Incidence, risk factors, and outcome of transfusion‐associated circulatory overload in a mixed intensive care unit population: a nested case‐control study

Publisher： John Wiley & Sons Inc

E-ISSN： 1537-2995|58|2|498-506

ISSN： 0041-1132

Source： TRANSFUSION, Vol.58, Iss.2, 2018-02, pp. : 498-506

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Abstract

BACKGROUNDThe 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.

STUDY DESIGN AND METHODSIn 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.

RESULTSTACO 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).

CONCLUSIONSThe 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.