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Association between blood transfusion and ventilator-associated events: a nested case-control study

Published online by Cambridge University Press:  17 May 2021

Wen Wang ,
Qiao He ,
Shichao Zhu ,
Mingqi Wang ,
Yan Kang ,
Rui Zhang ,
Peng Ji ,
Kang Zou ,
Zhiyong Zong  and
Xin Sun
Wen Wang
Affiliation:
Chinese Evidence-based Medicine Center and CREAT Group, West China Hospital, Sichuan University, Chengdu, China NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
Qiao He
Affiliation:
Chinese Evidence-based Medicine Center and CREAT Group, West China Hospital, Sichuan University, Chengdu, China NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
Shichao Zhu
Affiliation:
Department of Infection Control, West China Hospital of Sichuan University, Chengdu, China
Mingqi Wang
Affiliation:
Chinese Evidence-based Medicine Center and CREAT Group, West China Hospital, Sichuan University, Chengdu, China NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
Yan Kang
Affiliation:
Intensive Care Unit, West China Hospital of Sichuan University, Chengdu, China
Rui Zhang
Affiliation:
Information Center, West China Hospital, Sichuan University, Chengdu, China
Peng Ji
Affiliation:
Intensive Care Unit, West China Hospital of Sichuan University, Chengdu, China
Kang Zou
Affiliation:
Chinese Evidence-based Medicine Center and CREAT Group, West China Hospital, Sichuan University, Chengdu, China NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
Zhiyong Zong*
Affiliation:
Department of Infection Control, West China Hospital of Sichuan University, Chengdu, China Center of Infection Diseases, West China Hospital of Sichuan University, Chengdu, China
Xin Sun*
Affiliation:
Chinese Evidence-based Medicine Center and CREAT Group, West China Hospital, Sichuan University, Chengdu, China NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
*
Author for Correspondence: Xin Sun, E-mail: sunx79@hotmail.com. Or Zhiyong Zong, E-mail: zongzhiyong@gmail.com
Author for Correspondence: Xin Sun, E-mail: sunx79@hotmail.com. Or Zhiyong Zong, E-mail: zongzhiyong@gmail.com
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Abstract

Objectives:

The association between blood transfusion and ventilator-associated events (VAEs) has not been fully understood. We sought to determine whether blood transfusion increases the risk of a VAE.

Design:

Nested case-control study.

Setting:

This study was based on a registry of healthcare-associated infections in intensive care units at West China Hospital system.

Patients:

1,657 VAE cases and 3,293 matched controls were identified.

Methods:

For each case, 2 controls were randomly selected using incidence density sampling. We defined blood transfusion as a time-dependent variable, and we used weighted Cox models to calculate hazard ratios (HRs) for all 3 tiers of VAEs.

Results:

Blood transfusion was associated with increased risk of ventilator-associated complication-plus (VAC-plus; HR, 1.47; 95% CI, 1.22–1.77; P <.001), VAC-only (HR, 1.29; 95% CI, 1.01–1.65; P = .038), infection-related VAC-plus (IVAC-plus; HR, 1.78; 95% CI, 1.33–2.39; P < .001), and possible ventilator-associated pneumonia (PVAP; HR, 2.10; 95% CI, 1.10–3.99; P = .024). Red blood cell (RBC) transfusion was also associated with increased risk of VAC-plus (HR, 1.34; 95% CI, 1.08–1.65; P = .007), IVAC-plus (HR, 1.70; 95% CI, 1.22–2.36; P = .002), and PVAP (HR, 2.49; 95% CI, 1.17–5.28; P = .018). Compared to patients without transfusion, the risk of VAE was significantly higher in patients with RBC transfusions of >3 units (HR, 1.73; 95% CI, 1.25–2.40; P = .001) but not in those with RBC transfusions of 0–3 units.

Conclusion:

Blood transfusions were associated with increased risk of all tiers of VAE. The risk was significantly higher among patients who were transfused with >3 units of RBCs.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 5 , May 2022 , pp. 597 - 602
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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References

