.3% (23 of 1,613) in 2004 versus 1.4% (22 of 1,562) in 2011 (P = 0.72), with comparable overall rates in males versus females (1.4% [23 of 1,613] vs. 1.2% [22 of 1,766]) (P = 0.65). Overall, thoracic (3.0% [4 of 133]), vascular (2.7% [10 of 375]), and transplant surgeries (2.2% [4 of 178]) carried the highest rates of TRALI/possible TRALI. Obstetric and gynecologic surgical patients had no TRALI episodes. TRALI/possible TRALI incidence increased with larger volumes of blood product transfused (P < 0.001). Conclusions Perioperative TRALI/possible TRALI is more common than previously reported and its risk increases with greater volumes of blood component therapies. No significant reduction in the combined incidence of TRALI/possible TRALI occurred between 2004 and 2011, despite the introduction of TRALI mitigation strategies. Future efforts to identify specific risk factors for TRALI/possible TRALI in surgical populations may reduce the burden of this life-threatening complication.

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Section: Discussionmentioning

confidence: 89%

Characterizing the Epidemiology of Postoperative Transfusion-related Acute Lung Injury

et al. 2015

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“…Cases of pulmonary transfusion reactions were identified by active surveillance using a real-time electronic method that screened arterial blood gas results in patients older than 6 months who received blood transfusion, as previously described. 12 …”

Section: Methodsmentioning

confidence: 99%

Cytokines and clinical predictors in distinguishing pulmonary transfusion reactions

et al. 2015

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BACKGROUND Pulmonary transfusion reactions are important complications of blood transfusion, yet differentiating these clinical syndromes is diagnostically challenging. We hypothesized that biologic markers of inflammation could be used in conjunction with clinical predictors to distinguish transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), and possible TRALI. STUDY DESIGN AND METHODS In a nested case-control study performed at the University of California at San Francisco and Mayo Clinic, Rochester, we evaluated clinical data and blood samples drawn before and after transfusion in patients with TRALI (n =70), possible TRALI (n =48), TACO (n =29), and controls (n =147). Cytokines measured included granulocyte-macrophage–colony-stimulating factor, interleukin (IL)-6, IL-8, IL-10, and tumor necrosis factor-α. Logistic regression and receiver operating characteristics curve analyses were used to determine the accuracy of clinical predictors and laboratory markers in differentiating TACO, TRALI, and possible TRALI. RESULTS Before and after transfusion, IL-6 and IL-8 were elevated in patients with TRALI and possible TRALI relative to controls, and IL-10 was elevated in patients with TACO and possible TRALI relative to that of TRALI and controls. For all pulmonary transfusion reactions, the combination of clinical variables and cytokine measurements displayed optimal diagnostic performance, and the model comparing TACO and TRALI correctly classified 92% of cases relative to expert panel diagnoses. CONCLUSIONS Before transfusion, there is evidence of systemic inflammation in patients who develop TRALI and possible TRALI but not TACO. A predictive model incorporating readily available clinical and cytokine data effectively differentiated transfusion-related respiratory complications such as TRALI and TACO.

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“…Prospective surveillance for TRALI was conducted between 2006 and 2009 at the University of California, San Francisco (San Francisco, CA) and the Mayo Clinic (Rochester, MN) using an electronic surveillance system to screen for posttransfusion hypoxemia (11), as previously described (9). Study coordinators sent case information to two critical care physicians on the four-member expert panel (O.G., R.H., M.R.L., M.A.G.).…”

Section: Methodsmentioning

confidence: 99%

Prospective Study on the Clinical Course and Outcomes in Transfusion-Related Acute Lung Injury*

Looney

Roubinian

Gajic

et al. 2014

Critical Care Medicine

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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).

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Designing and Testing a Computer-Based Screening System for Transfusion-Related Acute Lung Injury

Cited by 14 publications

References 0 publications

Characterizing the Epidemiology of Postoperative Transfusion-related Acute Lung Injury

Characterizing the Epidemiology of Postoperative Transfusion-related Acute Lung Injury

Cytokines and clinical predictors in distinguishing pulmonary transfusion reactions

Prospective Study on the Clinical Course and Outcomes in Transfusion-Related Acute Lung Injury*

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