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Association of RBC Transfusion With Mortality in Patients With Acute Lung Injury^*

^* From the Division of Pulmonary and Critical Care (Dr. Netzer), University of Maryland School of Medicine, Baltimore, MD; Division of Pulmonary, Allergy and Critical Care (Drs. Shah, Iwashyna, Lanken, Finkel, Fuchs, and Christie), Hospital of the University of Pennsylvania, Philadelphia, PA; and Center for Clinical Epidemiology and Biostatistics (Dr. Guo), University of Pennsylvania School of Medicine, Philadelphia, PA.

Correspondence to: Giora Netzer, MD, MSCE, FCCP, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, MSTF Bldg, Room 800, 685 W Baltimore St, Baltimore, MD 21201; e-mail: gnetzer{at}medicine.umaryland.edu

Abstract

Background: RBC transfusion has been associated with increased morbidity and mortality in a variety of clinical settings. We assessed the effect of RBC transfusion on in-hospital mortality in patients with acute lung injury (ALI).

Methods: Cohort study of 248 consecutive patients with ALI. RBC transfusion was evaluated as both dichotomous and continuous variables, with outcome being in-hospital mortality adjusted for clinical confounders and length of total hospital stay.

Results: Overall in-hospital mortality rate was 39.5%. Of these patients, 207 of 248 patients (83.5%) received 1 U of packed RBCs. The transfusion of any packed RBCs was associated with an increased risk of death (adjusted odds ratio [OR], 3.12; 95% confidence interval [CI], 1.28 to 7.58; p < 0.001). The overall OR per unit was 1.06 (95% CI, 1.04 to 1.09; p < 0.001) in the complete multivariable model. Transfusion after ALI onset was associated with an adjusted OR of 1.13 (95% CI, 1.07 to 1.20; p < 0.001), while transfusion before ALI onset was not associated with higher risk. The adjusted OR per unit of nonleukoreduced RBC transfused was 1.14 (95% CI, 1.07 to 1.21; p < 0.001), while the adjusted OR for leukoreduced cells per unit transfused was 1.06 (95% CI, 1.03 to 1.09; p < 0.001).

Conclusions: Transfusion of RBCs in patients with ALI was associated with increased in-hospital mortality. This risk occurred with RBC transfusion after the onset of ALI, and was greater for nonleukoreduced than for leukoreduced RBCs. Aggressive transfusion strategies in patients with established ALI should be questioned, pending further study.

Key Words: blood component transfusion • blood transfusion • mortality • respiratory distress syndrome, adult

Related Editorial

Transfusion in Critical Care: Where Do We Go From Here?

Andrew F. Shorr and Howard L. Corwin
Chest 2007 132: 1105-1106. [Full Text] [PDF]

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				W. S. Lyons, G. Netzer, C. V. Shah, T. J. Iwashyna, P. N. Lanken, B. Finkel, B. Fuchs, J. D. Christie, and W. Guo Blood Banks Under Siege Chest, July 1, 2008; 134(1): 214 - 215. [Full Text] [PDF]

				A. F. Shorr and H. L. Corwin Transfusion in Critical Care: Where Do We Go From Here? Chest, October 1, 2007; 132(4): 1105 - 1106. [Full Text] [PDF]