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Association of Red Cell Transfusion with Mortality in Patients with Acute Lung Injury

¹Division of Pulmonary and Critical Care, University of Maryland School of Medicine ²Division of Pulmonary, Allergy and Critical Care, Hospital of the University of Pennsylvania ³Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine ⁴Leonard Davis Institute of Health Economics, University of Pennsylvania

gnetzer{at}medicine.umaryland.edu

Abstract

BackgroundRed blood cell (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).

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

ResultsOverall in-hospital mortality was 39.5%. Of these patients, 207/248 (83.5%) received one or more units of packed red cells. The transfusion of any packed red cells was associated with an increased risk of death, with an adjusted odds ratio (OR) of 3.12 (95%CI: 1.28, 7.58, p<0.001). The overall OR per unit was 1.06 (1.04, 1.09, p<0.001) in the complete multivariable model. Transfusion after ALI onset was associated with an adjusted OR of 1.13 (1.07, 1.20, p<0.001), while transfusion before ALI onset was not associated with higher risk. The adjusted OR per unit of non-leukoreduced RBC transfused was 1.14 (1.07, 1.21, p<0.001), while the adjusted OR for leukoreduced cells per unit transfused was 1.06 (95% CI:1.03, 1.09, p<0.001).

ConclusionsThe 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.

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]

This article has been cited by other articles:

				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]