Surveillance for ventilator-associated events. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/acute-care-hospital/vae/index.html. Published 2014. Accessed March 25, 2014.Google Scholar
Klein Klouwenberg, PM, van Mourik, MS, Ong, DS, et al. Electronic implementation of a novel surveillance paradigm for ventilator-associated events. Feasibility and validation. Am J Respir Crit Care Med 2014;189:947–955.CrossRefGoogle ScholarPubMed
Ventilator-associated events. Centers for Disease Control and Prevention website. https://arpsp.cdc.gov/profile/infections/VAE. Accessed December 5, 2020.Google Scholar
Klompas, M. Barriers to the adoption of ventilator-associated events surveillance and prevention. Clin Microbiol Infect 2019;25:1180–1185.CrossRefGoogle Scholar
Zhu, S, Cai, L, Ma, C, et al. The clinical impact of ventilator-associated events: a prospective multicenter surveillance study. Infect Control Hosp Epidemiol 2015;36:1388–1395.CrossRefGoogle Scholar
Ramirez-Estrada, S, Lagunes, L, Pena-Lopez, Y, et al. Assessing predictive accuracy for outcomes of ventilator-associated events in an international cohort: the EUVAE study. Intensive Care Med 2018;44:1212–1220.CrossRefGoogle Scholar
Chao, WC, Chang, WL, Wu, CL, Chan, MC. Using objective fluid balance data to identify pulmonary edema in subjects with ventilator-associated events. Respir Care 2018;63:1413–1420.CrossRefGoogle ScholarPubMed
Agrafiotis, M, Siempos, II, Ntaidou, TK, Falagas, ME. Attributable mortality of ventilator-associated pneumonia: a meta-analysis. Int J Tuberc Lung Dis 2011;15:1154–1163.CrossRefGoogle ScholarPubMed
Boyer, AF, Schoenberg, N, Babcock, H, McMullen, KM, Micek, ST, Kollef, MH. A prospective evaluation of ventilator-associated conditions and infection-related ventilator-associated conditions. Chest 2015;147:68–81.CrossRefGoogle ScholarPubMed
Klompas, M, Li, L, Kleinman, K, Szumita, PM, Massaro, AF. Associations between ventilator bundle components and outcomes. JAMA Intern Med 2016;176:1277–1283.CrossRefGoogle ScholarPubMed
Klompas, M. Potential strategies to prevent ventilator-associated events. Am J Respir Crit Care Med 2015;192:1420–1430.CrossRefGoogle ScholarPubMed
Villanueva, C, Colomo, A, Bosch, A, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med 2013;368:11–21.CrossRefGoogle ScholarPubMed
Salpeter, SR, Buckley, JS, Chatterjee, S. Impact of more restrictive blood transfusion strategies on clinical outcomes: a meta-analysis and systematic review. Am J Med 2014;127:124–131.CrossRefGoogle ScholarPubMed
Walsh, TS, Boyd, JA, Watson, D, et al. Restrictive versus liberal transfusion strategies for older mechanically ventilated critically ill patients: a randomized pilot trial. Crit Care Med 2013;41:2354–2363.CrossRefGoogle ScholarPubMed
Lewis, SC, Li, L, Murphy, MV, Klompas, M. Risk factors for ventilator-associated events: a case-control multivariable analysis. Crit Care Med 2014;42:1839–1848.CrossRefGoogle ScholarPubMed
Rohde, JM, Dimcheff, DE, Blumberg, N, et al. Health care-associated infection after red blood cell transfusion: a systematic review and meta-analysis. JAMA 2014;311:1317–1326.CrossRefGoogle ScholarPubMed
Cocoros, NM, Priebe, G, Gray, JE, et al. Factors associated with pediatric ventilator-associated conditions in six US hospitals: a nested case-control study. Pediatr Crit Care Med 2017;18:e536–e545.CrossRefGoogle Scholar
Benchimol, EI, Smeeth, L, Guttmann, A, et al. The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) Statement. PLoS Medicine 2015;12(10):e1001885.CrossRefGoogle ScholarPubMed
About us. West China Hospital of Sichuan University website. http://english.cd120.com/fastFacts/index.jhtml. Accessed December 11, 2018.Google Scholar
Wang, W, Zhu, S, He, Q, et al. Developing a registry of healthcare-associated infections at intensive care units in west China: study rationale and patient characteristics. Clin Epidemiol 2019;11:1035–1045.CrossRefGoogle ScholarPubMed
Li, S, Yu, C, Li, Y, et al. Study design and baseline characteristics of inpatients with diabetes mellitus in a tertiary hospital in China: a database study based on electronic medical records. J Evid Based Med 2018;11:152–157.CrossRefGoogle Scholar
Zhu, S, Kang, Y, Wang, W, Cai, L, Sun, X, Zong, Z. The clinical impacts and risk factors for non-central line-associated bloodstream infection in 5,046 intensive care unit patients: an observational study based on electronic medical records. Crit Care 2019;23:52.CrossRefGoogle Scholar
Wang, W, Liu, Y, Yu, C, et al. Cefoperazone-sulbactam and risk of coagulation disorders or bleeding: a retrospective cohort study. Expert Opin Drug Saf 2020;19:339–347.CrossRefGoogle ScholarPubMed
He, Q, Wang, W, Zhu, S, et al. The epidemiology and clinical outcomes of ventilator-associated events among 20,769 mechanically ventilated patients at intensive care units: an observational study. Crit Care 2021;25:44.CrossRefGoogle ScholarPubMed
Essebag, V, Genest, J, Suissa, S, Pilote, L. The nested case-control study in cardiology. Am Heart J 2003;146:581–590.CrossRefGoogle Scholar
Leffondre, K, Wynant, W, Cao, Z, Abrahamowicz, M, Heinze, G, Siemiatycki, J. A weighted Cox model for modelling time-dependent exposures in the analysis of case-control studies. Stat Med 2010;29:839–850.CrossRefGoogle ScholarPubMed
Zhang, Z. Multiple imputation with multivariate imputation by chained equation (MICE) package. Ann Transl Med 2016;4(2):30.Google ScholarPubMed
Lannan, KL, Sahler, J, Spinelli, SL, Phipps, RP, Blumberg, N. Transfusion immunomodulation—the case for leukoreduced and (perhaps) washed transfusions. Blood Cells Mol Dis 2013;50:61–68.CrossRefGoogle Scholar
Buddeberg, F, Schimmer, BB, Spahn, DR. Transfusion-transmissible infections and transfusion-related immunomodulation. Best Pract Res Clin Anaesthesiol 2008;22:503–517.CrossRefGoogle ScholarPubMed
Baumgartner, JM, Silliman, CC, Moore, EE, Banerjee, A, McCarter, MD. Stored red blood cell transfusion induces regulatory T cells. J Am Coll Surg 2009;208:110–119.CrossRefGoogle ScholarPubMed
Taylor, RW, Manganaro, L, O’Brien, J, Trottier, SJ, Parkar, N, Veremakis, C. Impact of allogenic packed red blood cell transfusion on nosocomial infection rates in the critically ill patient. Crit Care Med 2002;30:2249–2254.CrossRefGoogle ScholarPubMed
Taylor, RW, O’Brien, J, Trottier, SJ, et al. Red blood cell transfusions and nosocomial infections in critically ill patients. Crit Care Med 2006;34:2302–2308.CrossRefGoogle ScholarPubMed
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