Khan H, Belsher J, Yilmaz M, Afessa B, Moore SB, Hubmayr RD, Gajic O.
Background: Transfusion has long been identified as a risk factor for acute lung injury/acute respiratory distress syndrome (ALI/ARDS). No study has formally evaluated transfusion of specific blood products as a risk factor for ALI/ARDS in critically ill medical patients. Method In this single center retrospective cohort study, 841 consecutive critically ill patients were studied for the development of ALI/ARDS. Patients who received blood product transfusions were compared with those who did not, in univariate and multivariate analyses. Results Two hundred ninety eight patients (35%) received blood transfusion. Transfused patients were older (67+/-17 vs 62+/-19 years, p<0.001) and had higher acute physiologic and chronic health evaluation (APACHE) III scores (74+/-32 vs 58+/-23, p<0.001). ALI/ARDS (25% vs 18%, p= 0.025) developed more commonly in patients exposed to transfusion. Seventeen patients received massive (>10) red blood cell (RBC) transfusions, of whom 13 also received fresh frozen plasma (FFP) and 11 received platelet transfusion. When adjusted for probability of transfusion and other ALI/ARDS risk factors, any transfusion was associated with development of ALI/ARDS (OR 2.14, 95% CI 1.24 to 3.75). Amongst the individual blood products, recipients of FFP (OR 2.48, 95% CI 1.29 to 4.74) and platelets (OR 3.89 95% CI 1.36 to 11.52) were more likely to develop ALI/ARDS than patients who received only RBC (OR 1.39, 95%CI 0.79 to 2.43) transfusions. Conclusion Transfusion is associated with increased risk of developing ALI/ARDS in critically ill medical patients. The risk is higher with plasma rich blood products, FFP and platelets, than with RBC transfusions.