Chest. 2007 Mar 30;
Fresh frozen plasma and platelet transfusions are associated with development of acute lung injury in critically ill medical patients.Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine.
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.
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