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

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.

• Authors: Nareg H Roubinian, Dhuly Chowdhury, Jeanne E Hendrickson, Darrell J Triulzi, Jerome L Gottschall, Mark R Looney, Michael A Matthay, Daryl J Kor, Donald Brambilla, Steven H Kleinman, Edward L Murphy, NHLBI Recipient Epidemiology and Donor Evaluation Study-III (REDS-III)
• Journal: Transfusion (Transfusion) Vol. 60 Issue 11 Pg. 2548-2556 (11 2020) ISSN: 1537-2995 [Electronic] United States
• PMID: 32905629 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Research Support, N.I.H., Extramural)
• Copyright: © 2020 AABB.

Chemical References

• Peptide Fragments
• pro-brain natriuretic peptide (1-76)
• Natriuretic Peptide, Brain

Topics

• Adult
• Aged
• Female
• Humans
• Male
• Middle Aged
• Natriuretic Peptide, Brain (blood)
• Peptide Fragments (blood)
• Prospective Studies
• Respiratory Distress Syndrome (blood, classification)
• Transfusion-Related Acute Lung Injury (blood, classification)