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Clinical Trial
. 2020 Nov;60(11):2548-2556.
doi: 10.1111/trf.16059. Epub 2020 Sep 9.

NT-proBNP levels in the identification and classification of pulmonary transfusion reactions

Nareg H Roubinian  1   2   3 , Dhuly Chowdhury  4 , Jeanne E Hendrickson  5 , Darrell J Triulzi  6 , Jerome L Gottschall  7 , Mark R Looney  3 , Michael A Matthay  3 , Daryl J Kor  8 , Donald Brambilla  4 , Steven H Kleinman  9 , Edward L Murphy  2   3 ; NHLBI Recipient Epidemiology and Donor Evaluation Study-III (REDS-III)
Affiliations
Clinical Trial

NT-proBNP levels in the identification and classification of pulmonary transfusion reactions

Nareg H Roubinian et al. Transfusion. 2020 Nov.

Abstract

Background: Consensus definitions for transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) have recently been revised; however, pulmonary transfusion reactions remain difficult to diagnose. We hypothesized that N-terminal pro-brain natriuretic peptide (NT-proBNP) levels could have utility in the identification and classification of pulmonary transfusion reactions.

Study design and methods: We performed a secondary analysis of a case-control study of pulmonary transfusion reactions at four academic hospitals. We evaluated clinical data and measured NT-proBNP levels prior to and following transfusion in patients with TACO (n = 160), transfused acute respiratory distress syndrome (ARDS) [n = 51], TRALI [n = 12], TACO/TRALI [n = 7], and controls [n = 335]. We used Wilcoxon Rank-Sum tests to compare NT-proBNP levels, and classification and regression tree (CART) algorithms to produce a ranking of covariates in order of relative importance for differentiating TACO from transfused controls.

Results: Pre-transfusion NT-proBNP levels were elevated in cases of transfused ARDS and TACO (both P < .001) but not TRALI (P = .31) or TACO/TRALI (P = .23) compared to transfused controls. Pre-transfusion NT-proBNP levels were higher in cases of transfused ARDS or TRALI with a diagnosis of sepsis compared to those without (P < .05 for both). CART analyses resulted in similar differentiation of patients with TACO from transfused controls for models utilizing either NT-proBNP levels (AUC 0.83) or echocardiogram results (AUC 0.80).

Conclusions: NT-proBNP levels may have utility in the classification of pulmonary transfusion reactions. Prospective studies are needed to test the predictive utility of pre-transfusion NT-proBNP in conjunction with other clinical factors in identifying patients at risk of pulmonary transfusion reactions.

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References

REFERENCES

    1. Fatalities Reported to FDA Following Blood Collection and Transfusion 2018. https://www.fda.gov/media/136907/download. .
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