Outcomes and risk factors of transfusion‐associated circulatory overload: a case control study

Abstract

BACKGROUND: Transfusion-associated circulatory overload (TACO) is a growing concern in clinical practice. STUDY DESIGN AND METHODS: A case controlstudy was performed at the Nîmes University Hospital, France. TACO cases occurring after RBC transfusion reported from January 1, 2014, to May 31, 2017, were included as cases. Four controls by case were randomly selected among the other RBC recipients on the same day. RESULTS:During the study period, 60 TACO diagnoses were reported for 37,029 transfused RBCs to a total of 8787 patients; 240 controls were included. The average rate of TACO was one case every 616 RBCs transfused. One in 146 transfused patients experienced TACO. TACO was associated with a higher 28-day mortality (22% vs. 11%; p = 0.003), and a longer hospital stay compared with controls (23.5 AE 19.6 days vs. 15.9 AE 20.1 days; p < 0.001). Four risk factors were independently associated with TACO in multivariable analysis: chronic use of loop diuretics (odds ratio [OR], 6.5, 95% confidence interval [CI], 3.3-12.9), hemorrhagic shock (OR, 12; 95% CI, 2.9-50), body weight <46 kg (OR, 7.9; 95% CI, 2.3-26.8) and chronic hypertension (OR, 4.1; 95% CI, 2-8.5). CONCLUSION: TACO was frequent and associatedwith poor outcome. Four independent risk factors were identified: hemorrhagic shock, low body weight, chronic use of diuretics, and chronic hypertension.* Median (interquartile range).† Over a 24-hour period. ‡ Mean AE standard deviation (SD). TACO, transfusion-associated circulatory overload. All results are presented as absolute number (%) unless otherwise indicated.

Association of Veterinary Hematology and Transfusion Medicine (AVHTM) Transfusion Reaction Small Animal Consensus Statement (TRACS). Part 1: Definitions and clinical signs

“…The incidence of TACO ranges from <1% to 8% in human studies 28 . A 2018 study reported a transfusion‐related mortality rate of 5% and named TACO the leading cause of death 30 …”

“…In patients with heart failure, pulmonary edema can occur without increases in total blood volume 29 . Patients with TACO typically have a positive response to diuretic therapy 28,30,31 …”

Sex- and Gender-Related Factors in Blood Product Transfusions

“…Indeed, low body weight (<46 kg) confers 8 times the risk of TACO, and it seems a cautious volume-conscious approach to blood products may be a primary way to improve outcomes. 16 One case-control study found that among patients receiving over 4 units of any blood component, TACO rates were higher among females but not males when compared to their matched controls, but height or weight were not analyzed as specific variables by sex. 17 The fact that the quantity of blood products transfused affects people of different sizes and sexes differentially has important implications, as males and females tend to, and probably should receive different amounts of blood products in resuscitation.…”

Implementation of a low titer group O whole blood program for a law enforcement tactical team

“…TACO is responsible for the highest transfusion‐related mortality; however, there is less concern for this due to lower fluid resuscitation volumes and duration in combat settings . Patients who develop TACO are more likely to have comorbidities like congestive heart failure and kidney disease . Several concerns about the potential for transfusion reaction and transfusion‐transmitted diseases (TTDs) can be mitigated through regular and recommended testing.…”

“…48,49 Patients who develop TACO are more likely to have comorbidities like congestive heart failure and kidney disease. 50,51 Several concerns about the potential for transfusion reaction and transfusiontransmitted diseases (TTDs) can be mitigated through regular and recommended testing.…”