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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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