The accuracy of natriuretic peptides (brain natriuretic peptide and N-terminal pro-brain natriuretic) in the differentiation between transfusion-related acute lung injury and transfusion-related circulatory overload in the critically ill

Authors

  • Guangxi Li,

    1. From the Division of Pulmonary Department of Guanganmen Hospital China Academy of Chinese Medical Science, Beijing, China; the Division of Pulmonary and Critical Care Medicine, Mayo Epidemiology and Translational Research in Intensive Care (METRIC) and Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota; and the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.
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  • Craig E. Daniels,

    1. From the Division of Pulmonary Department of Guanganmen Hospital China Academy of Chinese Medical Science, Beijing, China; the Division of Pulmonary and Critical Care Medicine, Mayo Epidemiology and Translational Research in Intensive Care (METRIC) and Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota; and the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.
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  • Marija Kojicic,

    1. From the Division of Pulmonary Department of Guanganmen Hospital China Academy of Chinese Medical Science, Beijing, China; the Division of Pulmonary and Critical Care Medicine, Mayo Epidemiology and Translational Research in Intensive Care (METRIC) and Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota; and the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.
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  • Tami Krpata,

    1. From the Division of Pulmonary Department of Guanganmen Hospital China Academy of Chinese Medical Science, Beijing, China; the Division of Pulmonary and Critical Care Medicine, Mayo Epidemiology and Translational Research in Intensive Care (METRIC) and Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota; and the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.
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  • Greg A. Wilson,

    1. From the Division of Pulmonary Department of Guanganmen Hospital China Academy of Chinese Medical Science, Beijing, China; the Division of Pulmonary and Critical Care Medicine, Mayo Epidemiology and Translational Research in Intensive Care (METRIC) and Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota; and the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.
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  • Jeffrey L. Winters,

    1. From the Division of Pulmonary Department of Guanganmen Hospital China Academy of Chinese Medical Science, Beijing, China; the Division of Pulmonary and Critical Care Medicine, Mayo Epidemiology and Translational Research in Intensive Care (METRIC) and Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota; and the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.
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  • S. Breanndan Moore,

    1. From the Division of Pulmonary Department of Guanganmen Hospital China Academy of Chinese Medical Science, Beijing, China; the Division of Pulmonary and Critical Care Medicine, Mayo Epidemiology and Translational Research in Intensive Care (METRIC) and Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota; and the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.
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  • Ognjen Gajic

    1. From the Division of Pulmonary Department of Guanganmen Hospital China Academy of Chinese Medical Science, Beijing, China; the Division of Pulmonary and Critical Care Medicine, Mayo Epidemiology and Translational Research in Intensive Care (METRIC) and Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota; and the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.
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  • Contribution: TK and GAW performed data collection and management; GL and MK analyzed results and assembled the manuscript; CED, JLW, SBM, and OG designed the research and revised the paper.

  • This work was supported by the National Heart, Lung, and Blood Institute HL78743, HL81027 and the grant from National Blood Foundation.

Guangxi Li, Division of Pulmonary Department of Guanganmen Hospital China Academy of Chinese Medical Science, Beijing, China; e-mail: li.guangxi@mayo.edu.

Abstract

BACKGROUND: The diagnostic workup of transfusion-related acute lung injury (TRALI) requires an exclusion of transfusion-associated circulatory overload (TACO). Brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic (NT-pro-BNP) accurately diagnosed TACO in preliminary studies that did not include patients with TRALI.

STUDY DESIGN AND METHODS: In this prospective cohort study, two critical care experts blinded to serum levels of BNP and NT-pro-BNP determined the diagnosis of TRALI, TACO, and possible TRALI based on the consensus conference definitions. The accuracy of BNP and NT-pro-BNP was assessed based on the area under the receiver operating curve (AUC).

RESULTS: Of 115 patients who developed acute pulmonary edema after transfusion, 34 were identified with TRALI, 31 with possible TRALI, and 50 with TACO. Median BNP was 375 pg per mL (interquartile range [IQR], 123 to 781 pg/mL) in TRALI, 446 pg per mL (IQR, 128 to 743 pg/mL) in possible TRALI, and 559 pg per mL (IQR, 288 to 1348 pg/mL) in TACO patients (p = 0.038). The NT-pro-BNP levels among patients with TRALI, possible TRALI, and TACO differed significantly with a median value of 1559 pg per mL (IQR, 629 to 5114 pg/mL), 2349 pg/mL (IQR, 919 to 4610 pg/mL), and 5197 pg/mL (IQR, 1695 to 15,714 pg/mL; p = 0.004), respectively. The accuracy of BNP and NT-pro-BNP to diagnose TACO was moderate with an AUC of 0.63 (95% confidence interval [CI], 0.51-0.74) and 0.70 (95% CI, 0.59 to 0.80).

CONCLUSIONS: Natriuretic peptides are of limited diagnostic value in a differential diagnosis of pulmonary edema after transfusion in the critically ill patients.

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