PMID- 23357450 OWN - NLM STAT- MEDLINE DCOM- 20130507 LR - 20211021 IS - 1555-7162 (Electronic) IS - 0002-9343 (Print) IS - 0002-9343 (Linking) VI - 126 IP - 4 DP - 2013 Apr TI - Risk factors and outcomes in transfusion-associated circulatory overload. PG - 357.e29-38 LID - S0002-9343(12)00897-2 [pii] LID - 10.1016/j.amjmed.2012.08.019 [doi] AB - BACKGROUND: Transfusion-associated circulatory overload is characterized by new respiratory distress and hydrostatic pulmonary edema within 6 hours after blood transfusion, but its risk factors and outcomes are poorly characterized. METHODS: Using a case control design, we enrolled 83 patients with severe transfusion-associated circulatory overload identified by active surveillance for hypoxemia and 163 transfused controls at the University of California, San Francisco (UCSF) and Mayo Clinic (Rochester, Minn) hospitals. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using multivariable logistic regression, and survival and length of stay were analyzed using proportional hazard models. RESULTS: Transfusion-associated circulatory overload was associated with chronic renal failure (OR 27.0; 95% CI, 5.2-143), a past history of heart failure (OR 6.6; 95% CI, 2.1-21), hemorrhagic shock (OR 113; 95% CI, 14.1-903), number of blood products transfused (OR 1.11 per unit; 95% CI, 1.01-1.22), and fluid balance per hour (OR 9.4 per liter; 95% CI, 3.1-28). Patients with transfusion-associated circulatory overload had significantly increased in-hospital mortality (hazard ratio 3.20; 95% CI, 1.23-8.10) after controlling for Acute Physiology and Chronic Health Evaluation-II (APACHE-II) score, and longer hospital and intensive care unit lengths of stay. CONCLUSIONS: The risk of transfusion-associated circulatory overload increases with the number of blood products administered and a positive fluid balance, and in patients with pre-existing heart failure and chronic renal failure. These data, if replicated, could be used to construct predictive algorithms for transfusion-associated circulatory overload, and subsequent modifications of transfusion practice might prevent morbidity and mortality associated with this complication. CI - Copyright (c) 2013. Published by Elsevier Inc. FAU - Murphy, Edward L AU - Murphy EL AD - Department of Laboratory Medicine, University of California, San Francisco, CA 94118, USA. murphy@ucsf.edu FAU - Kwaan, Nicholas AU - Kwaan N FAU - Looney, Mark R AU - Looney MR FAU - Gajic, Ognjen AU - Gajic O FAU - Hubmayr, Rolf D AU - Hubmayr RD FAU - Gropper, Michael A AU - Gropper MA FAU - Koenigsberg, Monique AU - Koenigsberg M FAU - Wilson, Greg AU - Wilson G FAU - Matthay, Michael AU - Matthay M FAU - Bacchetti, Peter AU - Bacchetti P FAU - Toy, Pearl AU - Toy P CN - TRALI Study Group LA - eng GR - P50 HL081027/HL/NHLBI NIH HHS/United States GR - UL1 RR024131/RR/NCRR NIH HHS/United States GR - UL1-RR-024131/RR/NCRR NIH HHS/United States GR - R01 HL107386/HL/NHLBI NIH HHS/United States GR - K24 HL075036/HL/NHLBI NIH HHS/United States GR - P50-HL-81027/HL/NHLBI NIH HHS/United States GR - K24-HL-075036/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20130126 PL - United States TA - Am J Med JT - The American journal of medicine JID - 0267200 SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Blood Transfusion/mortality MH - Case-Control Studies MH - Female MH - *Hospital Mortality MH - Humans MH - Intensive Care Units/statistics & numerical data MH - Kaplan-Meier Estimate MH - Length of Stay MH - Logistic Models MH - Male MH - Middle Aged MH - Minnesota MH - Proportional Hazards Models MH - Pulmonary Edema/diagnosis/*etiology MH - Risk Factors MH - San Francisco MH - *Transfusion Reaction PMC - PMC3652681 MID - NIHMS467508 COIS- Conflict of Interest: None. FIR - Toy, Pearl IR - Toy P FIR - Gajic, Ognjen IR - Gajic O FIR - Looney, Mark IR - Looney M FIR - Hubmayr, Rolf IR - Hubmayr R FIR - Gropper, Michael A IR - Gropper MA FIR - Matthay, Michael IR - Matthay M FIR - Weiskopf, Richard B IR - Weiskopf RB FIR - Murphy, Edward L IR - Murphy EL FIR - Lowell, Clifford IR - Lowell C FIR - Kleinman, Steve IR - Kleinman S FIR - Stroncek, David IR - Stroncek D FIR - Kakaiya, Ram IR - Kakaiya R FIR - Price, Thomas H IR - Price TH FIR - Busch, Michael P IR - Busch MP FIR - Sheppard, Dean IR - Sheppard D FIR - Bacchetti, Peter IR - Bacchetti P FIR - Grimes, Barbara IR - Grimes B FIR - Koenigsberg, Monique IR - Koenigsberg M FIR - Lang, Kelly IR - Lang K FIR - Chin, Christopher IR - Chin C FIR - Lee, Deanna IR - Lee D FIR - Bartek, Lynda IR - Bartek L FIR - Wilson, Gregory IR - Wilson G FIR - Krpata, Tami IR - Krpata T FIR - Rasmussen, Deborah IR - Rasmussen D FIR - Medcalfe, Cindy IR - Medcalfe C FIR - Hirschler, Nora IR - Hirschler N FIR - Rosen, Rosa Sanchez IR - Rosen RS FIR - Norris, Philip IR - Norris P FIR - Hindes, Dan IR - Hindes D FIR - Moore, S Breandan IR - Moore S FIR - Winters, Jeffrey L IR - Winters JL FIR - Gandhi, Manish IR - Gandhi M FIR - Mair, David IR - Mair D FIR - Schuller, Randy IR - Schuller R FIR - Moore, S Breandan IR - Moore S FIR - Gandhi, Manish IR - Gandhi M FIR - DeGoey, Steven IR - DeGoey S FIR - Ploeger, Nancy IR - Ploeger N FIR - Norris, Philip IR - Norris P FIR - Lowell, Clifford IR - Lowell C FIR - Mei Hu, Yong IR - Mei Hu Y FIR - Wu, Ping IR - Wu P FIR - McConnell, Joseph IR - McConnell J FIR - Anderson, Charlene IR - Anderson C EDAT- 2013/01/30 06:00 MHDA- 2013/05/08 06:00 PMCR- 2014/04/01 CRDT- 2013/01/30 06:00 PHST- 2012/05/29 00:00 [received] PHST- 2012/08/06 00:00 [revised] PHST- 2012/08/28 00:00 [accepted] PHST- 2013/01/30 06:00 [entrez] PHST- 2013/01/30 06:00 [pubmed] PHST- 2013/05/08 06:00 [medline] PHST- 2014/04/01 00:00 [pmc-release] AID - S0002-9343(12)00897-2 [pii] AID - 10.1016/j.amjmed.2012.08.019 [doi] PST - ppublish SO - Am J Med. 2013 Apr;126(4):357.e29-38. doi: 10.1016/j.amjmed.2012.08.019. Epub 2013 Jan 26.