Dataset Information

Transfusion-associated circulatory overload in gastroenterology.

ABSTRACT:

Background

Transfusion-associated circulatory overload (TACO) is a rare life-threatening event associated with transfusion. This study aimed to identify any case of TACO in a large cohort of highly transfused patients with gastrointestinal tract (GI) bleeding.

Materials and methods

Data from patients who underwent an oesophago-gastro-duodenoscopy (OGD) were collected over one year from the gastroenterology service of a regional hospital.

Results

A total of 278 patients were identified, of which 81 required transfusion. In total, 811 blood components were transfused (red cell concentrate, platelets, plasma), leading to a cumulative TACO incidence of 12.3%. The probability of developing TACO was greater for patients aged ≥80 years (OR=3.9%; p=0.0058), with renal disease (OR=1.9%, p=not significant) and with cardiac disease (OR 11.1%; p=0.003). Patients with TACO had a lower overall survival (52 vs 20% at 3 years, p=0.034, HR=2.19, 95% CI: 1.04-4.63) compared to patients with cirrhosis without TACO (57 vs 28% at 3 years, p=0.003, HR=2.20, 95% CI: 1.30-3.72). Patients with an advanced stage of liver cirrhosis (Child Pugh c10 or more) were most likely to develop TACO.

Discussion

This study shows that within the GI setting TACO may be markedly under-reported. Clinical awareness for potential TACO development in GI patients with cardiac or renal disease or age >80 years is now required.

SUBMITTER: Piccin A

PROVIDER: S-EPMC8092035 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:OBJECTIVES:Transfusion-associated circulatory overload is characterized by hydrostatic pulmonary edema following blood transfusion. Restrictive transfusion practice may affect the occurrence and severity of transfusion-associated circulatory overload in critically ill patients. We sought to examine contemporary risk factors and outcomes for transfusion-associated circulatory overload. DESIGN:Case-control study. SETTING:Four tertiary care hospitals. PATIENTS:We prospectively enrolled 200 patients with transfusion-associated circulatory overload identified by active surveillance and 405 controls matched by transfusion intensity. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Among 20,845 transfused patients who received 128,263 blood components from May 2015 until July 2016, transfusion-associated circulatory overload incidence was one case per 100 transfused patients. In addition to cardiovascular comorbidities, multivariable analysis identified the following independent predictors of transfusion-associated circulatory overload: acute kidney injury, emergency surgery, pretransfusion diuretic use, and plasma transfusion-the latter especially in females. Compared with matched controls, transfusion-associated circulatory overload cases were more likely to require mechanical ventilation (71% vs 49%; p < 0.001), experienced longer intensive care and hospital lengths of stay following transfusion, and had higher mortality (21% vs 11%; p = 0.02) even after adjustment for other potentially confounding variables. CONCLUSIONS:Despite restrictive transfusion practice, transfusion-associated circulatory overload remains a frequent complication of transfusion and is an independent risk factor for in-hospital morbidity and mortality. In addition to cardiovascular and renal risk factors, plasma transfusion was associated with transfusion-associated circulatory overload after controlling for other covariates. Additional research is needed to examine the benefit of reduced erythrocyte or plasma exposure in patients at high risk for transfusion-associated circulatory overload.

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