Blood product transfusions and clinical outcomes in pediatric patients with acute lung injury

Abstract

Objective: There are data suggesting that blood product transfusions increase the risk of developing acute lung injury (ALI) in adults, and may be associated with increased mortality in adults with ALI. A possible association between transfusions and adverse outcomes of pediatric patients with ALI has not been studied previously. We tested the hypothesis that blood product transfusions to pediatric patients with ALI within the first 72 hours of the diagnosis would be associated with increased mortality and prolonged mechanical ventilation.

Design: An epidemiologic database of pediatric ALI prospectively gathered from July 1996 to May 2000 was analyzed.

Setting: Children were enrolled from both a tertiary referral hospital and a major community children's hospital.

Patients: Three hundred fifteen patients who met the 1994 American European Consensus Committee definition of ALI between the ages of 36 weeks corrected gestational age and 18 years.

Main outcome measure: Mortality in the pediatric intensive care unit.

Results: Multivariate analyses indicated that the transfusion of fresh-frozen plasma (FFP) was associated with increased mortality, independent of the severity of hypoxemia (Pao2/Fio2), presence of multiple organ system failure or disseminated intravascular coagulation (odds ratio = 1.08, 95% confidence interval = 1.00-1.17, p = 0.04). FFP transfusion was analyzed as a continuous variable, so that for each milliliter of FFP transfused per kilogram patient body weight per day, the odds of death increased by 1.08. There was a trend toward an association of the transfusion of FFP with a fewer number of days of unassisted ventilation (regression coefficient = -0.21, 95% confidence interval = -0.42-0.01, p = 0.06).

Conclusions: The transfusion of FFP is associated with an increased risk of mortality in children with ALI. The association between FFP and mortality in children with ALI should be investigated further.

Figure 1

The association of blood product transfusion with mortality: univariate analysis. *p < 0.005, **p < 0.001. RBC, red blood cells; FFP, fresh-frozen plasma; Tx, those patients who did not receive the indicated blood product; +Tx, those patients who did receive the indicated blood product.

Figure 2

The association of mortality with the amount of fresh-frozen plasma transfused: univariate analysis. The amount of fresh-frozen plasma transfused is depicted in 5 mL increments per patient body weight (kg).