2007 年至 2011 年间，在美国医疗保险索赔数据中记录的住院老年患者输血相关急性肺损伤和潜在危险因素。

Transfusion-related acute lung injury and potential risk factors among the inpatient US elderly as recorded in Medicare claims data, during 2007 through 2011.

机构信息

Food and Drug Administration, Rockville, Maryland.

出版信息

Transfusion. 2014 Sep;54(9):2182-93. doi: 10.1111/trf.12626. Epub 2014 Mar 28.

DOI:10.1111/trf.12626

PMID:24673344

Abstract

BACKGROUND

Transfusion-related acute lung injury (TRALI) is a serious complication leading to pulmonary edema and respiratory failure. This study's objective was to assess TRALI occurrence and potential risk factors among inpatient US elderly Medicare beneficiaries, ages 65 and older, during 2007 through 2011.

STUDY DESIGN AND METHODS

This retrospective claims-based study utilized large Medicare administrative databases. Transfusions were identified by recorded procedure and revenue center codes. TRALI was ascertained via ICD-9-CM diagnosis code. The study evaluated TRALI rates among the inpatient elderly overall and by calendar year, age, sex, race, blood components, and units transfused. Logistic regression analyses were used to assess potential risk factors.

RESULTS

Of 11,378,264 inpatient transfusion stays for elderly Medicare beneficiaries, 2556 had a recorded TRALI diagnosis code, an overall rate of 22.46 per 100,000 stays. TRALI rates were higher for platelet (PLT)- and plasma-containing transfusions and increased by year and number of units transfused (p < 0.0001). Significantly higher odds of TRALI were also found for persons ages 65 to 79 years versus more than 79 years (OR, 1.19; 95% confidence interval CI, 1.09-1.29), females versus males (OR, 1.26; 95% CI, 1.16-1.38), white versus nonwhite (OR, 1.43; 95% CI, 1.27-1.66), and with 6-month histories of postinflammatory pulmonary fibrosis (OR, 1.89; 95% CI, 1.52-2.20), tobacco use (OR, 1.16; 95% CI, 1.00-1.26), and other diseases.

CONCLUSION

Our study among the elderly suggests TRALI to be a severe event and identifies a substantially increased TRALI occurrence with greater number of units and with PLT- or plasma-containing transfusions. The study also suggests importance of underlying health conditions, prior recipient alloimmunization, and nonimmune mechanism in TRALI development among the elderly.

摘要

背景

输血相关的急性肺损伤（TRALI）是一种导致肺水肿和呼吸衰竭的严重并发症。本研究的目的是评估 2007 年至 2011 年期间，65 岁及以上的美国老年医疗保险受益人住院患者中 TRALI 的发生情况和潜在危险因素。

研究设计和方法

这是一项基于回顾性索赔的研究，利用了大型医疗保险管理数据库。通过记录的程序和收入中心代码来识别输血。TRALI 通过 ICD-9-CM 诊断代码确定。该研究评估了住院老年患者总体以及按日历年度、年龄、性别、种族、血液成分和输血量的 TRALI 发生率。使用逻辑回归分析评估潜在危险因素。

结果

在 11378264 名老年医疗保险受益人的住院输血患者中，有 2556 例记录了 TRALI 诊断代码，总发生率为每 100000 例 22.46 例。血小板（PLT）和血浆含量输血的 TRALI 发生率更高，且随年份和输血量的增加而增加（p<0.0001）。年龄在 65 至 79 岁之间的人与年龄超过 79 岁的人（OR，1.19；95%置信区间 CI，1.09-1.29）、女性与男性（OR，1.26；95% CI，1.16-1.38）、白人与非白人（OR，1.43；95% CI，1.27-1.66）相比，TRALI 的发生几率更高，且在过去 6 个月内有炎症后肺纤维化（OR，1.89；95% CI，1.52-2.20）、吸烟（OR，1.16；95% CI，1.00-1.26）和其他疾病史的人也是如此。