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- Title
Incidence, risk factors, and outcome of transfusion-associated circulatory overload in a mixed intensive care unit population: a nested case-control study.
- Authors
Bosboom, Joachim J.; Klanderman, Robert B.; Zijp, Maarten; Hollmann, Markus W.; Veelo, Denise P.; Binnekade, Jan M.; Geerts, Bart F.; Vlaar, Alexander P. J.
- Abstract
<bold>Background: </bold>The objective of this study was to determine the incidence, risk factors, and outcome of transfusion-associated circulatory overload (TACO) in a cohort of mixed intensive care unit patients and to compare risk factors with those for cardiac overload in the absence of transfusion.<bold>Study Design and Methods: </bold>In a retrospective cohort study, patients who developed TACO were compared using multivariate analysis of two control groups: patients without pulmonary deterioration who received transfusion and patients who developed circulatory overload in the absence of transfusion.<bold>Results: </bold>TACO was diagnosed in 66 of 1140 patients who received transfusions (5.8%). A total of 585 control transfusion recipients and 76 control patients who developed circulatory overload also were identified. Risk factors were the referring specialties cardiology (odds ratio [OR], 13.6; 95% confidence interval [CI], 5.1-35.7; p ≤ 0.001) and cardiothoracic surgery (OR, 8.8; 95% CI, 3.7-20.7; p ≤ 0.001), history of cardiac failure (OR, 2.4; 95% CI, 1.2-4.6; p = 0.01), continuous veno-venous hemofiltration (OR, 3.2; 95% CI, 1.2-8.9; p = 0.03), and degree of positive fluid balance (OR, 1.15; 95% CI, 1.07-1.24; p ≤ 0.001), which was associated less with the onset of TACO compared with circulatory overload (OR, 0.89; 95% CI, 0.82-0.97; p = 0.005). Patients in the TACO group had a longer length of stay in the intensive care unit compared with the transfusion and circulatory overload controls groups (median, 7.2 vs. 4.3 vs. 4.4 days; p = 0.001 vs. p = 0.008).<bold>Conclusions: </bold>The incidence of TACO is high in a mixed intensive care unit population. The risk factors identified for TACO are cardiac failure, renal failure, and degree of positive fluid balance. A positive fluid balance may be less essential in the onset of TACO than in the onset of circulatory overload in the absence of transfusion.
- Subjects
BLOOD transfusion reaction; BLOOD group incompatibility; BLOOD transfusion; BLOOD testing; HISTOCOMPATIBILITY; SAFETY; HEART failure risk factors; COMPARATIVE studies; CONFIDENCE intervals; INTENSIVE care units; LONGITUDINAL method; MULTIVARIATE analysis; TREATMENT effectiveness; RETROSPECTIVE studies; CASE-control method; DESCRIPTIVE statistics; ODDS ratio
- Publication
Transfusion, 2018, Vol 58, Issue 2, p498
- ISSN
0041-1132
- Publication type
journal article
- DOI
10.1111/trf.14432