Incidence and transfusion risk factors for transfusion‐associated circulatory overload among medical intensive care unit patients

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Abstract
BACKGROUND: Transfusion‐associated circulatory overload (TACO) is a frequent complication of blood transfusion. Investigations identifying risk factors for TACO in critically ill patients are lacking. STUDY DESIGN AND METHODS: We performed a 2‐year prospective cohort study of consecutive patients receiving blood product transfusion in the medical intensive care unit (ICU) of the tertiary care institution. Patients were followed for development of transfusion‐related complications. TACO was defined as acute hydrostatic pulmonary edema occurring within 6 hours of transfusion. In a nested case‐control design, transfusion characteristics were compared between cases (TACO) and controls after matching by age, sex, and ICU admission diagnostic category. In a secondary analysis, patient characteristics before transfusion were compared between cases (TACO) and randomly selected controls. RESULTS: Fifty‐one of 901 (6%) transfused patients developed TACO. Compared with matched controls, TACO cases had a more positive fluid balance (1.4 L vs. 0.8 L, p = 0.003), larger amount of plasma transfused (0.4 L vs. 0.07 L, p = 0.007), and faster rate of blood component transfusion (225 mL/hr vs. 168 mL/hr, p = 0.031). In a secondary analysis comparing TACO cases and random controls, left ventricular dysfunction before transfusion (odds ratio [OR], 8.23; 95% confidence interval [CI], 3.36‐21.97) and plasma ordered for the reversal of anticoagulant (OR, 4.31; 95% CI, 1.45‐14.30) were significantly related to the development of TACO. CONCLUSION: Volume of transfused plasma and the rate of transfusion were identified as transfusion‐specific risk factors for TACO. Left ventricular dysfunction and fresh‐frozen plasma ordered for the reversal of anticoagulant were strong predictors of TACO before the onset of transfusion.
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