Transfusion-related acute lung injury: incidence and risk factors
Transfusion-related acute lung injury: incidence and risk factors
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DOI：
10.1182/blood-2011-08-370932
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发表时间：
2012-02-16
期刊：
影响因子：
20.3
通讯作者：
Matthay, Michael A.
中科院分区：
文献类型：
--
作者：
Toy, Pearl;Gajic, Ognjen;Matthay, Michael A.
输血相关急性肺损伤(TRALI)是导致输血相关死亡的主要原因。为了通过前瞻性、主动监测确定TRALI的发病率，并通过病例对照研究确定危险因素，2个学术医学中心招募了89例患者和164名输血对照。多因素分析确定的受者危险因素为较高的IL-8水平、肝脏手术、长期酗酒、休克、机械通气时较高的气道峰压、当前吸烟和液体正平衡。输血危险因素有接受女性献血者血浆或全血(优势比=4.5，95%可信区间1.85~11.2，P=.001)，本底比值>27.5的人类白细胞抗原II类抗体阳性(OR=1.92/100毫升，95%可信区间，1.083.4，P=0.03)，粒细胞免疫荧光试验抗人中性粒细胞抗原阳性(OR=1.71/100毫升，95%可信区间，1.18~2.5，P=0.004)。与较老的红细胞单位、非同源或弱同源的II类抗体或I类抗体相关的风险很小或没有。输注女性献血者血浆的减少伴随着TRALI发生率的下降：2006年为2.57(95%可信区间，1.72-3.86)，2009年为0.81(95%可信区间，0.44-1.49)(P=0.002)。已确定的危险因素为减少残留TRALI提供了潜在的目标。(《血色》2012；119(7)：1757-1767)
Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related mortality. To determine TRALI incidence by prospective, active surveillance and to identify risk factors by a case-control study, 2 academic medical centers enrolled 89 cases and 164 transfused controls. Recipient risk factors identified by multivariate analysis were higher IL-8 levels, liver surgery, chronic alcohol abuse, shock, higher peak airway pressure while being mechanically ventilated, current smoking, and positive fluid balance. Transfusion risk factors were receipt of plasma or whole blood from female donors (odds ratio = 4.5, 95% confidence interval [CI], 1.85-11.2, P = .001), volume of HLA class II antibody with normalized background ratio more than 27.5 (OR = 1.92/100 mL, 95% CI, 1.083.4, P = .03), and volume of anti-human neutrophil antigen positive by granulocyte immunofluoresence test (OR = 1.71/100 mL, 95% CI, 1.18-2.5, P = .004). Little or no risk was associated with older red blood cell units, noncognate or weak cognate class II antibody, or class I antibody. Reduced transfusion of plasma from female donors was concurrent with reduced TRALI incidence: 2.57 (95% CI, 1.72-3.86) in 2006 versus 0.81 (95% CI, 0.44-1.49) in 2009 per 10 000 transfused units (P = .002). The identified risk factors provide potential targets for reducing residual TRALI. (Blood.2012;119(7):1757-1767)