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- Title
NT‐proBNP levels in the identification and classification of pulmonary transfusion reactions.
- Authors
Roubinian, Nareg H.; Chowdhury, Dhuly; Hendrickson, Jeanne E.; Triulzi, Darrell J.; Gottschall, Jerome L.; Looney, Mark R.; Matthay, Michael A.; Kor, Daryl J.; Brambilla, Donald; Kleinman, Steven H.; Murphy, Edward L.
- Abstract
Background: Consensus definitions for transfusion‐related acute lung injury (TRALI) and transfusion‐associated circulatory overload (TACO) have recently been revised; however, pulmonary transfusion reactions remain difficult to diagnose. We hypothesized that N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) levels could have utility in the identification and classification of pulmonary transfusion reactions. Study design and methods: We performed a secondary analysis of a case‐control study of pulmonary transfusion reactions at four academic hospitals. We evaluated clinical data and measured NT‐proBNP levels prior to and following transfusion in patients with TACO (n = 160), transfused acute respiratory distress syndrome (ARDS) [n = 51], TRALI [n = 12], TACO/TRALI [n = 7], and controls [n = 335]. We used Wilcoxon Rank‐Sum tests to compare NT‐proBNP levels, and classification and regression tree (CART) algorithms to produce a ranking of covariates in order of relative importance for differentiating TACO from transfused controls. Results: Pre‐transfusion NT‐proBNP levels were elevated in cases of transfused ARDS and TACO (both P <.001) but not TRALI (P =.31) or TACO/TRALI (P =.23) compared to transfused controls. Pre‐transfusion NT‐proBNP levels were higher in cases of transfused ARDS or TRALI with a diagnosis of sepsis compared to those without (P <.05 for both). CART analyses resulted in similar differentiation of patients with TACO from transfused controls for models utilizing either NT‐proBNP levels (AUC 0.83) or echocardiogram results (AUC 0.80). Conclusions: NT‐proBNP levels may have utility in the classification of pulmonary transfusion reactions. Prospective studies are needed to test the predictive utility of pre‐transfusion NT‐proBNP in conjunction with other clinical factors in identifying patients at risk of pulmonary transfusion reactions.
- Subjects
BLOOD transfusion reaction; ADULT respiratory distress syndrome; REGRESSION trees; PREDICTIVE tests
- Publication
Transfusion, 2020, Vol 60, Issue 11, p2548
- ISSN
0041-1132
- Publication type
Article
- DOI
10.1111/trf.16059