Transfusion and pneumonia in the trauma intensive care unit: an examination of the temporal relationship - PubMed (original) (raw)
Comparative Study
Transfusion and pneumonia in the trauma intensive care unit: an examination of the temporal relationship
Marianne J Vandromme et al. J Trauma. 2009 Jul.
Abstract
Background: Transfusion has been demonstrated to be associated with pneumonia in injured patients, and blood of older storage age may potentiate this morbidity. It remains unclear, however, whether this association is causal, as prior studies have not accounted for prepneumonia versus postpneumonia transfusion. We sought to evaluate the temporal relationship between transfusion and pneumonia and the influence of blood age on this relationship.
Methods: Admissions to a Level I trauma center between July 2004 and October 2007 with the following characteristics were selected for inclusion: overall length of stay of > or = 4 days; intensive care unit length of stay of > or = 1 day; and > or = 1 ventilator days. Date(s) of transfusion and blood storage age defined as "old" > or = 14 days and "young" < 14 days were obtained. Pneumonia was diagnosed by bronchoalveolar lavage (> 10(5) colonies/mL). Risk ratios (RR) and 95% confidence intervals (CIs) were calculated for the association between pneumonia and both date (in relation to pneumonia) and age of blood transfused, adjusted for age, gender, injury severity, mechanism of injury, ventilator days, and transfusion volume.
Results: A total of 1,615 patients met study criteria. Adjusted RR (CI) for the association between pneumonia and receipt of blood at any time was 1.99 (1.39-2.86). However, when postpneumonia transfusions were disregarded, no association was observed (RR 1.33; CI 0.98-1.80). Analysis by blood age, however, demonstrated that prepneumonia transfusion of exclusively older blood was significantly associated with an increased risk of pneumoinia (adjusted RR 1.42; CI 1.01-2.02), whereas transfusion of exclusively younger units (adjusted RR 1.02; CI 0.62-1.67) or mixed units (adjusted RR 1.35; CI 0.98-1.87) were not.
Conclusions: Prior reports of an association between transfusion and pneumonia may reflect transfusions received after pneumonia rather than etiologically relevant transfusions received before the onset of pneumonia. Transfusion of exclusively older blood, however, increased the risk of pneumonia, further suggesting the importance of blood age with respect to outcomes in trauma patients.
Similar articles
- Transfusions in the less severely injured: does age of transfused blood affect outcomes?
Weinberg JA, McGwin G Jr, Marques MB, Cherry SA 3rd, Reiff DA, Kerby JD, Rue LW 3rd. Weinberg JA, et al. J Trauma. 2008 Oct;65(4):794-8. doi: 10.1097/TA.0b013e318184aa11. J Trauma. 2008. PMID: 18849793 - Age of transfused blood: an independent predictor of mortality despite universal leukoreduction.
Weinberg JA, McGwin G Jr, Griffin RL, Huynh VQ, Cherry SA 3rd, Marques MB, Reiff DA, Kerby JD, Rue LW 3rd. Weinberg JA, et al. J Trauma. 2008 Aug;65(2):279-82; discussion 282-4. doi: 10.1097/TA.0b013e31817c9687. J Trauma. 2008. PMID: 18695462 - Operative repair or endovascular stent graft in blunt traumatic thoracic aortic injuries: results of an American Association for the Surgery of Trauma Multicenter Study.
Demetriades D, Velmahos GC, Scalea TM, Jurkovich GJ, Karmy-Jones R, Teixeira PG, Hemmila MR, O'Connor JV, McKenney MO, Moore FO, London J, Singh MJ, Lineen E, Spaniolas K, Keel M, Sugrue M, Wahl WL, Hill J, Wall MJ, Moore EE, Margulies D, Malka V, Chan LS; American Association for the Surgery of Trauma Thoracic Aortic Injury Study Group. Demetriades D, et al. J Trauma. 2008 Mar;64(3):561-70; discussion 570-1. doi: 10.1097/TA.0b013e3181641bb3. J Trauma. 2008. PMID: 18332794 - Subglottic secretion drainage for preventing ventilator-associated pneumonia: a meta-analysis.
Dezfulian C, Shojania K, Collard HR, Kim HM, Matthay MA, Saint S. Dezfulian C, et al. Am J Med. 2005 Jan;118(1):11-8. doi: 10.1016/j.amjmed.2004.07.051. Am J Med. 2005. PMID: 15639202 Review. - The silent risks of blood transfusion.
Rawn J. Rawn J. Curr Opin Anaesthesiol. 2008 Oct;21(5):664-8. doi: 10.1097/ACO.0b013e32830f1fd1. Curr Opin Anaesthesiol. 2008. PMID: 18784496 Review.
Cited by
- The Nlrp3 Inflammasome Does Not Regulate Alloimmunization to Transfused Red Blood Cells in Mice.
Gibb DR, Calabro S, Liu D, Tormey CA, Spitalnik SL, Zimring JC, Hendrickson JE, Hod EA, Eisenbarth SC. Gibb DR, et al. EBioMedicine. 2016 Jul;9:77-86. doi: 10.1016/j.ebiom.2016.06.008. Epub 2016 Jun 16. EBioMedicine. 2016. PMID: 27345021 Free PMC article. - Aged Human Stored Red Blood Cell Supernatant Inhibits Macrophage Phagocytosis in an HMGB1 Dependent Manner After Trauma in a Murine Model.
Zettel KR, Dyer M, Raval JS, Wu X, Klune JR, Gutierrez A, Triulzi DJ, Billiar TR, Neal MD. Zettel KR, et al. Shock. 2017 Feb;47(2):217-224. doi: 10.1097/SHK.0000000000000716. Shock. 2017. PMID: 27488090 Free PMC article. - Red blood cell transfusion-induced inflammation: myth or reality.
Hod EA. Hod EA. ISBT Sci Ser. 2015 Apr;10(Suppl 1):188-191. doi: 10.1111/voxs.12108. ISBT Sci Ser. 2015. PMID: 26347800 Free PMC article. - Transfusion of stored blood impairs host defenses against Gram-negative pathogens in mice.
Prestia K, Bandyopadhyay S, Slate A, Francis RO, Francis KP, Spitalnik SL, Fidock DA, Brittenham GM, Hod EA. Prestia K, et al. Transfusion. 2014 Nov;54(11):2842-51. doi: 10.1111/trf.12712. Epub 2014 May 19. Transfusion. 2014. PMID: 24840185 Free PMC article. - Noninvasive Imaging of Stored Red Blood Cell-Transfusion Aggravating Sepsis-Induced Liver Injury Associated with Increased Activation of M1-Polarized Kupffer Cells.
Wu T, Wang L, An J, Wu CY, Wang Y, Qian L, Zhou J, Zhang YL, Zhou QQ, Wang XH, Wang HF, Fu QX, Zhan LS. Wu T, et al. Shock. 2017 Oct;48(4):459-466. doi: 10.1097/SHK.0000000000000867. Shock. 2017. PMID: 28333715 Free PMC article.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical
Miscellaneous